Benzodiazepines Addiction: Statistics and Effects

In the United States, substance abuse trends have shifted dramatically over the past several decades. Many substances - both prescription and illicit - drive a significant public health burden related to emergency room visits, overdose deaths, and long-term dependence. Benzodiazepines, a class of sedatives commonly prescribed for anxiety or insomnia, have emerged as a particular concern because of rising misuse and the potential for dangerous interactions with opioids and other central nervous system depressants.

Benzodiazepines are now recognized as a key player in polysubstance use and overdose fatalities. This article offers an up-to-date overview of major trends in benzodiazepine usage patterns, including prescribing rates, demographics of misuse, co-prescription with opioids, and more. Understanding these findings can help inform safer prescribing practices, prevention efforts, and policy decisions aimed at curbing misuse and overdose.

Key Statistics at a Glance

• About 1.8% of all U.S. adults misused a benzodiazepine in 2019, down slightly from 2.1% in 2015.
• ~27% of adult doctor visits that involved a benzodiazepine prescription also included an opioid prescription in 2018–2019.
• In many regions, roughly 70% of benzodiazepine-related emergency department visits involved other substances (most commonly opioids, alcohol, or stimulants).
• Benzodiazepine-involved overdose deaths rose by 42.9% in one year (2019 to 2020) in a sample of 23 states.

Prescription Rates by Region

This data is important because it shows where benzodiazepine prescribing remains particularly high, guiding targeted interventions.

• Southern and Appalachian states have historically had higher benzodiazepine prescribing rates compared to other regions.
• One analysis found West Virginia had the nation’s highest rate at one point - around 3.7 times higher than in Hawaii, which had the lowest.
• Despite regional variation, prescribing has trended downward nationally since about 2016, partly due to growing caution around long-term benzodiazepine use.
• A CDC study noted the South census region tends to lead in benzodiazepine prescribing, while states like Hawaii and New York have lower rates.

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Demographics of Misuse

Demographic breakdowns highlight who is most affected, allowing prevention and treatment efforts to be more precisely directed.

• Age factors: Young adults (18–25) have the highest rates of benzodiazepine misuse (around 3.8% in recent surveys). Older adults misuse less frequently (about 0.6% among those 65+).
• Race and ethnicity: Over 90% of benzodiazepine-involved overdose decedents have historically been identified as White. This may reflect higher prescribing rates among White patients, but data for other groups are now being tracked more closely.
• Socioeconomic status: Benzodiazepine misuse spans all incomes. Stress factors, co-occurring substance misuse, and mental health conditions can elevate the likelihood of misuse across economic strata.
• Gender differences: Women are prescribed benzodiazepines at about twice the rate of men, but men represent a sizeable portion of misuse (often as part of polydrug use with opioids or alcohol).

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Co-Prescription with Opioids

Co-prescription trends matter because the combination of opioids and benzodiazepines significantly increases overdose risk through synergistic respiratory depression.

• At one time, around one-third of all benzodiazepine prescriptions overlapped with an opioid. This overlap has dropped to about 27% in recent years due to new prescribing guidelines.
• The absolute rate of coprescribing (benzodiazepines + opioids) declined by ~42% between 2016 and 2019 across U.S. outpatient settings.
• Despite reductions, concurrent prescribing remains common for certain groups (chronic pain plus anxiety, for example), and 1.9% of all primary care visits in 2019 still resulted in both an opioid and a benzo prescription.
• Benzodiazepines were involved in around 1 in 3 prescription opioid overdose deaths in 2017; more recent data show about 14% of opioid overdose deaths in 2021 also involved benzodiazepines.

Emergency Room Visits Related to Benzodiazepine Use

Tracking ER visits reveals how often benzodiazepine misuse or overdose leads to acute care, spotlighting severe or life-threatening cases.

• One national estimate from mid-2010s data found ~168,000 ER visits per year involved benzodiazepines as a factor in nonmedical use of pharmaceuticals.
• In these visits, only ~6.5% involved benzodiazepines alone; the rest included additional substances (particularly opioids or alcohol).
• From 2019 to 2020, benzodiazepine overdose ED visits rose ~24% - a concerning spike aligned with pandemic-related shifts and the appearance of illicit “designer” benzodiazepines.
• Roughly 70.7% of benzo-related ER cases involve polysubstance use, emphasizing the complexity of treatment when multiple drugs are in the mix.

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Duration of Prescribed Use Patterns

Examining prescription durations helps clarify why long-term use is common - even though clinical guidelines typically advise short-term treatment (2–4 weeks).

