Millions of people take benzodiazepines to cope with anxiety, panic attacks and certain medical conditions, such as seizures, as well as for alcohol withdrawal. Benzos are safe when taken as prescribed, yet they are all listed by the Drug Enforcement Agency (DEA) as Schedule IV controlled substances. This means they have a high potential for abuse, diversion and addiction. The downside of taking benzos, particularly for a long time or in combination with other drugs or alcohol, includes the possibility of overdose.
What Is a Benzo Overdose?
A benzo overdose occurs when a person takes more than the prescribed or recommended dose of the medication. When someone goes into benzo overdose, their vital signs and functions plummet, which may be life-threatening. Immediate emergency help is necessary to combat a benzo overdose.
Signs of a Benzodiazepine Overdose
How do you know someone is experiencing a benzodiazepine overdose? The most telling sign of benzo overdose is excessive sleepiness or drowsiness. The person may be difficult to rouse, have trouble standing up or fall repeatedly. Look for signs of confusion and speech that is slurred.
Other common signs of a benzodiazepine overdose include:
- Breathing that is slow or shallow
- Low blood pressure
- Pupils that are dilated
- Lips that are bluish in color
- Slowed or absent muscle reflexes
- Pulse that is rapid, or weak
- Skin that feels clammy
Understanding the Mechanisms of Benzo Overdose
An overdose of benzodiazepines causes central nervous system (CNS) depression. The chief appeal of benzos prescribed for sleep and anxiety disorders is their ability to affect the brain’s neurotransmitter gamma-aminobutyric acid (GABA), slowing down brain activity and producing calmness and drowsiness. During a benzo overdose, vital bodily functions slow to dangerous levels, precipitating a cascade of events that could result in death.
Effects of Overdose on Body Systems
Knowing what happens on various body systems as a result of a benzodiazepine overdose is important to prevent such an occurrence to begin with, as well as helping to avoid a future benzo overdose.
Benzodiazepines, as well as opiates, slow down body systems, particularly the cardiovascular and respiratory systems. Benzos also lower blood pressure and core body temperature. When benzos and opiates are combined, it’s a lethal combination in the making, with each of the drugs magnifying the effects of the other exponentially. This powerful assault is what stops breathing.
Different Drugs’ Overdose Effects
While many drugs qualify as benzodiazepines, that does not mean that their overdose effects are the same. In fact, there is a great deal of difference between certain types of benzodiazepines. Taking too much of one may result in severe overdose, while another may wind up being less severe, with fewer or less serious complications.
Sold under the brand name of Xanax, alprazolam is the most commonly prescribed benzodiazepine in the U.S. Alprazolam may be used as an adjunctive drug in the short-term treatment of generalized anxiety disorder (GAD). A short-acting benzo, alprazolam has also been found to have greater toxicity than diazepam, sold under the brand name of Valium.
The overdose effects of too much alprazolam can range from mild to severe, depending on the quantity of the drug taken and whether it was taken with alcohol or other drugs. The specific overdose effects of alprazolam are that it causes the central nervous system to be severely depressed. This, in turn, can lead to coma and death, if alprazolam is taken along with other drugs. Other alprazolam overdose symptoms may include fainting, dizziness, drowsiness, slow or shallow breathing, low blood pressure, weak muscles, loss of balance and impaired reflexes.
Alprazolam (Xanax) is 10 times stronger than diazepam. And, although alprazolam overdoses are less likely than other benzodiazepine overdoses, people can underestimate the strength of the drug and get themselves in a dangerous situation that may result in an unintentional overdose.
Another very commonly prescribed benzodiazepine is diazepam, sold under the brand name of Valium. Diazepam is a long-acting benzodiazepine and is often a first-line treatment for acute alcohol withdrawal. It is also used in treating GAD. As with alprazolam, those who overdose on diazepam commonly experience respiratory depression, dizziness, drowsiness and muscle weakness and fatigue. With diazepam, however, uncommon and rare overdose effects include the following:
- Heart failure
- Delirium tremens
- Paranoid psychosis
- Emotional numbness
- Amnesia and anterograde amnesia
- Memory loss
- Hypersensitivity to visual, auditory and physical stimuli
In addition, dementia may occur in elderly adults under long-term diazepam treatment.
A third example of benzodiazepine is lorazepam, sold under the brand name Ativan. With a half-life of 10-20 hours, lorazepam is a medium-acting benzo. Taking lorazepam and drinking may increase the effects of alcohol. Commonly occurring overdose effects include lethargy, mental confusion and drowsiness. More severe overdose effects include several stages of coma, hypnosis, abnormally low blood pressure, low muscle tone, loss of control over bodily movements and death in rare instances.
