Characterising benzodiazepine use and the association with non-fatal overdose among people who inject opioids in England, Wales and Northern Ireland

Introduction: In Scotland, co-use of opioids and benzodiazepines has been strongly linked to rising drug-related deaths, but little similar information is available for the rest of the UK. We compared characteristics of people who inject opioids (PWIO) by benzodiazepine use and examined its association with non-fatal overdose in England, Wales and Northern Ireland. Methods: PWIO in England, Wales and Northern Ireland were recruited through specialist drug services in 2022 as part of the Unlinked Anonymous Monitoring Survey. Participants self-reported socio-demographic, behavioural, and health-related information. PWIO with and without past-month benzodiazepine use were compared on sociodemographic characteristics, drug use patterns, use of harm-reduction services, markers of vulnerability, quality of life and mental health. Poisson regression was used to estimate bivariable and multivariable associations between past-month benzodiazepine use and non-fatal overdose in the past year. Results: Of 1333 PWIO included, 29.3 % reported past-month benzodiazepine use, and 21.8 % reported past-year non-fatal overdose. PWIO who used benzodiazepines were more likely to report using other drugs—both injected and non-injected—greater social vulnerabilities such as homelessness, incarceration, and engagement in sex work, and poorer mental health. For example, they more frequently injected speed (19.0 % vs. 9.5 %) and cocaine (46.4 % vs. 29.2 %), smoked cannabis (62.3 % vs. 31.7 %) and used pregabalin/gabapentin (60.8% vs. 10.1 %). Differences in sociodemographic characteristics, use of harm-reduction services and most quality-of-life domains were minimal. After adjusting for potential confounders, benzodiazepine use remained associated with higher prevalence of non-fatal overdose (adjusted prevalence ratio: 1.43; 95 %CI: 1.13–1.82). Discussion: Benzodiazepine use is common among PWIO in England, Wales, and Northern Ireland, and is associated with higher prevalence of non-fatal overdose. These findings underscore the need to strengthen overdose prevention and harm reduction efforts addressing benzodiazepine use across the UK.