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Throwaway08080909070 t1_jef0df3 wrote

Not all CNS depressants are born equal.

Something like morphine (or any μ-agonist), which strongly depresses the breathing reflex, has a much more narrow therapeutic index than for example, alcohol. Benzodiazepines don't depress respiratory function on their own, but when mixed with alcohol or opiates they have a synergistic effect that can be lethal.

Edit: More than one reply pointed out that this was less than layperson accessible, I hope the following helps somewhat.

μ-agonist: A type of receptor found in the brain and the GI tract among other places. Agonist just means something that binds to those receptors and makes them work. Opioids are a well known example of these substances.

Therapeutic Index: How much of a drug it takes to have the desired effect, compared to how much of the drug causes toxicity. Some medications have a very broad therapeutic index, many antibiotic types are the classic example of this.

Depressed Respiratory Function: In this case it's all about the signals your brain sends to keep you breathing. Opioids are famous for depressing that part of your brain, sometimes with lethal consequences. Benzodiazepines are not really known for this, although technically they do have some effect.


psychrolute OP t1_jef6b89 wrote

That is what I figured out years ago, thank you! So they are CNS depressants but do not depress respiratory functions?

Fun story: I once ingested 950mg of Etizolam (which equates to almost 9.5 grams of Diazepam, or 475mg of Alprazolam) and went to a party. Don't remember doing the whole bag of pure powder before leaving, but I still have a few memories of the very start of that evening...

I was later told I was so effin messed up that one point it took me like 15 minutes for me to tie one of my shoes.

No memories of coming back home either. Woke up on my bathroom floor, feeling surprisingly not too bad or anything.

Had much, muuch worse hangovers from just Ethanol haha

Same with snorting 140mg of Zolpidem (again I blacked out after the second pill; I never actually intended to do the whole box..): I woke up on the floor, realized I raided my entire fridge because of all the packagings and stuff surrounding me.. First thought was immediately being worried about food poisoning or something bacause not everything that was in there was still safe to eat...

I don't fuck with such ludicrous doses anymore since those 2 incidents years ago.

edit: spelling

Also, ⚠️TW: suicide⚠️

I once tried to end my life with Ethanol, GHB, Clonazepam, Alprazolam, Pregabalin, Ketamine, Methadone, Heroin, and think Carisoprodol (not sore about this one at all).

And blacked out as you could expect.

Just woke up a bit groggy really, my theory is I didnt have enough of each substance, also in combination with this I had a non-negligeable tolerance to ethanol + GHB/opioids/benzos+gabaergics.

After that I swowly started my day, slowly realizing I was pissed more about the waste of such products, not so much about the failed attempt haha..

Sorry if this not a appropriate comment, if it is mods please just ask to remove


Dr_Bombinator t1_jefm98q wrote

Saying something is a central nervous system depressant is kinda like saying cats are mammals - it’s true, but it won’t tell you what cats eat or what they’ll scratch. You really have to dive into what chemical receptors the drug attaches to to know what it’s going to do to you.


Prinzka t1_jefa5l9 wrote

>9.5 grams of Diazepam

That's like 1 full gram of lorazepam.
I had a 1/20th of that and I only remember a few seconds of that day (and felt the after effects for multiple days).
How do you even get that much? That's like a soda bottle full.


RLDSXD t1_jefx36r wrote

Anyone not familiar with them would be absolutely shocked how cheap and available RC benzos are. I love them and even I think it’s pretty scary.


Ericrobertson1978 t1_jeg7elp wrote

I had to stop taking benzodiazapines altogether after getting C-LAM. That shit is bad decision making incarnate.

I would always start with the very best intentions, but then it would kick in and I'd inevitably black out and wake up in jail or the hospital a few days later.

I wish I could take benzodiazapines to sleep, but instead of going down, I wanna go on some idiotic adventure. I become a mindless automaton and shell of my former self.

Now I don't use them at all, if only to avoid prison and death.

They are certainly terrifying. Lol


epanek t1_jegciew wrote

I saw my PCP for anxiety during presentations. I was set to give a full day presentation to about 100 people I didn’t know. I was doing it only because our vp of marketing liked my look and presentation ability. Needless to say my two year hiatus from the subject did not help.

My dr gave me klonopin. Only take if anxious. Lol. Well those things worked too well. 6 months later I was eating them like candy. Serious problems and memory impairment. I remember visiting a customer in a complicated office park with my boss. I literally could not remember each morning how to get there. It was bad. I knew I had a problem.

The detox is deadly like alcohol.


shockencock t1_jegefyy wrote

Funny they didn’t give you propranolol for stage fright. Not a benzo either


epanek t1_jegi9jc wrote

I take propranolol now. No physical anxiety and mental sharpness


metamongoose t1_jegv15t wrote

I read PCP as the dissociative drug not a doctor, really throws your comment for a loop!