• In 2018, about half of patients dispensed an outpatient benzodiazepine continued use for 2 months or longer, indicating a high rate of extended use.
• Older adults especially tend to be on benzodiazepines well beyond recommended durations. Up to 30% of seniors prescribed benzos take them for 120+ days.
• A cohort study found 1 in 4 older adults started on a benzodiazepine still used it a year or more later. Patients initially given bigger supplies were more likely to transition to chronic use.
• While awareness has grown, long-term use of benzodiazepines remains prevalent, raising dependence and withdrawal risks.

Sources of Illicit Benzodiazepine Acquisition

Understanding where people get benzodiazepines without a legitimate prescription is crucial for diversion-prevention strategies.

• Friends or Relatives: Nearly 70% of people who misuse benzodiazepines obtain them from someone they know, whether freely or by purchase. This “medicine cabinet” source is by far the most common.
• Single Prescriber: About 19% of misusers get them directly from a doctor (though perhaps under false pretenses). Only ~1% engage in true “doctor shopping” with multiple prescribers.
• Street Dealers/Illicit Market: Historically less common, but illicitly manufactured benzodiazepines (counterfeit pills) have surged. Recent increases in overdose cases are partly tied to these fake benzos.
• Other Sources: Online or pharmacy theft is minimal by comparison. Overall, preventing leftover medication diversion (e.g., limiting overprescribing) remains a priority.

Treatment Admission Rates for Benzodiazepine Misuse

These statistics show the scope of benzodiazepine-specific addiction treatment and how often sedative use disorder appears alongside other substances.

• Treatment admissions for primary benzodiazepine misuse surged in the 2000s - from ~8,000 in 2004 to nearly 19,000 by 2011 - before declining to around 14,000 by 2015.
• Most people in rehab who use benzodiazepines do so in combination with other drugs; admissions involving both opioids and benzos jumped 570% in the early 2000s.
• Currently, benzodiazepines as the primary substance still comprise a single-digit percentage of total rehab admissions, but the secondary involvement of benzos in opioid or alcohol treatment is substantial.
• As of the late 2010s, about 1.2% of total substance use treatment admissions listed benzodiazepines (alone or with others), underscoring an ongoing but modest fraction relative to opioids or alcohol.

Withdrawal Severity and Duration Statistics

Withdrawal difficulties underscore why caution is advised in prescribing benzodiazepines for extended periods.

• Up to 40–80% of long-term benzodiazepine users experience withdrawal symptoms if they abruptly reduce or stop use.
• Symptoms can range from mild anxiety to severe outcomes like seizures or psychosis. About 10–20% of long-term users may have intensely distressing withdrawal.
• Acute withdrawal peaks around 1–2 weeks after cessation for short-acting benzodiazepines; some individuals develop protracted withdrawal that can persist for months or more.
• Gradual, medically supervised tapers dramatically reduce the risk of severe complications - underscoring the importance of close clinical guidance.

Age Distribution of Benzodiazepine Users

Age-based patterns show who is most likely to use (or misuse) benzodiazepines and for what reasons.

• Younger adults have the highest rates of misuse but lower rates of receiving a prescription. Many initial exposures occur in late teens or early 20s, sometimes recreationally.
• Older adults (65+) have the highest legitimate prescription usage (up to 8–9% per year), often for insomnia or chronic anxiety. This can lead to unintentional dependence if used long-term.
• Middle-aged adults (especially 50–64) have become the largest overall group for prescribed benzodiazepine use - exceeding 12% in some studies.

Gender Differences in Prescription and Use

Gender distinctions inform how screening, interventions, and prescriber behaviors might differ for men versus women.

• Women are prescribed benzodiazepines at roughly double the rate of men; for example, 5.6% of adult women vs. 3.0% of men in certain insurance databases.
• Men are more likely to present with polydrug misuse patterns that include benzodiazepines alongside opioids, alcohol, or stimulants.
• Chronic, long-term benzo use is more common in women - especially older women dealing with persistent insomnia or anxiety.
• During the COVID-19 pandemic, female benzodiazepine prescription fills spiked by around 6%, while men’s rates continued a slow decline in the same period.

Doctor Shopping Prevalence for Benzos

Examining how often patients attempt to obtain multiple benzodiazepine prescriptions offers insight into one type of misuse strategy.

• Doctor shopping for benzodiazepines appears relatively low compared to opioids - only about 1–2% of benzo misusers report getting prescriptions from multiple providers.
• Prescription Drug Monitoring Programs (PDMPs) have likely reduced multi-provider shopping, and many individuals can secure large-quantity prescriptions from a single prescriber.
• Some doctor shoppers seek both opioids and benzos concurrently. However, improved opioid monitoring has also curtailed benzo co-shopping.
• The vast majority of misuse stems from a single prescription (taken improperly) or from someone else’s prescribed supply.

