Benzodiazepine Overdose

Benzodiazepines can be dangerous when used in ways other than as prescribed by a doctor. The abuse of benzodiazepines has increased in recent years, particularly involving the abuse of multiple substances at once.[1]

Benzodiazepines with a rapid onset are misused to produce a euphoric effect as well as to increase the effect of other substances, such as alcohol when taken together. Such use is dangerous, as users can misjudge the intensity of the effects of the drugs they are taking.[2] 

Combining substances puts individuals at a much higher risk of overdose. Taking benzodiazepines with other substances that are also central nervous system depressants, such as alcohol or opioids, greatly increases the risk of fatal overdose.[2]

Benzodiazepine Overdose Symptoms

When consumed alone, benzodiazepines are unlikely to cause an overdose, though it is possible.[3] Because they depress the central nervous system, an overdose of benzodiazepines can depress breathing and alertness. 

Symptoms of a benzodiazepine overdose include the following:[3]

• Difficulty breathing
• Drowsiness
• Coma 
• Ataxia (loss of muscle control)
• Respiratory arrest

Individuals presenting with an overdose from benzodiazepines alone are typically able to be aroused and provide information about their substance use. However, when taken in very high doses, benzodiazepines can make a person unconscious and lead to death.[3] 

Long-Term Problems Caused by a Benzodiazepine Overdose

In 2023, researchers asked 1,207 benzodiazepine users about their health and wellness. Some were still taking the drug, others were trying to quit, and others had stopped altogether. Mamy of these people discussed issues such as the following:[10]

• Low energy
• Distractedness
• Memory loss
• Nervousness
• Anxiety

People who experience an overdose may have specific injuries associated with their episode. Some overdoses, especially those involving opioids in addition to benzos, can cause severe respiratory depression and associated brain injury. People with this type of trauma can experience issues like slow reaction time, memory loss, reduced motor skills, and diminished physical functioning.[11]

The Increased Risk of Overdose When Mixing Substances

Mixing benzodiazepines with other substances severely increases the risk of overdose, particularly a fatal one. 

Opioids & Benzodiazepines

Opioids and benzodiazepines are two types of prescription medications that are frequently misused together. Combing these substances increases the risk of overdose by suppressing breathing, impairing cognitive function, and causing sedation.[2]

The National Institute on Drug Abuse (NIDA) says nearly 14% of overdose deaths involving opioids in 2021 also involved benzodiazepines.[2] People who use both benzodiazepines and opioids at the same time are at a significantly increased risk of being brought to an emergency room, being admitted to a hospital for drug overdose treatment, and suffering a fatal overdose.

Alcohol & Benzodiazepines 

Consuming benzodiazepines and alcohol at the same time poses a significant risk of overdose, which can easily become fatal. Like benzodiazepines, alcohol is a central nervous system depressant and poses a risk of overdose. When consumed in large quantities, alcohol can suppress breathing and reduce heart rate to dangerously low levels.[4]

Combining alcohol with prescription medications, like benzodiazepines, intensifies the effects of the drugs and their impact on vital bodily functions, like breathing. Even small amounts of alcohol combined with benzodiazepines can cause an overdose that requires emergency medical treatment.[4]

How Are Overdoses Treated?

Benzodiazepine overdoses are treated based on the symptoms the individual is presenting with. The treatment plan is different if the person only took benzodiazepines or if they combined use with other substances.

Benzodiazepine-Only Overdoses

In the case of a benzodiazepine-only overdose, it is likely the person will be conscious and able to discuss their use to better inform treatment. Supportive care, which may include breathing assistance, is most common.[3]

Teams typically keep people in the hospital for close monitoring during a benzodiazepine overdose. They might monitor your breathing carefully to ensure that you don’t experience complications.

Polysubstance Overdose

Treatment of benzodiazepine overdose is complicated by multi-substance use. In such cases, it is likely harder to arouse the individual. 

If it is known that opioids were taken in combination with benzodiazepines, opioid-specific interventions can be used. Naloxone is a life-saving medication that can reverse the effects of a fatal opioid overdose. It is also safe to use even if opioids are not present in the person’s system. If opioid use is a suspected cause of the overdose, immediate use of naloxone is recommended.[5]

Naloxone works by blocking the effects of opioids, such as depressed breathing. Within two to three minutes, someone who has significantly slowed or stopped breathing will be able to breathe normally again. 

According to the Centers for Disease Control and Prevention (CDC), opioids were involved in 80,411 overdose deaths in 2021, which represents 75.4% of all drug overdose deaths.[8] Almost 50,000 people died in 2019 from drug overdoses that involved opioids.[5] Many of those deaths could have been prevented with the quick administration of naloxone.

Naloxone is now available in all 50 states, in many without a prescription, and it should be readily available in the homes of individuals with a history of benzodiazepine and opioid use.[6]

What to Do in the Event of an Overdose

If you are ever in the presence of someone overdosing on any drug, stay calm and stay with the individual. The CDC recommends taking the following steps if you are with someone having an overdose:[5]

• Call 911 right away.
• If the person may be overdosing due to opioids, administer naloxone if you have it.
• Keep the individual awake and breathing, as best you can.
• Lay the person down on their side to reduce the chances of choking.
• Remain with the person until emergency medical care has arrived.

​​While you wait for the emergency responders to arrive, you can help. Ensure that the person is still breathing. If you don’t see their chest moving up or down, or feel air moving by your fingers when they’re pressed under the person’s nose, you can provide rescue breathing. Take the following steps:[9]

1. Put your fingers in the person’s mouth to ensure the airway is clear.
2. Place a hand on the person’s chin, tilt the head back, and pinch the nose closed.
3. Place your mouth over the person’s mouth to make a seal.
4. Give two slow breaths. You should see the person’s chest rise.
5. Follow up with one breath every five seconds.

Once the person is breathing, place them on their side to ensure they don’t choke if they vomit. Place a blanket or a coat over them to keep them warm.

The CDC also explains that most states have laws in place that protect people who are overdosing, as well as anyone trying to assist them in getting help, from legal trouble. There is no reason to delay calling for help for fear of legal repercussions.[7] Quick medical intervention can prevent benzodiazepine-related overdoses from becoming fatal.