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Benzodiazepine Use and Mortality Risk: A Nationwide Cohort Study on New Benzodiazepine Users With a 5-Year Follow-Up
Hanna Särkilä1,2, Heidi Taipale3,4,5,6, Antti Tanskanen3,4
1Department of Psychiatry, Clinical Institute, University of Turku, Turku, Finland.
Acta Psychiatrica Scandinavica
|June 22, 2026
Summary
Benzodiazepine and Z-drug (BZDR) use increases mortality risk, especially at higher doses. Very high-dose BZDR users face a six-fold increased risk of overdose deaths compared to non-users.
Area of Science:
- Pharmacovigilance
- Public Health
- Epidemiology
Background:
- Investigating mortality risks associated with benzodiazepine and Z-drug (BZDR) use.
- Examining dose-dependent effects on all-cause and cause-specific mortality.
- Focusing on new BZDR initiators in the Finnish population with a five-year follow-up.
Purpose of the Study:
- To assess the association between dose-dependent benzodiazepine and Z-drug (BZDR) use and mortality.
- To identify specific mortality risks, including overdose, suicide, and accidents, linked to BZDR dosage.
- To analyze the impact of initiating BZDR use on long-term mortality outcomes.
Main Methods:
- Included 48,124 incident BZDR users (aged 18-65) with no prior BZDR dispensing (2004-2005).
- Modeled drug dispensing using the PRE2DUP method, categorizing use into low (<1.0 DDD/day), medium to high (1.0-<3.0 DDD/day), and very high (≥3.0 DDD/day) doses.
- Utilized Cox regression models to analyze mortality risk over a five-year follow-up period.
Main Results:
- BZDR use was linked to increased all-cause mortality (aHR 1.28) compared to non-use periods.
- Medium to high-dose (aHR 1.58) and very-high-dose (aHR 2.68) BZDR use significantly elevated mortality risk; low-dose use did not.
- Very high-dose use showed the highest risk for overdoses (aHR 6.18), suicides (aHR 4.46), and accidents (aHR 3.77).
Conclusions:
- Very high-dose BZDR users face a significantly elevated risk of overdose deaths.
- Medium to high-dose BZDR use is associated with increased all-cause mortality.
- Mortality risk escalates with higher BZDR doses, often involving concurrent use of multiple BZDRs.
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