{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:05:35Z","timestamp":1789495535475,"version":"build-2803163510"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["153070"],"award-info":[{"award-number":["153070"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["178163"],"award-info":[{"award-number":["178163"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The unregulated drug supply in Canada increasingly contains benzodiazepines, particularly those not approved for medical use, raising concerns about toxicity risk, especially when combined with opioids. Therefore, we aimed to describe trends in benzodiazepine-related toxicity deaths and compare their characteristics and circumstances by benzodiazepine type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a descriptive cross-sectional study of accidental benzodiazepine-related toxicity deaths in Ontario between January 1, 2018 and June 30, 2022, using linked administrative healthcare at ICES including coroner\u2019s investigation records from the Drug and Drug\/Alcohol Related Death Database. We measured monthly crude rates of benzodiazepine toxicity deaths and summarized characteristics (age, sex, region of residence, etc.) and circumstances (number and types of substances involved, healthcare encounters for toxicities and substance use disorders, etc.) of decedents and compared these by benzodiazepine type (approved vs. not approved for medical use in Canada).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between January 2018 and June 2022, 782 Ontarians died of benzodiazepine-related toxicity (median age of 40 years), of which 70.5% were male and 88.6% resided in Southern Ontario The rate of benzodiazepine toxicity death peaked in December 2020 (0.27 per 100,000; N\u2009=\u200940). Overall, 98.1% of benzodiazepine deaths involved another substance, most commonly opioids (91.2%). Moreover, one-fifth (22.6%) of decedents had experienced a hospital-treated substance toxicity in the year prior to death, and almost two-thirds (64.1%) had a healthcare encounter with a substance use disorder diagnosis in the prior five years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Benzodiazepines remain an important contributor to substance-related mortality in Ontario, with nearly 800 benzodiazepine-related toxicity deaths observed over a four-and-a-half-year period. As almost all deaths involved multiple substances, most commonly opioids, harm reduction and treatment programs must adapt to the evolving needs of people who use drugs who may experience both intentional and unintentional benzodiazepine exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355210","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:40:02Z","timestamp":1789494002000},"page":"e0355210","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characterizing trends and patterns in benzodiazepine-related toxicity deaths in Ontario: A descriptive cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8459-208X","authenticated-orcid":true,"given":"Tonya","family":"Campbell","sequence":"first","affiliation":[{"name":"MAP Centre for Urban Health Solutions, St. Michael\u2019s Hospital","place":["Toronto, Ontario, Canada"]},{"name":"Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital","place":["Toronto, Ontario, Canada"]},{"name":"Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies","place":["Kingston, Jamaica"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaleesa","family":"Ledlie","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, St. Michael\u2019s Hospital","place":["Toronto, Ontario, Canada"]},{"name":"Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital","place":["Toronto, Ontario, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Leece","sequence":"additional","affiliation":[{"name":"Public Health Ontario","place":["Toronto, ON, Canada"]},{"name":"University of Toronto","place":["Toronto, ON, Canada"],"department":["Dalla Lana School of Public Health"]},{"name":"University of 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Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9512-7407","authenticated-orcid":true,"given":"Nikki","family":"Bozinoff","sequence":"additional","affiliation":[{"name":"University of Toronto","place":["Toronto, ON, Canada"],"department":["Department of Family and Community Medicine"]},{"name":"Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health","place":["Toronto, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Boyd","sequence":"additional","affiliation":[{"name":"Ottawa Inner City Health Inc.","place":["Ottawa, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Franklyn","sequence":"additional","affiliation":[{"name":"Northern Ontario School of Medicine","place":["Sudbury, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Smoke","sequence":"additional","affiliation":[{"name":"Ontario Drug Policy Research Network Lived Experience Advisory Group","place":["Toronto, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8008-3974","authenticated-orcid":true,"given":"Dana","family":"Shearer","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, St. Michael\u2019s Hospital","place":["Toronto, Ontario, Canada"]},{"name":"Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital","place":["Toronto, Ontario, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Gomes","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, St. Michael\u2019s Hospital","place":["Toronto, Ontario, Canada"]},{"name":"Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital","place":["Toronto, Ontario, Canada"]},{"name":"ICES","place":["Toronto, Ontario, Canada"]},{"name":"University of Toronto","place":["Toronto, ON, Canada"],"department":["Leslie Dan Faculty of Pharmacy"]},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto","place":["Toronto, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"pone.0355210.ref001","doi-asserted-by":"crossref","first-page":"103933","DOI":"10.1016\/j.drugpo.2022.103933","article-title":"The increase in benzodiazepine-laced drugs and related risks in Canada: the urgent need for effective and sustainable solutions","volume":"111","author":"C Russell","year":"2023","journal-title":"Int J Drug Policy"},{"key":"pone.0355210.ref002","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr.mm7034a4","article-title":"Notes from the field: illicit benzodiazepines detected in patients evaluated 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