Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines — 38 States and the District of Columbia, 2019–2020

Nonfatal and fatal drug overdoses increased overall from 2019 to 2020 (1).*Illicit benzodiazepines (e.g., etizolam, flualprazolam, and flubromazolam) † were increasingly detected among postmortem and clinical samples in 2020, often with opioids, § and might have contributed to overall increases in drug overdoses.Availability of recent multistate trend data on nonfatal benzodiazepine-involved overdoses and involvement of illicit benzodiazepines in overdoses is limited.This data gap was addressed by analyzing annual and quarterly trends in suspected benzodiazepine-involved nonfatal overdoses ¶ treated in emergency departments (EDs) (benzodiazepine overdose ED visits) during January 2019-December 2020 (32 states and the District of Columbia [DC]) and benzodiazepineinvolved overdose deaths (benzodiazepine deaths), which include both illicit and prescription benzodiazepines, during January 2019-June 2020 (23 states) from CDC's Overdose Data to Action (OD2A) program.From 2019 to 2020, benzodiazepine overdose ED visits per 100,000 ED visits increased (23.7%), both with opioid involvement (34.4%) and without (21.0%).From April-June 2019 to April-June 2020, overall benzodiazepine deaths increased 42.9% (from 1,004 to 1,435), prescription benzodiazepine deaths increased 21.8% (from 921 to 1,122), and illicit benzodiazepine deaths increased 519.6% (from 51 to 316).During January-June 2020, most (92.7%)benzodiazepine deaths also involved opioids, mainly illicitly manufactured fentanyls (IMFs) (66.7%).Improving naloxone availability and enhancing treatment access for persons using benzodiazepines and opioids and calling emergency services for overdoses involving benzodiazepines and opioids, coupled with primary prevention of drug use and misuse, could reduce morbidity and mortality.* https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm† "Illicit benzodiazepines" refers to benzodiazepines that are not marketed in the United States for medical purposes; "prescription benzodiazepines" refers to those that are marketed as prescription drugs in the United States (but does not imply that the decedent had a prescription for that benzodiazepine; prescription benzodiazepines might be diverted).https://www.who.int/medicines/access/controlled-substances/Final_Etizolam.pdf;https://www.