Stopping Dropping: Avoiding Benzo Overdose
Avoiding, recognising and getting help for benzo overdoses.
What are Benzodiazepines (Benzos)?
Benzos are prescribed medications for anxiety, sleeping problems, seizures and alcohol withdrawal. They are a depressant (meaning they depress the nervous system). They work by helping to boost the activity of gamma-aminobutyric acid (GABA). GABA is a natural brain relaxant that makes us feel good. If your GABA gets too low, it's difficult for the body to relax after stressful events. Low GABA activity leads to anxiety, depression, insomnia and mood disorders.
Key brands in Australia:
• diazepam (Valium)
• clorazepate (Tranxene)
• oxazepam (Serapax)
• alprazolam (Xanax)
• clonazepam (Rivotril)
• flunitrazepam (Rohypnol)
• lorazepam (Ativan)
Benzos are generally a Schedule 4 (‘prescription-only medication’) drug in Australia, although some (e.g. alprazolam) are Schedule 8 (‘drugs of addiction’). They are usually only prescribed for short term use. If you take them daily, your tolerance for benzos may increase after a week or so. You can become dependent on benzos after daily use of 3 to 4 weeks.
It can be dangerous to withdraw from benzos if you’ve been taking regular high doses or using them daily more than 3 weeks. To withdraw safely, you need to reduce your dose gradually. For this reason, some detox units will not accept people with benzo dependencies. However others may accept you for stabilisation with support to continue withdrawing at home afterwards. Even if you did not get your benzos from your own prescription, you can still see a doctor to help you withdraw — this could be a GP or a specialist at a drug and alcohol centre (see here for LHD intake lines or call PeerLine on 1800 644 413).
Benzo overdose can lead to coma, respiratory depression (very shallow or no breathing) and death.
Naloxone cannot reverse a benzo overdose, even though benzos are depressants like heroin. Naloxone is only effective with opiates.
Overdose risk is highest when benzos are mixed with other drugs, particularly other depressants like opioids, ketamine and GHB – even if you took the benzos the day before other use.
Telling if you are close to overdose
Overdose doesn’t always happen quickly or soon after taking drugs, especially if you are mixing with other drugs and alcohol over an extended period. These warning signs may help you know when it’s time to tell someone you think something is wrong.
• It gets harder to think clearly and remember things
• It’s harder to properly control how you move
• Your vision is blurry or you are seeing 2 of things
• It feels like you are hardly breathing — count your breaths or get someone else to. Are you breathing at least 12 times a minute?
• You feel dizzy and weak
• You start to feel very sleepy, like you want to drift away.
How you can tell if someone else has overdosed
• They seem confused and disoriented
• They may behave out of character or even bizarrely
• Uncoordinated muscle movements and/or they have tremors (shakes)
• Very slow, shallow breathing (oxygen is not reaching the lungs) or not breathing at all — usual breathing is 12–20 times a minute
• Fingertips/lips are bluish in pale-skinned people or greyish in dark-skinned people
• Slow heartbeat
• Stupor (no response to conversation but may respond to touch)
• Cold, clammy skin
• Unconscious — they can’t be woken up or can’t stay awake if you pinch their ear and call their name
• Coma.
This is how to help with Benzo overdoses
What can I do?
• If someone is unconscious, not breathing or showing signs of a benzo overdose, or if they have fallen on benzos and become hurt or unconscious, call the ambulance on 000 immediately — before you do anything else
• Make the area safe, keep them safe
• Try to clear their airways if you can. You can roll their head to the side so any liquid or vomit can run out
• Give rescue breathing if you know how and want to — but being COVID-safe means using a resuscitation mask
• Put them in the recovery position (on their side) if you know it
• Wait with them until the ambos come
• Tell the ambos everything you know about the overdose
• It is very important to tell the ambos if you know your friend has a dependency on benzos. How will the ambos help?
• If breathing has stopped, they will be given help to breath mechanically
• Most benzo overdoses are treated by monitoring patients until the effects of the drugs wear off
• The ambos would usually take the person to hospital for all the tools needed to keep them alive
• A health professional is trained for these situations
• Hospital is the best place for help if the situation escalates.
To reduce the risk of police attending or being asked to an ambulance call:
• Be calm and polite when you call 000
• Keep background noise down if you can
• No need to mention drugs — just say “I found my friend collapsed” and explain when they come. They will have the meds to treat overdose without mentioning ‘overdose’.
• Remove any drugs and/or equipment
• Tell anyone who needs to avoid police intervention to leave, just in case.