Benzodiazepine overdoses are common and deadly, especially when the benzo is taken with an opioid.
First aid (dos and don’ts)
Do call 911.
Do give naloxone (Narcan) if you suspect the person has taken an opioid along with the benzo.
Don’t wait: benzo overdoses can be deadly.
Can You Overdose on Benzos?
Yes, you can overdose on benzos. Benzo overdose deaths are unfortunately increasing in prevalence. From 2019 to 2020, benzodiazepine overdose deaths increased 42.9%. This includes a whopping 519.6% increase in illicit benzo overdose deaths and a 21.8% increase in prescription benzo overdose deaths.
A lethal dose of benzodiazepines can vary widely depending on the drug. Many lethal benzo doses have only been studied in animals, making it difficult to predict with certainty what the lethal dose is in humans.
Most benzo names end with –zepam. As such, drugs like diazepam, lorazepam, and temazepam are all classified as benzos. Exceptions include chlordiazepoxide and illicit benzos whose names typically end in -zolam, like etizolam, flualprazolam and flubromazolam.
Benzo Toxicity/Overdose Symptoms
The following symptoms are most likely to occur as a result of a benzo overdose:
- Slurred speech
- Movement problems
- Altered mental state
- Slowed breathing if the benzo has been taken with another substance like alcohol or an opioid
What To Do During a Benzodiazepine Overdose
- Call 911 immediately.
- Keep the individual talking and ensure their airway is clear.
- If the person is unconscious, make sure their airway is clear and turn them on their side to avoid aspiration and asphyxiation (do not induce vomiting).
- Wait with them until emergency services arrive and tell the responder what drug was taken and any other details you know about the situation.
Drug overdose can be fatal. If you suspect someone is experiencing an overdose, call 911 immediately. Do NOT be afraid to seek help. If you do not have access to a phone, contact Web Poison Control Services for online assistance.
Benzo Reversal Drug
In limited situations, doctors can use flumazenil to reverse a benzo overdose. This drug is not routinely used due to the risk of seizures and heart rhythm problems. Its use is generally limited to accidental benzo ingestion in children and waking a person after sedation for a medical procedure.
It is important to note that the opioid reversal agent naloxone (Narcan) does not work on benzo overdoses.
Flumazenil is an intravenous drug and can only be given in a health care setting. It is not available for home use.
Benzodiazepine Overdose Treatment
A benzo overdose is a medical emergency that cannot be treated at home. If you think someone is overdosing on a benzo, call 911. Even if the person is taking benzos without a prescription, you will not get in trouble for seeking help and potentially saving a life.
Common Overdose Risk Factors
You may be at a higher risk of a benzo overdose in certain cases:
- Taking an opioid with a benzo: Benzo overdoses with opioid use are so common and dangerous that the FDA has a Black Box Warning about using the substances together.
- Taking a higher dose of your benzo than prescribed: Taking a higher dose than prescribed, or taking your benzo more frequently than prescribed, can increase your risk of overdose.
- Taking an illicit benzo: Certain benzos, including etizolam, flualprazolam and flubromazolam, have not been approved for medical use and have a high overdose risk.
Benzos can stay in your system for varying amounts of time depending on the benzo and other factors.
When it comes to overdose risk, benzos can either be used alone or combined with other drugs, like opioids. Taking a benzo with an opioid can significantly increase your overdose risk.
Next Steps & Follow-up
After a person has recovered from a benzo overdose, it is important for them to seek help. This can include screening for intentional benzo overdose as well as medical detox and rehab. Doctors and loved ones need to be on the lookout for additional risks, like suicidal ideation and relapse risk.
Benzos can increase a person’s risk of suicide, especially if they have a history of anxiety and take benzos as their only treatment. Many instances of suicide by benzo overdose have occurred, especially in older adults. For these reasons, doctors should closely monitor a person with a history of mental health problems who is on a benzo.
Relapse & Tolerance Considerations
When a person has been taking a benzo for a long time, their body gets used to the dose, leading to tolerance. When a person is tolerant to a drug, they require higher doses to obtain the same effects. When a person stops the drug, their tolerance decreases.
This means that if a person stops taking the benzo and then relapses, a dose they would have previously been able to take without a problem now puts them at risk of overdose. The risk is especially pronounced in those who take relatively high benzo doses and those who use multiple substances.
If you or your loved one are struggling with benzodiazepine abuse or misuse, help is available. The Recovery Village offers benzodiazepine addiction treatment that addresses the root causes of a person’s relationship with benzos and any co-occurring mental health conditions that may have led to their benzo use. Contact us to get started on the path to lifelong recovery.
Liu, Stephen; O’Donnell, Julie; Gladden, R. Matt; et al. “Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines — 38 States and the District of Columbia, 2019–2020.” Centers for Disease Control and Prevention, August 27, 2021. Accessed September 30, 2021.
Kang, Michael; Galuska,Michael A.; Ghassemzadeh, Sassan. “Benzodiazepine Toxicity.” StatPearls, July 26, 2021. Accessed September 30, 2021.
Drugs.com. “Flumazenil.” July 15, 2020. Accessed September 30, 2021.
Drugs.com. “Diazepam.” October 30, 2020. Accessed September 30, 2021.
Boggs, Jennifer M. et al. “Association between suicide death and concordance with benzodiazepine treatment guidelines for anxiety and sleep disorders.” General Hospital Psychiatry, January 2020. Accessed September 30, 2021.
Carlsten, Anders; Waern, Margda; Holmgren, Per; Allebeck, Peter. “The role of benzodiazepines in elderly suicides.” Scandinavian Journal of Public Health, 2003. Accessed September 30, 2021.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.