$1.9M CAD Lawsuit Dismissed
7 Years on Benzodiazepines Without Informed Consent

→ This page has been translated from French. Some links lead to French-language documents. Pages on the BenzoVeillance website can be viewed in English by clicking the Quebec flag in the site menu.

Under Quebec medical liability law, fault is not assessed against what the Charter or the Civil Code guarantees patients. It is assessed against standard practice at the time of the relevant events. When the absence of informed consent regarding the risks of benzodiazepine dependence and withdrawal corresponds to the standard conduct of physicians at the relevant time, that absence does not constitute fault — even when the evidence establishes that the physician did not specifically and explicitly advise the patient.

This is the mechanism this judgment illustrates. BenzoVeillance documents it.

Three Findings

The Case

The plaintiff alleges that her family physician committed several acts of professional negligence between November 30, 2006, and March 26, 2013: prescribing medications that were inappropriate given the circumstances, for an excessively long duration, without providing the required information and warnings regarding side effects, without ensuring adequate follow-up, and without offering less risky alternatives (paragraph 1).

The defense's family medicine expert, Dr. Franck Paul-Hus, reviewed each consultation and concluded that Dr. Mathieu's treatment decisions, including the prescriptions, "were appropriate and consistent with the practice standards in this area" (paragraph 161). The court accepts this conclusion.

What the court documented — but did not treat as fault: Dr. Mathieu did not inform his patient of the risks of physical dependence or of the need for a gradual taper (paragraph 188).

The Superior Court dismissed the claim.

What the Court Found

First Consultation: November 30, 2006

What the court documents

At the first consultation on November 30, 2006, which lasted at least one hour, Dr. Mathieu conducted a comprehensive examination. The patient described having had sleep problems, anxiety, hyperventilation, palpitations, loss of appetite, nausea, and vomiting for six months. He noted the medications already in use: an antidepressant and two benzodiazepines (paragraph 16).

BenzoVeillance observation

Dr. Mathieu took over the care of a patient who was already on two simultaneous benzodiazepines (Serax and clonazepam). The record shows no question asked of the patient about what she knew of the risks associated with the benzodiazepines already prescribed, and no information provided on the subject during this first consultation.

The Training Cited and the 1997 CMQ Recommendations

What the court documents

Dr. Mathieu testified that the antidepressant (Effexor) and antipsychotic (Seroquel) combination prescribed at the first consultation had been recommended to him during continuing medical education courses he attended in 1996 and 1997, taught to family physicians by psychiatrists in his region (paragraph 21).

BenzoVeillance observation

According to Dr. Mathieu, these courses justify the antidepressant-Seroquel combination prescribed at the first consultation. They did not address benzodiazepines. Around the same time, the CMQ published its recommendations on the prolonged use of benzodiazepines (October 1997). These recommendations state the following regarding simultaneous benzodiazepine use:

• "The simultaneous use of two benzodiazepines is not recommended, regardless of their duration of action. Only rare exceptions apply:
• The treatment of occasional insomnia (fewer than five times per month) in a patient already receiving a benzodiazepine for a recognized indication;
• The use of a short-acting benzodiazepine for an acute episode in a patient with panic disorder being treated with alprazolam."

The CMQ's 1997 recommendations on the prolonged use of benzodiazepines are not mentioned in the judgment.

Anxiety Persists, Doses Increase

What the court documents

Seven weeks after the first benzodiazepine prescription (October 30, 2006), on December 21, 2006, Dr. Mathieu noted "anxiety still significant despite medication" (paragraph 25). He increased the dosages of the antidepressant and both benzodiazepines (paragraph 26).

BenzoVeillance observation

The development of tolerance is among the documented clinical explanations for persistent anxiety despite benzodiazepine use. Dosage increases are a commonly observed response to this phenomenon. The record reflects no assessment of this possibility, and no information provided to the patient on the subject.

The prescriptions continued. So did the silence.

The Refusal of Treatment Used to Justify Prolonged Prescribing

What the court documents

The defense's pharmacy expert, Mr. Frédéric Poitras, testified that the prolonged benzodiazepine prescribing was justified by the patient's repeated refusal to take antidepressants and engage in psychotherapy (paragraph 118).

BenzoVeillance observation

At no point in the record was the patient told that the alternative being offered carried a documented risk of physical dependence. She declined other treatments without having been informed of the specific risk of the one being substituted.

A choice made without information is not a choice.

The Absence of Information on Withdrawal: A Finding Without Consequence

What the court documents

Judge Sophie Picard makes the following finding at paragraph 188:

This finding does not give rise to civil liability. Expert Paul-Hus testified that physicians inform patients of "common and ordinary" risks, such as loss of appetite, nausea, or dizziness. As for withdrawal, he stated at paragraph 189 that he never discusses it, "given that rebound is certainly possible, but in such an eventuality the patient comes back to see him and the symptoms generally do not last long."