Treatment for Benzo Overdose
If a benzo overdose is suspected, get emergency help right away. Good Samaritan laws in all 50 states protect you in the case of calling for emergency assistance for someone you believe is experiencing a benzo overdose. Responding paramedics may be able to administer lifesaving treatment, in the case of severely depressed breathing or other potentially fatal symptoms, and timing is critical to save a life. Getting the person to a hospital emergency department for further assessment and care is the most advantageous thing that can happen.
Benzo overdose treatment may involve a benzo antidote, a drug that acts as a benzo reversal. Flumazenil is a benzodiazepine antagonist that has proven useful in some cases to reverse respiratory depression and sedation common in deliberate overdose with benzos, as well as in those under anesthesia during medical or surgical procedures. Flumazenil is administered intravenously. While there’s some controversy surrounding flumazenil, and its use must be carefully monitored, it has been widely validated for efficacy and safety as a benzodiazepine reversal agent. The drug may cause the onset of seizures if the overdose involved mixed tricyclic antidepressant-benzodiazepines.
Activated Charcoal or Other Treatments?
While activated charcoal may be indicated for treatment of some kinds of intoxication, medical experts say it is not recommended for use in treating toxicity in benzodiazepine overdose.
Similarly, stomach pumping and irrigation of the whole bowel are not recommended treatments for benzo overdose.
If someone experiences severe consequences from benzo overdose, there may be permanent brain damage. This is due, in part, to the lack of oxygen to the brain during unconsciousness or coma. The result may be memory loss, difficulty communicating, coordination problems, trouble concentrating— even dementia. For some of those who’ve been comatose following a benzo overdose, the outlook can sometimes be living in a persistent vegetative state.
Anyone who’s experienced a benzo overdose should get professional help so that it doesn’t happen again. Benzodiazepine addiction and repeated overdoses increase the risks of permanent damage.
Benzodiazepine Overdose and Death
Benzodiazepine overdose alone, and not in combination with alcohol, or other drugs, specifically opiate drugs, synthetic or otherwise, generally does not result in death. The risk of overdose death from benzodiazepines, however, is greater in children and in elderly adults, as well as individuals with chronic illnesses. Relatively low doses of benzodiazepines in these populations can prove fatal.
As for numbers, according to the National Institute on Drug Abuse (NIDA), overdose deaths involving benzodiazepines were 11,537 in 2017, up from 1,135 in 1999. While the number of overdose deaths from benzodiazepines minus any opiate drugs has been relatively steady, the stats for benzodiazepines in combination with other synthetic narcotic drugs has been on a steady increase since 2014.
How the Mechanism of Action Causes Death
Death from benzo overdose can occur as a result of the heart stopping, and breathing cessation to the point where the brain is starved of oxygen and reaches critical brain-death stage. In the case of benzo overdose-induced coma, this persistent vegetative state may last indefinitely, with the overdosed individual left in a state of limbo.
How Drug Interactions can Increase Risk
Adults aged 50 and older who misused benzodiazepines and prescription opiate drugs were at increased risk for suicidal thoughts, according to study data reported on by the NIDA. Among those older adults who misused both drugs simultaneously, however, the risk of suicidal thoughts was significantly higher than adults who reported no misuse.
An American rap artist, Lil Peep, died in November 2018 from accidentally overdosing on Xanax and the synthetic opiate painkiller fentanyl. Singer and songwriter Tom Petty died in October 2017 from an accidental overdose of two benzodiazepines, alprazolam and temazepam, an antidepressant, and two painkillers, oxycodone and fentanyl.
Family members and friends should take notice if someone they care about is seeking early benzodiazepine refills, or obtaining prescriptions from several doctors at once for benzodiazepines. These are signs of potential benzo abuse. Doctors should screen older adults who take benzos and assess them for signs of suicidal thoughts.
Unique Factors of Benzo Overdose
Compared to other types of overdose, benzo overdose is less likely to be fatal, unless the drug is taken in combination with other drugs, especially synthetic opiates, or the person taking the massive dose of benzodiazepines is a child, an elderly adult, or someone suffering with chronic disease.
Those overdosing on benzos are more likely to exhibit profound sleepiness and may, in many cases, sleep it off without permanent effects. The practice of taking too many benzos, however, is always dangerous, since the way the drug interacts may be different on separate occasions, or the person may ingest the drug without remembering or taking into account the interactions with alcohol and other drugs of any kind.
Reaching out for help for yourself or a loved one after a benzo overdose is always a good rule of thumb. Contact FHE Health today, so we can assist you on the road to recovery.