Benzodiazepine Use Tied to Increased Risk of Death, Especially at Higher Doses

Benzodiazepine use is common, with research estimating as many as 12.6% of US adults report past-year use. A 2019 study found significant increases in off-label prescription of benzodiazepines to treat non-FDA approved ailments such as chronic pain while overdoses linked to these drugs have increased significantly. A new Finnish study published in Acta Psychiatrica Scandinavica finds that benzodiazepine use is linked to increased risk of death, especially from preventable causes such as suicide and overdose. This study, led by Hanna Särkilä from the University of Turku in Finland, reports that this increased mortality risk is most strongly linked to medium and higher doses. Taking multiple drugs simultaneously was also linked to significantly increased mortality risk. The authors write:

Harms Linked to Benzodiazepine Use

Past research has linked benzodiazepine use to increased risk of suicide, brain damage, dementia, heart disease, worsening anxiety, disability, cognitive impairment, sleep disturbances, muscle weakness, body pain, and negative life consequences such as relationship issues and losing employment, with some negative effects lasting for years after stopping these drugs. A 2012 study found that stopping benzodiazepines improved quality of life, verbal and working memory, and psychiatric symptoms in people diagnosed with schizophrenia.

Benzodiazepines are highly addictive and coming off of these drugs is associated with significant, life-threatening withdrawal effects. According to the FDA, “physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed.” One service user said “if I could think of the one worst possible thing you could do to a person, it would be benzo withdrawal. Beats cancer and Alzheimer’s combined. If I could make it go away by chopping my arms and legs off, I would!”

Lived experience experts have detailed physical and mental deterioration as a result of using benzodiazepines. Patients and service users have reported that they were not told about the risks of taking these drugs or the possibility of addiction. This lack of informed consent led many to be blindsided by struggles with benzodiazepine addiction and withdrawal.

Study Details

The goal of this study was to investigate the increased risk of death associated with benzodiazepine use in an adult Finnish population. The authors used data from the Finnish National Health Insurance Scheme register. To be included in the current work, service users and patients had to start a benzodiazepine prescription in 2006 with no use in the previous two years and be between 18 and 65 years old. Those that filled only a single prescription were excluded. In total, the authors used data from 48,124 benzodiazepine users.

Patients and service users were followed for five years or until death. For the purposes of analysis, periods of benzodiazepine use were compared to periods of non-use. This means this study did not use a control group that was unexposed to benzodiazepines. With past research finding that these drugs are linked to long-term injuries, it is likely that the increased risk of death from taking benzodiazepines would be significantly higher than these findings indicate when compared to a control group.

Benzodiazepine use was divided into three categories. Low dose was defined as less than 10mg per day of diazepam (Valium) or equivalent. Medium to high doses were defined as 10mg – 29mg of diazepam per day, with very high doses being 30mg or more of diazepam per day. For reference, between 0.5 – 1mg of alprazolam (Xanax) and clonazepam (Klonopin) is considered equivalent to 10mg of diazepam.

Overall, participants were at a 28% increased risk of death during periods of benzodiazepine use compared to periods of non-use. Using one benzodiazepine was linked to a 13% increased risk of death, with the use of two (81%) and three or more (212%) associated with significantly increased odds of mortality. The use of a benzodiazepine combined with a z-drug (such as Ambien) was linked to an 86% increased risk of death.

While low dose use of benzodiazepines was not linked to increased overall or natural-cause mortality risk, they were linked to a 17% increased risk of external-cause mortality such as accidents (12% increased risk), suicide (32%), and overdose (39%). The authors note:

Medium to high dose use periods were linked to increased risk of overall mortality (58%), natural-cause mortality (31%), and external-cause mortality (129%). Medium to high dose use was associated with a more than doubling of the risk of death from suicide (2.43 times more likely) and accidents (2.24), and a more than tripled risk of death from overdose (3.34). A majority (50.8%) of the patients and service users included in the current work had periods of medium to high dose benzodiazepine use.

While the authors describe this category as “medium to high dose,” many service users would start at a dose within this range. For example, the recommended starting dose to treat generalized anxiety disorder for the most commonly prescribed benzodiazepine in the US (alprazolam, commonly sold as Xanax) is between 0.75 to 1.5mg per day, which would fall into this medium to high dose category.

Very high dose use periods were associated with dramatically increased risk of overall mortality (2.68 times more likely). This included a 67% increased risk of natural-cause mortality and a quadrupled risk of external-cause mortality (4.04). This dose was linked to a substantial increase in the risk of death from suicide (4.46 times more likely), accidents (3.77), and overdose (6.18). Nine-point-one percent of the patients and service users included in the current study had periods of very high benzodiazepine use.

The authors note that two drugs in particular were associated with very high doses, alprazolam (Xanax) and clonazepam (Klonopin). Alprazolam and clonazepam are the two most prescribed benzodiazepines in the US. According to the authors, initiating treatment with these two drugs poses a significantly higher risk of high dose and high-risk usage patterns compared to other benzodiazepines.

This study had several limitations. The authors used data from an administrative register that lacked clinical information such as why the drugs were prescribed and short-term clinical status changes. This study only looked at benzodiazepine use that was tracked by the Finnish National Health Insurance Scheme register. This would exclude non-reimbursed prescription and illegal use. While the analysis was adjusted to account for demographic factors, underreporting of substance use disorders and other factors associated with high dose use such as high-risk behaviors could have affected the results. This analysis was based on data from 2006 to 2011 and may not reflect current trends. As the included data came exclusively from Finland, generalization to other populations is limited.

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Särkilä, H., Taipale, H., Tanskanen, A., Taiminen, T., Sund, R., Kurko, T., Hietala, J., & Niemelä, S. (2026). Benzodiazepine use and mortality risk: A nationwide cohort study on new benzodiazepine users with a 5‐year follow‐up. Acta Psychiatrica Scandinavica. (Link)