![]() Xylazine contaminated heroin was first reported in the United States in 2002. Often, these mixes include heavy doses of caffeine to offset some of the tranquilizing effects – with some seizures being as much as 30% caffeine by weight. This ‘opioid cocktail’ blends heroin or fentanyl or one of their analogues with sedatives including xylazine. Tranq or tranq dope is increasingly common on the east coast in the United States. In fact, in British Colombia, benzo dope was responsible for 30% of all overdose deaths. This makes benzo dope significantly more harmful than “pure” heroin and fentanyl, despite the fact that pure heroin and fentanyl now make up less than 10% of the available supply of drugs. This puts them at higher risk of personal harm as well as at increased risk of violence and sexual violence. For example, a person heavily sedated on benzos can walk into traffic, off of stairs without walking down them, or pass out on the street. A blood test can take days to process, meaning emergency rooms won’t always know what they’re treating until it’s too late.īenzodiazepines are also more sedative, that means heavy users are more likely to be sedated into presenting a danger to themselves. Instead, many people go into overdose, the Naloxone does nothing, and the individual starts to go into opioid withdrawal while still suffering from the benzodiazepine overdose. Plus, traditional opioid overdose reversal drugs like Naloxone have no effect on benzodiazepine overdose. For example, while an opioid overdose normally lasts 10-20 minutes, benzodiazepine overdoses can last for hours. Largely, they greatly increase the risk of overdose and cause a separate type of overdose than opioids. While benzodiazepines are often issued as a prescription drug, they interact with opioids in new and unexpected ways. In addition, most samples contained other drugs, with caffeine, Flualprazolam (a benzodiazepine), Bromazolam (a benzodiazepine), etizolam (a benzodiazepine analogue), and xylazine (a sedative used on horses) being the most common. While not yet extremely common in the United States, benzo dope represents more than half of all fentanyl samples brought into Toronto’s free drug testing sites. An interprofessional team approach would help achieve maximum efficacy and minimize potential risks associated with flumazenil therapy.Benzo dope is a mix of benzodiazepines, which are a tranquilizer that effect the body-regulating GABA system of the brain, and an opioid – namely heroin or fentanyl. As depicted above, clinicians(MDs, DOs, NPs, PAs) should collaborate to improve patient outcomes. In addition, medical toxicologist consultation is often required for multiple-drug ingestions. Critical care physician consultation is required in severe poisoning with respiratory depression. Hospital pharmacists should ensure proper dosing of flumazenil. Emergency department physicians should rapidly stabilize the patient. Normally flumazenil overdose is handled by emergency department physicians. Overall, the use of flumazenil to manage benzodiazepine overdose is diminishing as the drug may cause more harm than good. A few patients may develop rhabdomyolysis and aspiration pneumonia. In most isolated cases of benzodiazepine overdose, supportive management may prove useful. The problem arises when the individual has co-ingested alcohol or other illicit drugs. ![]() In general, patients who overdose on benzodiazepines alone rarely have significant mortality. The nurse and the pharmacist should educate the patient on the use of benzodiazepines, their potential to cause addiction, and physical dependence. The ideal circumstance for flumazenil is when a naive benzodiazepine individual has overdosed. Additionally, all healthcare workers need to know that this drug should not be used in patients with a history of seizures, head injury, or those who have ingested a tricyclic antidepressant. The drug may precipitate seizures and withdrawal in patients who have been using benzodiazepines for a medical disorder. Not everyone with benzodiazepine overdose will respond to it. The problem with flumazenil is that its effects are not consistent or predictable. Despite the initial hype about the drug, many experts believe that its risks may outweigh its benefits. This competitive antagonist of benzodiazepines can rapidly reverse benzodiazepine overdose. Today, with the epidemic of drug overdoses, nurses, pharmacists, and physicians need to be aware of flumazenil. ![]()
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