BenzoVeillance observation
Dr. David Lussier, a geriatrician at the Institut universitaire de gériatrie de Montréal, stated on Radio-Canada in February 2024 that benzodiazepine withdrawal is "very, very, very difficult" and that, in elderly patients, these medications are "far more dangerous than an opioid" (Radio-Canada, February 28, 2024).

In September 2020, the FDA documented — based on an analysis of 104 reported cases — that the median duration of benzodiazepine withdrawal symptoms was 9.5 months, and that the longest documented case involved a patient who remained symptomatic after 8 years.

In January 2026, the UK's Medicines and Healthcare products Regulatory Agency (MHRA) made it mandatory to include on the packaging of all benzodiazepines the warning "May cause addiction, dependence, and withdrawal reactions" (Drug Safety Update, January 8, 2026).

Protracted Withdrawal Syndrome: Divergent Positions

What the court documents

The defense's pharmacy expert, Mr. Frédéric Poitras, testified at paragraph 239 that protracted withdrawal syndrome "is still not covered in pharmacy education in Quebec given the insufficient research on the subject" and that "the phenomenon remains to this day only a hypothesis."

BenzoVeillance observation

In 2019, the FDA reviewed 104 cases selected from approximately 300,000 adverse event reports submitted through MedWatch, in part following a reporting campaign led by the Benzodiazepine Information Coalition (BIC, 2020). The median duration of withdrawal symptoms was 9.5 months. In the longest case in the series, symptoms were still present after 8 years. In September 2020, the FDA announced a new boxed warning on benzodiazepines.

The American Society of Addiction Medicine (ASAM) published guidelines in March 2025, in partnership with ten medical societies and with FDA funding, that formally incorporate benzodiazepine-induced neurological dysfunction (BIND) as a clinical framework for symptoms persisting after discontinuation. The guidelines also draw a distinction between physical dependence — a biological phenomenon affecting the majority of long-term users — and addiction, documented in approximately 1.5% of users. These developments are documented on BenzoVeillance:
The international recognition of protracted withdrawal syndrome
BIND explained

The Physician-Pharmacist Chain: Two Independent Obligations, One Shared Outcome

What the court documents

The defense's pharmacy expert, Mr. Poitras, testified that the physician is the specialist in diagnosis and that he "will expect all pharmaceutical counseling to be provided by the pharmacist" (paragraph 122). The defense's family medicine expert testified that "the pharmacist usually supplements the information" provided by the physician (paragraph 190).

Each of the two experts expected the other to convey the information. The outcome is documented at paragraph 186: during her deposition, the patient stated that she had no recollection of the physician having spoken to her about the risk of benzodiazepine dependence, or having told her to taper gradually — and that no pharmacist had given her such warnings either, verbally or in writing.

BenzoVeillance observation

The family medicine expert expected the pharmacist to convey the information. The pharmacy expert expected the physician to have done so. In the meantime, the patient received nothing. Her right to informed consent was respected by no one.

The judgment documents what Dr. Mathieu did not convey to his patient: the risks of physical dependence, the possibility of developing tolerance, the need for a gradual taper, the risks associated with a poorly managed withdrawal, and the length of time a safe taper can require. He says he does not recall doing so. His notes contain no such record (paragraph 188).

According to the decisions registry published on CanLII, to the best of our knowledge, no pharmacist has been disciplined in connection with benzodiazepine treatments in more than 25 years at the OPQ. BenzoVeillance also documents that 14 formal complaints filed with the OPQ's syndic (the body's complaints officer) for failure to provide information on the risks of dependence and withdrawal were not referred to the disciplinary council, after ten months of investigation.

The president of the OPQ, Mr. Jean Desgagnés, called it "aberrant" that patients remain on benzodiazepines for years — a characterization he put in writing in the journal L'Interaction (Spring 2025, p. 3).

The Legal Mechanism at Issue

Standard Practice as the Benchmark for Fault

Under Quebec medical liability law, fault is assessed against the conduct of "a reasonably prudent and diligent physician placed in the same circumstances" (paragraph 135). Practice standards are "those that are recognized, accepted, and shared by members of the medical profession practicing in the relevant field" (paragraph 139). Paragraph 140 states:

This legal framework has a direct consequence: if an inadequate practice is sufficiently widespread within a profession, it becomes the standard to which its members are held. Standard practice constitutes both the floor and the ceiling of the obligation.

