Approaches for Managing Benzodiazepine Dependence Arising From Use of the Adulterated Opioid Supply: A Delphi TechniqueApproaches for Managing Benzodiazepine Dependence Arising From Use of the Adulterated Opioid Supply: A Delphi Technique
Addiction Medicine: Beyond the Abstract
Drs Nicole Malette and Paxton Bach discuss how benzodiazepines in the adulterated opioid supply create new clinical challenges, especially around overdose and withdrawal. They outline current consensus approaches, research gaps, and the personal realities of working in addiction medicine during a toxic drug crisis.
32:27•20 Aug 2026
Benzos in the Opioid Supply: Clinicians Confront a Moving Target
Episode Overview
- Benzodiazepines mixed into the unregulated opioid supply increase overdose severity, complicate reversal with naloxone, and make drug use more unpredictable.
- Anyone using unregulated opioids daily may be at risk of benzodiazepine tolerance, dependence, and withdrawal, even if they do not knowingly take benzodiazepines.
- Timing and certain symptoms, such as tremors, perceptual disturbances, and seizures, can help distinguish benzodiazepine withdrawal from opioid withdrawal, though overlap is common.
- Inpatient management is strongly favoured for suspected co‑withdrawal, pairing opioid agonist treatment with carefully structured benzodiazepine tapers.
- Existing testing and research methods lag behind the fast-changing drug supply, highlighting an urgent need for more responsive evidence generation and use of frontline observations.
“Nothing important ever comes easy, and I think it is a really rewarding career path and one where you truly can make a profound difference in people's lives.”
What insights can experts and survivors share about addiction? This conversation from *Addiction Medicine: Beyond the Abstract* pulls back the curtain on a rapidly changing drug landscape, focusing on benzodiazepine dependence arising from the adulterated opioid supply. Journal Podcast Editor Dr Shawn McNeil chats with Dr Nicole Malette and Dr Paxton Bach about their recent article on how clinicians can respond when benzodiazepines quietly slip into the unregulated opioid supply.
The tone stays practical and grounded, aimed at clinicians, researchers, and anyone curious about how evidence and real-life practice intersect in addiction care. Dr Malette lays out the problem bluntly: benzodiazepines mixed with opioids intensify sedation, increase overdose severity, and blunt the impact of naloxone. As she explains, people “are exposed to benzodiazepines unknowingly,” which makes withdrawal and treatment far more complicated.
Dr Bach adds clinical context from British Columbia, noting that “as much as 50% of the opioids tested in our province over the past five years have contained benzodiazepines,” and that many of these are newer analogues unfamiliar to clinicians. Together, they walk through how co‑withdrawal from benzodiazepines and opioids can look different from each substance alone, why timing of symptoms matters, and why inpatient care is often recommended when both dependencies are suspected.
They also highlight serious gaps: limited drug-testing accuracy, lack of established guidelines, and the struggle to generate evidence fast enough for a drug supply that keeps changing. Beyond the technical details, both guests share candid reflections on why they chose addiction medicine, the emotional weight of working during a toxic drug crisis, and the importance of self-care and interdisciplinary collaboration.
If you care about safer care for people who use drugs, this episode might leave you asking: how can practice, policy, and research move fast enough to keep people alive?
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