Unintentional benzodiazepine use and frequency of drug checking service utilization: a cross-sectional study

There are increasing accounts of benzodiazepine adulteration and contamination in the unregulated drug supply in Canada and internationally. In some Canadian settings, drug checking services (DCS) are available for people to identify the constituents of their drugs. This study examines the relationship between suspected, unintentional benzodiazepine consumption and DCS utilization frequency, and whether gender modifies this relationship. We hypothesized that suspected unintentional benzodiazepine consumption would predict frequent DCS utilization, particularly for women, who may be at heightened risk for pertinent harms related to benzodiazepine use.

Data were drawn from a cross-sectional study (2021-2023) evaluating DCS that used spectroscopy and immunoassay strips in British Columbia, Canada. Multivariable ordinal logistic regression was used to examine the relationship between suspected unintentional benzodiazepine consumption and DCS utilization frequency, categorized as: once, > once and < once/month, once/month, > once/month and < three times/month, weekly, and > weekly. Potential confounders included age, population centre size, and frequent unregulated opioid use (≥ weekly). In planned exploratory analyses, gender was included as a possible effect modifier.

Of 220 participants, 73 (33.2%) were women and 143 (65.0%) believed they had unintentionally consumed benzodiazepines in the previous six months. Bivariable ordinal regression showed a significant relationship between suspected unintentional benzodiazepine consumption and DCS utilization frequency (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.22-3.69). However, after adjusting for confounders, particularly frequent unregulated opioid use, this association was no longer statistically significant (adjusted OR: 1.49; 95%CI: 0.75-2.99). We also failed to find that gender modified the relationship between suspected unintentional benzodiazepine consumption and DCS utilization.

Findings suggest that frequent unregulated opioid use may best explain the frequency of DCS utilization. Although gender did not significantly modify the association between suspected unintentional benzodiazepine consumption and frequency of DCS utilization, continued research should explore the role and context of gender in this relationship.