Insurance Coverage Patterns and Access

Insurance plays a major role in whether patients can (or choose to) fill benzodiazepine prescriptions, with multiple policy changes affecting trends.

• Medicare Part D began covering benzodiazepines in 2013 (after a long exclusion). This coverage expansion correlated with increased benzo use and an uptick in fall-related injuries in older adults.
• Some private insurers limit benzodiazepine coverage via prior authorization, quantity caps, or step-therapy requirements - sharply reducing usage in certain populations.
• Medicaid programs vary by state; expanded coverage in some regions might increase benzodiazepine access for low-income patients. Conversely, strict monthly limits can lower prescribing rates.
• Uninsured individuals may purchase cheap generic benzodiazepines out of pocket or turn to illicit sources if they lack regular medical care.
• Updated FDA labeling in 2020 heightened warnings on addiction and withdrawal risks, prompting some insurers to impose more stringent coverage requirements.

Relapse Rates After Benzodiazepine Addiction Treatment

Relapse trends reveal how challenging it can be to maintain abstinence from sedatives, especially without ongoing support.

• Substance use disorder relapse overall hovers around 40–60%, and benzodiazepine dependence largely aligns with that range.
• One long-term follow-up found about 51% of patients who discontinued benzodiazepines eventually relapsed within ~2 years.
• Immediate relapse can be relatively low if patients undergo a carefully supervised taper, but persistent anxiety or insomnia can drive people back to benzodiazepines over time.
• Co-occurring opioid or alcohol use raises relapse risk further, as many individuals misuse multiple substances.

Overdose Mortality Rates Involving Benzodiazepines

Monitoring deaths in which benzodiazepines are implicated (often alongside other depressants) highlights the seriousness of this trend.

• Overdose deaths involving benzodiazepines quadrupled from 1999 to 2010 and have continued to climb - with more than 118,000 total such fatalities from 2000 to 2019.
• The vast majority (~90% or more) of benzodiazepine-related overdose deaths also involve opioids, predominantly fentanyl in recent years.
• From 2019 to 2020, benzodiazepine-involved deaths increased by 42.9% in a 23-state analysis - driven by both prescription misuse and illicit benzo analogs that surfaced in the drug supply.
• Prescription benzodiazepines alone rarely cause fatal respiratory depression; the risk multiplies when combined with opioids or alcohol.

Combined Substance Abuse Rates (Polysubstance Use)

Polysubstance use is central to understanding why benzodiazepines frequently appear in overdose statistics and emergency visits.

• About 70–75% of benzodiazepine-involved ER visits and overdoses also involve other substances.
• Combining opioids and benzos is one of the most dangerous patterns - an ongoing driver of the national opioid crisis.
• Alcohol plus benzos is another common combination, raising the risk of accidents, falls, and severe sedation.
• In some drug-using networks, benzodiazepines are part of multi-drug “cocktails,” heightening the risk of accidental overdose or respiratory depression.
• Treatment centers report rising polydrug admissions in which benzodiazepines contribute to the overall addiction picture (often with opioids, alcohol, or stimulants).

When taken together, these findings paint a portrait of a medication class once regarded as relatively safe, now recognized for its high misuse potential - particularly in combination with other depressants. Broader prescribing oversight, patient education, and targeted harm reduction measures are needed to reduce the toll of benzodiazepine misuse and co-occurring substance abuse.

Effective responses may include robust prescription monitoring, co-prescribing safeguards (especially for opioid patients), and accessible, integrated addiction treatment services. Public health campaigns have also emphasized the danger of sharing prescription medications and the heightened risk of overdose when benzodiazepines are combined with opioids or alcohol.

In the bigger picture of substance abuse in America, benzodiazepines neither match opioids in sheer mortality numbers nor overshadow alcohol or methamphetamine in overall misuse prevalence. However, they remain deeply intertwined with the current overdose epidemic, frequently serving as a silent multiplier that increases the lethality of other substances. As prescribing norms shift and illicit analogs spread, vigilance and patient-centered strategies will be vital to preventing further harm.

Ultimately, the greatest successes are likely to come from recognizing that benzodiazepine misuse does not occur in isolation. It often reflects inadequately managed mental health conditions, a broader pattern of polysubstance use, or a lack of awareness about how powerful these drugs can be. Holistic approaches - spanning prevention, education, prescribing guidelines, and comprehensive treatment - are key to reducing benzodiazepine-related harm and ensuring safer outcomes for individuals and communities alike.

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