Benzodiazepine Overdose: What to Do for Benzo Overdose
Benzodiazepines, also referred to as “benzos,” are a class of medication prescribed for the short-term management of anxiety, insomnia, seizures, and muscle spasms.1
However, benzodiazepines carry the potential for misuse, addiction, and deadly overdose, especially when they are used in combination with other substances, including opioids, alcohol, and certain other illicit and prescription drugs.2,3 In 2020, over 12,000 people lost their lives to drug overdose involving benzodiazepines.3,4
This page will provide you with information about benzodiazepine overdose, including recognizing the symptoms, what to do if someone overdoses, and how you or a loved one can get help for a benzo addiction.
What are Benzodiazepines?
Benzodiazepines are central nervous system (CNS) depressant medications, also known as sedative hypnotics. Some of the most commonly prescribed benzos include Ativan (lorazepam), Valium (diazepam), Xanax (alprazolam), and Klonopin (clonazepam).1 Though each medication may accomplish the task slightly differently, all benzodiazepines work to calm an otherwise over-excited nervous system.5
Each year, over 92 million prescriptions for benzodiazepines are dispensed in the United States.6 However, benzos are also often misused for non-medical purposes—including to get high, to increase the euphoric effects of other substances like opioids or alcohol, or to relieve the unpleasant withdrawal side effects associated with cocaine, such as irritability and agitation.1
Can You Overdose on Benzos?
Experiencing an overdose from benzodiazepines alone is rare. Severe overdose toxicity and/or fatal overdose is more likely to occur with the concomitant use of benzodiazepines and other substances, particularly other CNS depressants such as alcohol, and opioids.7
Between 1999 and 2017, the number of overdose deaths involving benzodiazepines and opioids (primarily illicitly manufactured fentanyl) increased 916%. From 2017-2020, the number of opioid-and-benzodiazepine-related deaths decreased, but in 2020, it rose again to 12,290.4
According to the Centers for Disease Control and Prevention, which published a data set based on benzodiazepine-involved overdose rates in 38 states and the District of Columbia, benzodiazepines were involved in nearly 17% of the more than 41,000 overdose deaths between January 2019 and June 2020 in 23 states. However, opioids were also involved in 91% of the benzodiazepine deaths.7
Signs of Benzodiazepine Overdose
When an individual takes a larger dose of benzodiazepines than their body can handle, benzodiazepine toxicity can occur. Signs of a benzodiazepine overdose may include:2.3
- Slurred speech.
- Extreme drowsiness.
- Loss of consciousness.
- Shallow or slowed breathing.
- Uncoordinated movements.
Risk Factors for Benzo Overdose
There are factors that can impact the symptoms and severity of benzo overdose, including:2
- The dosage.
- The benzodiazepine taken.
- The concomitant use of other substances, specifically, alcohol, opioids, and other sedatives.
Benzodiazepines taken in toxic doses can cause overdose.2
Additionally, studies indicate that alprazolam, marketed under the brand name Xanax, may be significantly more toxic in overdoses than other benzodiazepines.8
Furthermore, as previously mentioned, when benzodiazepines are combined with other substances, such as opioids, alcohol, or other sedatives, deep sedation, respiratory depression, and death can occur.2,9
How to Respond During a Benzo Overdose
If you suspect that someone is experiencing a benzo overdose, call 911 immediately. Be prepared to provide your location and the amount and types of substance(s) the individual ingested.
After calling 911, remain with the individual and keep their airway open. If they stop breathing, perform mouth-to-mouth resuscitation. If their heart stops beating, begin CPR.
Benzo Overdose Reversal
In some instances, healthcare professionals may administer flumazenil, a benzodiazepine antidote medication, to reverse the effects of a benzodiazepine overdose. Flumazenil may not completely remedy depressed breathing and, because it’s a short-acting medication, may need to be given every 20 minutes. Additionally, it can lead to seizures in some individuals who may be taking certain antidepressants.10
As previously mentioned, many benzodiazepine overdoses involve opioids. If you suspect that an individual has taken another substance besides benzodiazepines or has taken a counterfeit benzo that could have been cut with a toxic dose of opioids, call 911, and administer Narcan (naloxone). Narcan is a medication available at pharmacies without a prescription in many states that can be given to reverse an opioid overdose. Narcan won’t do anything to reverse an overdose from benzodiazepines, but it doesn’t cause any harm either. If the individual used opioids, in addition to benzos, or used benzos cut with opioids, it could save their life.3,7,11
Getting Help for Benzodiazepine Misuse
Treatment is available to effectively treat benzodiazepine misuse and addiction. Depending on several individual variables and the severity of the benzodiazepine or other sedative use disorder, treatment may include one or more levels of care. Many individuals begin treatment for benzodiazepine addiction with medical detox. This is because stopping benzodiazepine use suddenly or drastically reducing dosing can cause extremely unpleasant withdrawal symptoms, which can become potentially dangerous if left untreated.12
During medically managed detoxification, the body rids itself of the substances and toxins, while healthcare professionals manage the withdrawal symptoms—typically with medication—and prevent withdrawal complications to keep an individual safe and as comfortable as possible.12 Detox, alone, however, is typically not enough to sustain abstinence. It is typically the first step in a more comprehensive treatment plan, which can help an individual identify the thoughts, emotions, and behaviors behind the addiction.12
While personalized treatment for benzo addiction differs from patient to patient, rehab options may include:13
Inpatient or residential programs. Individuals live at the facility temporarily for the duration of treatment, which includes around-the-clock support and monitoring from healthcare professionals and staff. Additionally, individuals participate in individual and group counseling, behavioral therapies, classes, meetings, and skills training.
Outpatient and intensive outpatient programs. Outpatient treatment may be an option for some. The program looks very similar to the inpatient and residential treatment but individuals can return to work, home, or a sober living environment after completing their required sessions each day.
There are several types of therapies for addiction that may be incorporated into treatment, depending on an individual’s needs. Research indicates that for someone with a benzodiazepine addiction, gradual dose reduction of benzos, coupled with behavioral therapy, is more effective than dose reduction alone.14 Cognitive behavioral therapy (CBT), for instance, can help individuals identify triggers, manage stressors, and prevent relapse while they change their thoughts, emotions, and behaviors surrounding their substance use. Additionally, motivational interviewing may help address an individual’s motivation to change and sustain it in recovery.13,14
If you or a loved one struggle with benzodiazepine (or other substance) use, take the first step, reach out to American Addiction Centers, and let one of our compassionate Admissions Navigators answer your questions, explain your options, and help get you on the path to recovery. Call .