123rune20 t1_jeg957x wrote

CLAM is like the craziest of them all I swear. Forced myself to never look into it again.


Simple_Bass_5564 t1_jegbgkz wrote



nocolon t1_jegck4f wrote

Per Google it’s Clonazolam, some kind of super benzo.


RLDSXD t1_jegticv wrote

Third most potent benzo I’m aware of. Flunitrazolam and flubromazolam seem to be a bit more potent, but clonazolam was much more popular because flunitrazolam only lasts like two hours and flubromazolam was way too hypnotic for normal use.


TheGreenKillShirt t1_jeh23og wrote

Took Clonazolam. Ran out. Was terrified and told my wife. Went to the ER at 5am just in case I had a seizure. Had a seizure in the waiting room 20 minutes after arriving. Thank god I told her, or who knows if I would have stopped seizing.


boshbosh92 t1_jegf7so wrote

I thought they all got banned? I know etizolam did at least in my state, and the vendor I would buy from is in federal prison right now for misleading customs. I am definitely on a watch list of some sort


RLDSXD t1_jegrcij wrote

Etizolam got banned in a few places because it’s more well-known. The tough part about figuring out what’s banned and what isn’t is that we’re often dealing with multiple country’s lists of substances; even if a substance is legal here, it may have been banned in the country it’s coming from and vice versa.

A lot of the more popular ones got banned either in the NL or the US recently, I believe, but there’s always another obscure one popping up. Seems like a lot more etizolam analogues than straight up benzo analogues lately.


boshbosh92 t1_jegx3i8 wrote

Ahem could you possibly point me in the direction of an analogue or two, for research purposes of course?


coniferous-1 t1_jegj6yp wrote

What is an "RC benzo"?


DamnThatsLaser t1_jegks6k wrote

"RC" in this context means Research Chemical, these are substances that are usually novel and as such not yet well researched and regulated. They are called research chemicals because you're free to do your own "research on them" since there's no law stopping you from doing it. They often can be ordered from specialized vendors or from another country where manufacturing is done, like India or China.

These can either be actual novel substances in a given class or designer prodrugs that were invented to circumvent existing laws, for the latter 1p-LSD is an example, it's technically not LSD so it was legal but it turns into LSD in your body so it's not only mimicking the effect in another way like NBOMe, but it becomes the real thing. Anyhow, the downside with the other RC drugs is that there's usually little to no reliable scientific information about toxicity and other long term effects.

Benzos which this thread is about is a class of depressant drugs. But I guess you knew that already. I don't think they're very popular over here in Germany though.


parks_canada t1_jegl34r wrote

RC stands for research chemical, and sometimes they're called designer drugs. Really it refers to any chemical that isn't well studied and understood, but typically when people talk about RCs they're referring to drugs that aren't federally scheduled, and which fall into a legal grey area in many cases (allowing them to be sold on the open market). A lot of these are analogues of scheduled drugs, for example:

  • Clonazolam ("CLAM"), an analogue of clonazepam (Klonopin)
  • 1P-LSD, an analogue of LSD
  • MDMC, an analogue of MDMA

coniferous-1 t1_jeglinv wrote

Informative, thank you.


PK1312 t1_jegnhlb wrote

one little addition because i think the chemistry is cool- 1P-LSD is also a prodrug of LSD, meaning it turns into actual LSD inside your body, which is neat. It's like psilocybin in mushrooms- psilocybin by itself is not psychoactive, but in the acidic conditions of the stomach it turns into psilocin- the thing that actually makes you trip.


Srnkanator t1_jegt819 wrote

That's 950 milligrams, almost ten times a standard dose of Valium.

As someone trying to abstain, I just use 30 mg a day spread every 6-8 hours out when I withdraw.


shockencock t1_jege75h wrote

How much lorazepam did you have?


Prinzka t1_jegef12 wrote

About 50mg


shockencock t1_jegehos wrote

Impossible. You would be dead


Prinzka t1_jegfo73 wrote


Lorazepam has an ld50 of nearly 2g/kg.
That's the whole reason OP made this post, they were wondering why you can take high doses of benzos without dying even though it's a cns depressant.


shockencock t1_jegfze2 wrote

I guess you are right. Most people that try to kill themselves with it drink alcohol too. I stand corrected. I couldn’t imagine taking 50 mg of it.


Prinzka t1_jeggj2d wrote

> Most people that try to kill themselves with it drink alcohol too.

Yeah and then you need a lot less, that's the danger.

>I couldn’t imagine taking 50 mg of it.

