Table 4.

Findings on Functional Consequences Associated with Benzodiazepine Misuse

Population	Finding	References
Overdose
Individuals with opioid use, prescription drug misuse, or injection drug use	Benzodiazepine misuse was retrospectively associated with non-fatal overdose	(Bennett and Higgins, 1999; Dietze et al., 2005; Galea et al., 2006; Hakansson et al., 2008; Kerr et al., 2007; Kinner et al., 2012; Maloney et al., 2009; Mateu-Gelabert et al., 2017; Moses et al., 2018; Neale and Robertson, 2005; Rossow and Lauritzen, 1999; Silva et al., 2013b; Stein et al., 2017b; Wines et al., 2007)
	Benzodiazepine misuse was not retrospectively associated with overdose	(Bouvier et al., 2018; Darke et al., 1996; Havens et al., 2011; Sherman et al., 2007)
	Benzodiazepine misuse was associated with overdose in unadjusted but not adjusted analyses	(Calvo et al., 2017; Jenkins et al., 2011; Mcgregor et al., 1998; Ochoa et al., 2005)
Suicidal Behaviors
Individuals with opioid use, prescription drug misuse, or injection drug use	Benzodiazepine misuse was associated with suicidal ideation or attempt	(Artenie et al., 2015a; Artenie et al., 2015b; Darke et al., 2004)
	Benzodiazepine misuse was not associated with suicidal ideation or attempt, or associations were only significant in unadjusted but not adjusted analyses	(Backmund et al., 2011; Maloney et al., 2009; Wines et al., 2004)
Individuals with alcohol dependence	Benzodiazepine misuse was associated with suicidal ideation or attempt	(Preuss et al., 2003)
General population samples in the U.S.	Benzodiazepine misuse was associated with suicidal ideation or attempt	(Blanco et al., 2018; Borges et al., 2000; Schepis et al., 2019; Schepis et al., 2018b)
Adolescent samples outside of the U.S.	Benzodiazepine misuse was associated with suicidal ideation or attempt	(Guo et al., 2016; Juan et al., 2015; Kokkevi et al., 2012)
Infectious Disease and Associated Behaviors
Individuals with opioid use, prescription drug misuse, or injection drug use	Benzodiazepine misuse was associated with higher rates of HCV and/or HIV	(Bach et al., 2016; Bleich et al., 1999; Ickowicz et al., 2015)
	Benzodiazepine misuse was associated with risk behaviors for infectious disease (e.g., injection drug use, unsafe injection practices, risky sexual behavior)	(Caplehorn, 1996; Caplehorn and Saunders, 1993; Darke et al., 1992; Darke et al., 1994a; Darke et al., 1993; Dinwiddie et al., 1996; Donoghoe et al., 1992; Evans et al., 2009; Gilchrist et al., 2006; Ickowicz et al., 2015; Klee et al., 1990; Rooney et al., 1999; Ross et al., 1996; Tucker et al., 2016; Young and Havens, 2012)
	Benzodiazepine misuse was not associated with HCV infection or sexual risk behaviors	(Havens et al., 2013; Kecojevic et al., 2015b)
College students in the U.S.	Benzodiazepine misuse was associated with regretted sexual experiences and sexual victimization	(Parks et al., 2017; Young et al., 2011)
Criminality
Individuals with opioid use, prescription drug misuse, or injection drug use	Benzodiazepine misuse was associated with criminal involvement	(Comiskey et al., 2012; Darke et al., 2010; Hammersley et al., 1992; Hammersley and Morrison, 1987; Horyniak et al., 2016; Sutherland et al., 2015)
	Benzodiazepine misuse was not associated with criminality	(Darke et al., 2002; Hall et al., 1993)
Adolescents in the U.S.	Benzodiazepine misuse was associated with criminal involvement	(Ford, 2008a)
Treatment Outcomes (Substance Use)
Individuals receiving SUD treatment (most commonly for OUD)	Ongoing benzodiazepine misuse during treatment was associated with continued use of participants’ primary substance and the use of other substances during and after treatment	(Bleich et al., 1999; Bleich et al., 2002; Comiskey and Snel, 2016; Darke et al., 2010; Eiroa-Orosa et al., 2010; Kamal et al., 2007; Nirenberg et al., 1996; Shaffer and LaSalvia, 1992)
	Baseline benzodiazepine misuse was associated with continued substance use during and after treatment	(Ghitza et al., 2008; Naji et al., 2016)
	No association between baseline benzodiazepine misuse and substance use during and after treatment	(Darke et al., 2010; Eiroa-Orosa et al., 2010)
Treatment Outcomes (Retention)
Individuals receiving SUD treatment (most commonly for OUD)	Benzodiazepine misuse was associated with increased odds of retention	(Bleich et al., 2002)
	Benzodiazepine misuse was associated with treatment attrition	(DeMaria et al., 2000; Eiroa-Orosa et al., 2010; Franklyn et al., 2017; Peles et al., 2006; Peles et al., 2010; Schiff et al., 2007; White et al., 2014)
	Benzodiazepine misuse was not associated with treatment retention	(Davstad et al., 2007; Kellogg et al., 2006; Proctor et al., 2015; Schuman-Olivier et al., 2013; Specka et al., 2011)
Quality of Life and Physical Health
General population samples in the U.S.	Benzodiazepine misuse was associated with poorer self-reported physical health and disability	(Ford et al., 2018; Schepis et al., 2018b)
General population samples outside of the U.S.	Benzodiazepine misuse was associated with poorer self-reported quality of life	(Abrahamsson et al., 2015)
Individuals with opioid use, illicit/prescription drug misuse, or injection drug use	Benzodiazepine misuse was associated with poorer self-reported quality of life	(Becker et al., 2007; Darke et al., 1993; Deacon et al., 2016; Lavie et al., 2009; Lugoboni et al., 2014; Millson et al., 2006)
	Ongoing benzodiazepine misuse during treatment was associated with poorer physical health	(Darke et al., 2010; Eiroa-Orosa et al., 2010)
	Benzodiazepine misuse was associated with greater pain severity	(Anagnostopoulos et al., 2018; Moses et al., 2018)
	Benzodiazepine misuse was associated with greater sleep dysfunction	(Blanco et al., 2013; Manconi et al., 2017; Mazza et al., 2014; Peles et al., 2009)
Other subgroups (e.g., healthcare workers, adolescents in the emergency department)	Benzodiazepine misuse was associated with poorer self-reported quality of life	(Jiraporncharoen et al., 2016)
	Benzodiazepine misuse was associated with more emergency department visits	(Whiteside et al., 2013)