The Double Barrier: Fault and Causation

The judgment sets out at paragraphs 213 to 216 the principles governing causation. Under Quebec civil law, this standard is equivalent to the U.S. preponderance of the evidence standard:

The court states at paragraph 216 that "expert evidence is generally required in order to analyze the causal link between the alleged fault and injury." Yet the judgment documents that the plaintiff was unable to find a Quebec family physician willing to testify on her behalf (paragraph 154).

What This Means for the Right to Informed Consent

The Right Guaranteed, the Obligation Absent

The right to informed consent is guaranteed by the Quebec Charter of Human Rights and Freedoms and the Civil Code of Quebec. These texts do not define the content of the information to be provided based on what colleagues are doing. They define what the patient needs in order to give informed consent.

The judgment holds that Dr. Mathieu's prescriptions were "adequate" and consistent with the practice standards of the time (paragraph 177). Expert Paul-Hus testified that he never discusses withdrawal syndromes (paragraph 189), and the court accepts this testimony as reflecting standard practice. The absence of information is therefore not fault — because it corresponds to the standard.

Available Remedies and Their Limits

A claim based exclusively on the violation of the right to informed consent could in theory have been brought directly under the Quebec Charter of Human Rights and Freedoms, seeking damages for an infringement of the right to personal integrity. This avenue falls outside the reasoning by which standard practice constitutes the benchmark for fault in medical civil liability.

However, Quebec's human rights and youth rights commission (Commission des droits de la personne et des droits de la jeunesse) does not intervene on all rights guaranteed by the Charter. Its mandate is limited to infringements based on a ground of discrimination enumerated in section 10. An infringement of the right to personal integrity in the context of a medical prescription falls outside that mandate. BenzoVeillance submitted a separate application to the Commission, which was declined on those grounds.

The right to informed consent is guaranteed by statute. No existing judicial or quasi-judicial mechanism is currently capable of ensuring its effective enforcement in the context of prescribed medications in Quebec.

The lever that remains is regulatory, not judicial. The CMQ and the OPQ have the authority to revise the standard of practice through mandatory guidelines, continuing education requirements, and disciplinary enforcement. It is at that level — the definition of what constitutes acceptable professional conduct — that the standard can be changed. The court applies the standard. The professional orders set it.

Who Is Watching Out for the Patient?

When Inadequate Practice Becomes the Standard

The legal mechanism documented in N.L. v. Mathieu has an internal logic: courts assess fault against standard practice because they presuppose that this practice has been defined and regulated by the competent authorities. When an inadequate practice is sufficiently widespread, it becomes the standard. The court has no other benchmark.

The two experts retained by the defense confirm that this is the norm within both professions in Quebec: the family medicine expert states that he never informs his patients of the risks of withdrawal (paragraph 189); the pharmacy expert confirms that protracted withdrawal syndrome "is still not covered in pharmacy education in Quebec" and that "the phenomenon remains to this day only a hypothesis" (paragraph 239).

These risks are not trivial. Quebec coroners have issued recommendations following deaths among patients on prescribed benzodiazepines.

This did not happen for lack of awareness. As early as September 25, 2002, Le Devoir reported that discussions had apparently taken place between the CMQ and the OPQ with a view to establishing a continuing education program on benzodiazepines, "but the project is said to have remained informal."

In the area of medication prescribing in Quebec, two professional licensing bodies have a mandate to protect the public and ensure that their members comply with their professional obligations: the CMQ and the OPQ.

For physicians, articles 28 and 29 of the Code of Ethics of Physicians (CQLR, M-9, r. 17) require the physician to obtain informed consent — described in Quebec law as "free and informed" — and to ensure that the patient has received relevant explanations regarding the nature, purpose, and possible consequences of the treatment.

For pharmacists, article 6 of the Code of Ethics of Pharmacists (CQLR, P-10, r. 7) establishes that the pharmacist has a primary duty to protect and promote the health and well-being of patients.

Neither body delegates this obligation to the other. It is the responsibility of both to ensure that these obligations are reflected in practice.

Conclusion

The civil court is not charged with protecting the public. It applies the law as it exists. The professional licensing bodies and the Office des professions (Quebec's statutory authority overseeing all professional orders) hold the mandate — and the authority — to ensure that standard practice meets the informed consent standard guaranteed to every patient by the Charter and the Civil Code, and that such consent is, in practice, systematic and documented.

The schoolteacher at the center of this case took benzodiazepines for seven years. She was never told what she was taking on. The court found no fault. The question that remains is not legal — it is institutional: who is responsible for making sure this does not happen to the next patient?

Some links on this page lead to French-language pages that have not been translated. Pages on the BenzoVeillance website can be viewed in English by clicking the Quebec flag in the site menu.

Note: The plaintiff's initials are used in accordance with the publication practice of the judgment.