441-01176 (Health)

Benzodiazepines are a group of medications that can help reduce anxiety and make it easier to sleep. They are also used as a muscle relaxant, to induce sedation for surgery and other medical procedures, and in the treatment of seizures and alcohol withdrawal. Health Canada understands benzodiazepine use can become problematic, which can lead to substance use disorder, overdose and even death.  One way in which we provide information to Canadians about benzodiazepines is on our Government of Canada webpage on benzodiazepines.  Healthcare professionals and patients can also access the official product monographs and relevant patient information for prescription benzodiazepines online from the Drug Product Database.  These documents outline the approved indications (uses) of the drugs, as well as relevant dosing and safety information. The risk of serious falls in elderly patients as well as suicidal ideation in the context of withdrawal are known class risks for benzodiazepines and details are included in the Warnings and Precautions section of updated product monographs.

Due to the known risks of benzodiazepines, in Canada, prescription drugs containing benzodiazepines are also scheduled under the Controlled Drugs and Substances Act (CDSA). Activities such as sale, possession and production of benzodiazepines are illegal, unless authorized for medical, scientific or industrial purposes. Benzodiazepines are only legally available by prescription.

 Canada’s approach to substance use issues is comprehensive, collaborative, and compassionate, guided by our federal drug strategy – the Canadian Drugs and Substances Strategy (CDSS). The CDSS takes a public health-focused approach and lays out our framework for evidence-based actions to reduce the harms associated with substance use in Canada. In the context of the worsening overdose crisis, and taking steps to reduce harms and deaths related to substance use, the Government is placing particular focus on:

• ensuring that harm reduction services are available to Canadians who need them;
• working with stakeholders to reduce stigma directed at people who use drugs, which acts as a barrier to accessing critical health and social services and often leads to social isolation and further risk of harms;
• continuing to work with provinces and territories to improve access to evidence-based treatment options;
• continuing to address illegal production and trafficking, with a focus on organized drug crime; and,
• implementing additional surveillance and research activities that will further build the evidence base and allow us to pursue innovative solutions to this public health crisis.

Since 2017, the federal government has taken significant actions and made commitments of more than $800 million to address the toxic drug and overdose crisis and substance use-related harms. Recent examples of key federal investments in this area include:

• Nearly $350 million to the Substance Use and Addictions Program (SUAP) between 2017-2022 in support of community-based organizations responding to substance use issues, including investments to help them provide direct services in a COVID-19 context and to scale-up key lifesaving measures and increase access to a safer drug supply as an alternative to the contaminated supply;
• $150 million through the one-time Emergency Treatment Fund to provinces and territories, which, when cost-matched with the provinces and territories, will result in an investment over $300 million to improve access to evidence-based treatment services;
• $45 million to develop national standards for mental health and substance use services, in collaboration with provinces and territories, health organizations and key stakeholders, to address long-standing challenges in the delivery of mental health and substance use services and supports across the country; and,
• $22.8 million in public education through national and targeted advertising, partnerships and experiential marketing on the risks of opioids, overdose awareness, harm reduction and stigma awareness and reduction.

Budget 2023 proposes to provide a total of $359.2 million over five years, starting in 2023-24, with $5.7 million ongoing and $1.3 million in remaining amortization, to support a renewed Canadian Drugs and Substances Strategy, which would guide the government's work to save lives and protect the health and safety of Canadians. This includes:

• $144 million over five years, starting in 2023-24, to Health Canada for the Substance Use and Addictions Program to fund community-based supports, including safer supply, supervised consumption sites, and other evidence-based health interventions;
• $20.2 million over five years, starting in 2023-24, to the Public Health Agency of Canada for a new community-based program to prevent substance use among young people; 
• $73.9 million over five years, starting in 2023-24, with $4.6 million ongoing, to Health Canada to streamline authorizations for supervised consumption sites and drug checking services, scale-up access to safer supply, and evaluate innovative approaches;
• $50.8 million over five years, starting in 2023-24, with $1.1 million ongoing and $1.3 million in remaining amortization, to Health Canada; and $16 million over five years, starting in 2023-24, to the Public Health Agency of Canada to support vital data collection on substance-related harms and lab-based analysis of the illegal drug supply;
• $4.6 million over five years, starting in 2023-24, to Public Safety Canada to develop an overdose monitoring app for paramedics and other first responders; and,
• $42 million over five years, starting in 2023-24, to the Royal Canadian Mounted Police; $6.2 million over five years, starting in 2023-24, to Public Services and Procurement Canada; and $1.6 million over five years, starting in 2023-24, sourced from existing resources, to Global Affairs Canada to take further action to work with our partners to tackle drug trafficking and stem the global flow of these devastating substances.

