Abstract
Benzodiazepines are widely prescribed for anxiety and insomnia, yet they carry potential risks, including side effects, tolerance, withdrawal, and dependence. Additionally, an illicit market exists, driven by individuals using these drugs outside of medical guidance. Despite widespread prescription and non-prescription use, little research has explored the experiences of people who use benzodiazepines and the associated harms, leaving a critical knowledge gap. This study investigated benzodiazepine use in Aotearoa New Zealand from the perspective of people who use benzodiazepines, addressing four key questions: What characterises benzodiazepine use in Aotearoa New Zealand? Are there any associated harms with using benzodiazepines as prescribed? What motivates individuals to use benzodiazepines without a prescription? And, are there any associated harms with non-prescription use? A nationwide survey of 242 people who use benzodiazepines was conducted to answer these questions. Quantitative statistical analyses examined usage patterns, harms, and motivations, and qualitative analysis of participant comments provided additional depth and context. Findings revealed that individuals using benzodiazepines as prescribed were on them long-term, with some not recalling being offered alternative treatments or having the risks clearly outlined by their healthcare provider. Prescribed users who found benzodiazepines ineffective, were unaware of risks, or experienced unexpected euphoria faced higher risks of harm. Qualitative data reinforced concerns that benzodiazepines should be limited to short-term or emergency use to minimise adverse effects and can be beneficial in these situations. These findings suggest that prescribing practices may not always align with best-practice guidelines, potentially increasing the risk of harm. However, with improved prescribing, benzodiazepines can still potentially have a role in short-term treatment. Among illicit users, diverted prescription benzodiazepines were most common, though novel benzodiazepines also appeared. The primary motivation for non-prescription use was self-medication. Qualitative insights highlighted that access issues to prescribed benzodiazepines drove individuals to seek illicit alternatives, potentially exposing them to greater risks. These findings highlighted the need for tailored harm reduction advice for those self-medicating with illicit benzodiazepines. Overall, the findings emphasise the importance of reserving benzodiazepines for short-term or emergency interventions, with a focus on using the benefits of initial treatment to transition individuals toward more comprehensive approaches, such as therapy. Ensuring that those who genuinely need benzodiazepines can access them through proper channels may reduce reliance on illicit sources while addressing underlying issues for long-term benefits. However, achieving this requires better funding for therapy and mental health services, as well as ensuring healthcare professionals have the time and resources to properly manage patients on benzodiazepines.