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1. The problem

  • Benzodiazepines increasingly contributing to complex opioid overdoses and illicit drug toxicity deaths in BC.
  • Benzos (mostly etizolam) detected in 50% of illicit drug toxicity deaths between Dec 2020-Jan 2021.
  • Increasing contamination of illicit opioids with benzos: 20% of all drug samples checked by BC Centre on Substance Use and 50% of samples from Vancouver Island in Jan 2021.


2. What does this mean for your patients?

  • Opioid overdoses may be more difficult to reverse if benzos are on board: Naloxone will reverse opioid effects, but patients’ level of consciousness may remain depressed.
  • Overdose may be prolonged due to long half-life of etizolam (~7-15 hours); especially in patients with liver disease (liver metabolism).
  • Patients who use illicit opioids may present with benzo withdrawal that can be hard to differentiate from opioid withdrawal or stimulant toxicity (anxiety, sleeplessness, autonomic instability).
  • SUPPORTIVE CARE is paramount! Support patients’ ventilation/oxygenation, monitor (O2 saturation, end-tidal CO2 where available), treat symptoms.
  • Note: urine toxicology screens will not detect all benzos. Point-of-care screens in BC will detect etizolam but reported sensitivity is 50-70%. **Treat patients clinically**


3. Should I give Naloxone?

  • YES. This will reverse the opioid component of mixed opioid/benzo overdoses.
  • Give more if an incomplete response is seen.


4. Should I give Flumazenil?

  • NO. High risk of seizures and dysrhythmias.


5. What else can I do?





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