Tbf, I can only imagine it.
About an hour after I took the first 4mg I don't recall anything for the next day or so.
I took the rest of the bottle I had I'm assuming because I forgot that I'd already taken some.
There was never an intent to take the whole bottle, just the first ones made me not form any new memories....


wighty t1_jegvuav wrote

IIRC the pharmacist that did our benzo lecture called it a "ceiling effect", benzos will only cause so much respiratory depression but not enough to stop you breathing. Add alcohol to the mix, though, and you absolutely can overdose yourself and stop breathing.


effrightscorp t1_jegevz4 wrote

50 mg lorazepam won't even kill a rat


shockencock t1_jegf1ja wrote

You have it confused with another benzo. 50 mg of lorazepam will kill you in about an hour


effrightscorp t1_jegfzyj wrote

LD50 is 1850 mg/kg in mice, so it takes around 40 mg to kill an average one. Here's a case study where one guy took 100 mg, one woman took 120 mg and both were out of the hospital within a few days and didn't really need any treatment

You can take stupid big overdoses of benzos and survive because they all have pretty good therapeutic indices. The bigger issue is that, if you don't pass out, you'll probably run out blacked out and can do enough stupid shit to end up in jail etc


shockencock t1_jegfcqz wrote

My brother is a psychiatric nurse in a hospital. He would inject 2 mg of lorazepam into patients then put them into seclusion to sleep it off. The starting dose for lorazepam is like .5 mg


effrightscorp t1_jeggc1l wrote

That says nothing about the lethal dose, which is much higher than 50 mg in humans


Itsoktobe t1_jefibm1 wrote

Damn, dude. You've gotten lucky. I hope you're doing better now. Life is a lot more fun without parties full of drugs and shitty people, imo. Gods I do not miss my teens..


paulstelian97 t1_jefvreg wrote

On why you didn't get a hangover from the CNS depressant. Ethanol gives hangovers not when it's still ethanol, but after it turns into acetaldehyde; not all substances have such metabolic paths where the intermediate product can have such effects.


amandack t1_jefmszr wrote

I have multiple failed attempt including one with Clonazepam and alcohol to try to take advantage of the cns factor. Bodies just like to stay alive. And it's an ld50 for a reason, so theres still a 50% chance you live.


dlige t1_jegit68 wrote

Eugh I hate reddit for doing what I'm about to do, but I always find this distinction interesting.

Strictly it's 50% of the population would die.

The reason why that is different than '50% chance of dying' is because 50%chance of death implies that everytime you take that dose you're flipping a coin. The reality is that if you tried it once and it didn't kill you, it would never kill you (ignoring the fact that this is certainly not true due to everything from the liver damage you would sustain to the fact you'd be aging as time went on). But if you were able to repeat the same experiment on yourself again and again after the first outcome where it didn't kill you, it is not 50% chance of death each time.


Ishana92 t1_jegrlge wrote

So it's more like the dose that 50% of people can survive or dose that kills 50% of people


Icy_Law9181 t1_jefpig5 wrote

I used to trip off benzos in a way that scared anyone around me at the time.I would be absolutely convinced as if I was in psychosis that things were real.Then when I came down 5 or 6 days later I would hear the stories from everyone,people I knew and stares from people I didnt know,not remembering any of it.I also used to take em when I drank and was guaranteed no hangovers whatsoever as I'd be so out of it for 3 or 4 days,by the time I came round the any hangover would be gone.How I survived that time I dont know,now I'm glad I did and the rattle of benzo's is second in ferocity to only one other drug in my experience and that's heroin and it's a very close second.


Tool_looT t1_jegf131 wrote

Yeah I’ve just recently been clean off Bezos, combined with alcohol or Opiates before that. I was taking around 100mg of Xanax or something close too that everyday. I quit around 5 months now almost dies for second time, the seizures from withdrawal are no joke and I struggled with it for years. Dropped right in front of my folks this time saved my life after the hospital sent me home and told me I wouldn’t have them off just benzos, yeah right. Spent a month in the hospital detoxing and another six weeks in rehab took about 6 weeks of detox too even be myself. Be careful guys!


filijonkish t1_jeg8ps4 wrote

>snorting 140mg of Zolpidem

My guy, you must have been in a deep shitty abyss if you did those big boi doses. How was the comedown?


Ippus_21 t1_jefldmx wrote

F'n hell, man. This makes me really glad I never got into that scene in my young-and-dumb years. Worst I ever did was get a little too drunk here and there.

Sounds like you had to roll successive Nat 20s to survive all that...


Potatoe292 t1_jeg1lsq wrote

Holy shit dude. I take .25 mg of alprazolam on planes and that does the trick. I can’t imagine taking that much at once.


Ordinary_Story_1487 t1_jegjcmr wrote

I was on 4-5mg of Xanax for 12 years(panic disorder). The withdrawal was my single worst life experience. I was fully in a panic attack for 3 months. At 3 years in, I am still not 100%.


boshbosh92 t1_jeges1b wrote

Dude as someone who used to abuse the hell out of etizolam I don't know how you even physically took 950mg.

