The association between benzodiazepine proliferation in the unregulated drug supply and experiences of violence: A gender-based analysis.

Abstract

Rising contamination of illicitly-manufactured benzodiazepines in unregulated opioids in Canada poses concern as their strong sedative effects may increase vulnerability to violence for people who use drugs (PWUD), particularly women. The current study longitudinally examined the relationship between suspected exposure to benzodiazepines (SEB) and violent victimization, assessing for gender differences. Data were drawn from 1049 participants (40.9 % women) from three harmonized prospective cohorts of community-recruited PWUD in Vancouver, Canada between 2021 and 2023. We conducted gender-stratified analyses, with a three-level exposure variable 1) primary SEB: through using unregulated benzodiazepines, 2) secondary SEB: only through using other unregulated drugs, and 3) no exposure (reference category). Patterns of unregulated opioid and stimulant use were examined as effect modifiers. At baseline, 249 (58.0 %) women and 349 (56.3 %) men reported any SEB; 84 (19.6 %) women and 126 (20.3 %) men reported experiencing violence. For all participants, secondary SEB was significantly related to higher odds of violence (adjusted odds ratio [AOR]=1.48; 95 % confidence interval [CI]:1.14-1.92), however this association did not persist for primary SEB (AOR=1.26; 94 % CI:0.73-2.18). In gender-stratified analyses, the association between secondary SEB and violence was only significant for women (AOR=1.62; 95 % CI:1.10-2.38). Secondary SEB was also associated with higher odds of violence when participants reported daily stimulant and no daily opioid use (AOR=2.76; 95 % CI:1.58-4.82). Our findings suggest lack of agency over exposure to benzodiazepines, as created by drug supply unpredictability, may exacerbate risk of violence among women who use drugs and PWUD who do not frequently use opioids.