Benzodiazepine intoxication and overdose: signs, risks and what to do

Benzodiazepines are a group of sedative drugs. FRANK explains that some, such as diazepam, are prescription medicines used to treat anxiety, while others are illicit, sometimes called street benzos, which can be far more dangerous. Intoxication is the state that results when the amount taken is more than the body can safely handle, or when the drug is more potent than the person realises.

Even at lower doses, FRANK says people may feel sleepy, relaxed, calm, confused and disorientated, may be unsteady on their feet and have slower reflexes. Taking them can make you drowsy, dizzy and sometimes aggressive. The point at which this turns into an emergency is when breathing, heart rate and consciousness are affected.

WithYou, a UK drug and alcohol charity, adds that benzodiazepines can affect how easily you can move, cause extreme drowsiness, result in loss of memory, and slow down the heart and breathing rate, especially when mixed with alcohol or other depressant drugs.

Several situations lead to intoxication: taking more than prescribed, taking a tablet that contains a stronger benzodiazepine than expected, or combining benzodiazepines with alcohol or other sedatives. FRANK says illicit or fake products often come in blister packs that look legitimate and safe, but the tablets are usually sold as diazepam or alprazolam and often do not contain any of the drug they are sold as, and may contain other dangerous benzodiazepines, analogues or other chemicals.

FRANK names flubromazolam and etizolam as newer benzodiazepine analogues that can be dangerously high in potency. It also warns that some drugs are increasingly cut with dangerous synthetic opioids, so you can never really know what is in a street or counterfeit drug.

The charity WithYou says street benzos often contain several different drugs, which can increase the risk of overdose, and that tolerance can develop with regular use, which can lead to taking more.

WithYou lists the symptoms of benzodiazepine overdose, and several of them are easy to mistake for ordinary sleepiness or drunkenness. A person who is breathing slowly or noisily and cannot be woken is not simply asleep.

• Problems with breathing.

• Confusion or disorientation, and an altered mental state.

• Feeling extremely dizzy, caused by low blood pressure.

• Uncontrolled eye movements.

• Muscle weakness or tremor, lack of coordination and slurred speech.

• Extreme drowsiness, slowed heart rate and falling into a coma.

FRANK says that if you or someone else needs urgent help after taking drugs or drinking, you should call 999 for an ambulance and tell the crew everything you know. WithYou says that if someone passes out or falls asleep and cannot be woken after using benzodiazepines, you should put them in the recovery position, get help fast by calling 999 and tell emergency services what you know.

The recovery position, as WithYou explains, helps to prevent someone who is unconscious from choking on vomit; staying with the person and getting help if needed reduces the risk of harm. WithYou also says that because illicit drugs can contain a mixture of substances including opioids, naloxone should be used if you have it, and that it will not harm someone who has not overdosed on opioids. Naloxone does not reverse benzodiazepines themselves, so it never replaces calling 999.

Do not leave someone to sleep it off if they cannot be roused. Tell paramedics what was taken, how much, when, and whether alcohol or other drugs were involved.

FRANK says that mixing is the biggest risk. Alcohol and some drugs depress the central nervous system, which affects breathing. The drugs that do this include benzodiazepines, heroin and other opioids, pregabalin and gabapentin, so any combination of these, with or without alcohol, increases the risk of overdose and death.

FRANK also says that crushing tablets to inject them is extremely dangerous and can lead to skin infections, abscesses and rapid, potentially fatal overdose. WithYou says injecting also increases the risk of blood-borne viruses.

FRANK says benzodiazepine use can negatively affect mental health and may increase the risk of suicidal thoughts, particularly in young adults and those who are alcohol or opioid dependent, and that some can cause short-term memory loss.

FRANK says benzodiazepines can cause psychological and physical addiction, and that because tolerance increases over time people may need larger doses to get the same effect. They are normally recommended only for short periods and for severe cases. FRANK adds that withdrawal can include tremors, nausea, vomiting, headaches, anxiety, panic attacks and depression, and that fits can occur.

WithYou says withdrawal from benzodiazepines can be fatal, that if someone is experiencing withdrawal symptoms including seizures you should call 999, and that if you are dependent you can be helped to cut down safely because stopping suddenly can lead to complications. FRANK recommends talking to your GP for help and support if you want to stop.

If an overdose was intentional or you or someone you know is thinking of harming themselves, urgent mental health support is needed, through the GP, NHS 111 or 999, and the person should not be left alone.

In the UK, overdose is treated as a medical emergency through 999 and A&E, where staff monitor breathing and consciousness and provide supportive care. Follow-up for dependence, anxiety or sleep problems is usually through the GP, local drug and alcohol services or NHS mental health services.

Private addiction and mental health services exist and can offer assessment or rehabilitation, but they do not replace emergency care. A GP can advise on withdrawal plans, because stopping long-term benzodiazepines suddenly can be dangerous.