Nonmedical Benzodiazepines in Canada

The Canadian Community Epidemiology Network on Drug Use (CCENDU), co-ordinated by the Canadian Centre on Substance Use and Addiction (CCSA), publishes this newsletter regularly to inform people living in Canada about emerging substance use issues and trends, pulling from the best available information sources at the time of publication. 

Non-medical benzodiazepines (NMBs) are benzodiazepines and benzodiazepine-like substances that have been either illegally produced or diverted from legal sources for non-medical use. They continue to appear in the unregulated drug supply, increasing risks to people who use drugs (PWUD).

Benzodiazepines are central nervous system depressants or sedative-hypnotics. They slow down the nervous system, giving them calming, sleep-inducing properties. Some are prescribed to treat anxiety, sleep and seizure disorders, including clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax) and diazepam (Valium). Referred to as novel NMBs in this newsletter, others are substances that were developed but not approved for the Canadian market or are newly synthesised designer drugs.

Key Findings

• Detection of NMBs in the unregulated drug supply is quite common across Canada overall. However, there are fluctuations over time, and new NMBs emerge and replace each other often.
• Some people use NMBs intentionally, but others are not aware of NMBs being in other drugs they are taking, primarily opioids or down (a term used to refer to opioids in some jurisdictions).
• Implications and response options reported by CCENDU network members and partners include:
  • Combining NMBs and opioids increases the risk of drug poisoning and can lead to prolonged sedation and memory loss. This increases the need to inform PWUD about NMBs and adjust first response protocols to consider NMB presence.
  • Regular use of NMBs can create tolerance. Stopping regular use — including inadvertently by stopping use of opioids containing them — can lead to lifethreatening withdrawal, increasing the need for updated clinical protocols for managing substance use disorders. o Maximising the health and safety of PWUD requires a comprehensive response to the unpredictability and toxicity of the unregulated supply.