Of note, under SUAP, more than $24 million has been allocated to fund Naloxone distribution, education and training. In addition, through SUAP, the Government of Canada is supporting policies and approaches for greater access to pharmaceutical-grade alternative to the toxic illegal drug supply – a practice often referred to as safer supply. As of March 2023, Health Canada has supported 30 safer supply pilot projects across Canada through the Substance Use and Addictions Program, representing total funding commitments of over $88.3 million. This includes supporting a range of service delivery projects in British Columbia, Manitoba, Ontario, Quebec and New Brunswick, research/knowledge transfer and exchange projects, and a National Safer Supply Community of Practice to help share knowledge amongst stakeholders.

Health Canada has supported the rapid expansion of supervised consumption services across Canada. Since January 2016, the number of federally approved supervised consumption sites (SCS) offering services grew from 1 to 40. Health Canada also proactively issued exemptions that allows provinces and territories to establish new temporary Urgent Public Health Need Sites – also known as overdose prevention sites – within existing supervised consumption sites, shelters or other temporary sites, as needed. Urgent Public Health Need Sites, unlike supervised consumption sites, are temporary locations that can be set up rapidly to address the overdose crisis. Both share the goal of reducing overdose deaths.

We have also made a number of regulatory changes at the federal level to help improve access to medications used in drug treatment and safer supply programs, including:

• issuing a class exemption (an exemption authorized to a group of people, such as pharmacists, to conduct specific activities with controlled substances) to make it easier for patients to access the medications they need;
• approving injectable hydromorphone as a treatment option for patients with severe opioid use disorder;
• approving injectable diacetylmorphine as a new treatment option for patients with severe opioid use disorder; as well facilitating the prescribing and dispensing of methadone and diacetylmorphine; and  
• authorizing nurses who provide health care services at a community health facility to conduct certain activities with controlled substances.

The federal government is committed to using every tool at its disposal and examining all evidence to respond to the tragic increase in overdoses and to help save lives, while also ensuring the safety of communities across the country. The Government is working to divert people who use drugs away from criminal justice systems and toward supportive and trusted relationships in health services and social supports, when needed. For example, the Good Samaritan Drug Overdose Act was passed into law in May 2017, providing some legal protection from simple drug possession charges for individuals who seek emergency help during an overdose.

Furthermore, Bill C-5, which received Royal Assent on November 17, 2022, made legislative amendments to the Criminal Code and to the Controlled Drugs and Substances Act (CDSA). Among other measures, the amendments encourage police and prosecutors to consider alternative measures – including diverting individuals to treatment programs – instead of laying a criminal charge or prosecuting individuals for personal drug possession. These amendments also repealed mandatory minimum penalties for certain offences in the Controlled Drugs and Substances Act to reflect the Government’s public-health-focused approach to substance use. These measures are consistent with the August 2020 Guidelines issued by the Public Prosecution Service of Canada directing prosecutors that alternatives to prosecution should be considered for the personal possession of drugs, except where public safety concerns arise.

Health Canada regularly engages with stakeholders to better understand concerns and values the input of all actors within the health system, including healthcare practitioners and patient groups. While Health Canada oversees the regulation of drugs, it has no jurisdiction over how health care professionals prescribe drugs once they are authorized. The prescribing, dispensing and administration of marketed drugs falls under the jurisdiction of provincial and territorial governments, their medical colleges, as well as physicians.

Canada has also taken action on the broader issue of predatory practices of pharmaceutical companies, including significantly increasing the maximum financial penalties. We will continue to explore all options to ensure that companies are held accountable for their role in the overdose crisis if they acted inappropriately in the marketing and distribution of opioids. For example, there is significant cooperation in BC’s litigation between all Canadian governments, as we work together to address the overdose crisis. At our request, in November 2022, the BC government amended their legislation which reinforced the federal government’s participation in BC’s proposed Class Action against opioid manufacturers and distributors who allegedly acted inappropriately in the sale and distribution of opioids. Participating in the Purdue settlement is another example of the significant cooperation that exists in this litigation between all Canadian Governments. Canada is also part of BC’s proposed class action against McKinsey & Company that allegedly acted in appropriately in the course of providing consulting services to opioid manufacturers and distributors.