They came in liek 1-2 MG tablets. I literally remember nothing from the entire year of 2016 from taking 5-8mg of etizolam. I cannot fathom almost a gram. Hope you stopped that stuff and are doing well. It was hard getting off but it's worth it.


KingAngeli t1_jegni9q wrote

Benzos work to make GABA receptors more functional. These are the locks. Glutamate is the key that activates it. Taking benzos make the lock more unlockable. Drinking alcohol affects glutamate activitity. As a CNS depressant it inhibits these GABA receptors therefore your body compensated by creating more GABA receptors. This is why someone who’s drank too much for too long has severe withdrawals. The increase in GABA receptors is fine when they’re all inhibited, but when you stop drinking then the glutamate levels shoot up and it causes people to have seizures when they stop drinking. So they literally need to keep drinking to stay alive.

That’s also a distinction i like to make in the dependence/addiction vernacular but thats a side point you’re not asking about :)


reverendsteveii t1_jegvf90 wrote

> 475mg of Alprazolam

Holy shit dude I once ate 8mg of alprazolam and was asleep for two straight days. That's kind of amazing. Doubly so that you didn't have any withdrawal symptoms. Benzos are weird, you can't die of an overdose but withdrawal can kill you instead.


nined_out t1_jefolej wrote

Glad your still alive and kickin bud ✌🏼 hope your feeling better these days❤️

Coming from a former raging benzo addict myself I can relate to fuckin everything you are saying.

ETIZ! Maybe the most curious benzodiazepine I ever abused. The memory loss combined with the general lack of side effects (including drowsiness! Wtf!) made it v dangerous for me….

But quite fun.


Steamvolt t1_jegktxp wrote

I doubt snorting would make it stronger. Benzos have a high bioavailability when swallowed. They dont dissolve in water so unlikely to be absorbed through blood mucus membranes. However it would have ended up in your stomach eventually. I lost 2 days my phone, geekvape 200 and crashed my 30 mph ebike. Without even knowing. Woke up 3 days later with black eye cut head etc. Dont even know how I got up 4 flights of stairs. I dont remember a thing about it. I hadn't been out is what I thought Eventually enough people who saw me said how fucked up and confused I Was. Expensive day and lucky I didn't kill myself accidentally again. My TV was also broken and my flat looked like it had been ransacked This isn't the first time but the last from know on its only Legit Diazepam like Kern prodes


Cma1234 t1_jegn16o wrote

Dude, you're going to lose this battle. Stop.


dman2316 t1_jeg1gcs wrote

Can attest to that one unfortunately. I'm on very high doses of hydromorphone (which for those who don't know is much stronger than regular morphine, 1mg of hydromorphone is equivalent to 10mg of regular morphine, and a small dose for me is 8mg of hydromorphone but have had to take up to 18mg before at doctors instruction) due to a combination of the seriousness of the pain and also the fact that my body for some reason is insanely good at processing medications, not just opioids but all types of meds, i always need far higher than the normal dose no matter what the medication is. So i was in the hospital when the dumbass doctor decided to give me benzos at a dose that was 4 times higher than they normally give to help me sleep cause i hadn't slept in almost 4 days, and i was far too tired to catch the problem until it was already too late. Scariest shit i've ever experienced.


timmmmehh t1_jegg9jx wrote

What ended up happening after being given that much? I would imagine you would be knocked out after that lol.


dman2316 t1_jegh07w wrote

You know that feeling when you randomly forget how to swallow and no matter how hard you try you just can't make it happen until suddenly the issue just goes away? It was like that, except with my lungs and being unable to breathe, like i knew how to perform the motion but no matter how hard i tried i couldn't take in a breath, if a nurse hadn't been right there at that moment there is a good chance i would have died due to passing out before being able to alert someone. They ended up putting me on a ventilator for 4 days and then took me off it. Had slight breathing problems ever since.


luciensadi t1_jegr6ao wrote

> You know that feeling when you randomly forget how to swallow

Is this a normal thing? I don't think I've ever experienced it :o


INtoCT2015 t1_jegs5br wrote

Take a deep breath, hold it in, and try to swallow five times in a row before exhaling. If you can, just up the number to like 6 or 7. You can experience it right now if you want


reverendsteveii t1_jegv66m wrote

Once. I was able to swallow exactly once. I tried a second time and my body simply rebuked me. What a weird little thing.


Attempt101 t1_jeh4jty wrote

I almost hit 7…tapped out when I could barely do 6…


WarthogWarlord t1_jegu4op wrote

What?! I managed to swallow only four times, and after that it became completely impossible! Why? How?


Geodude532 t1_jegxhs5 wrote

Another fun one is to stick your face into the blast of the shower and breath through your mouth. Your body will fight you on that one too.


seeking_hope t1_jeh1d80 wrote

That reminds me of learning to scuba dive. That first breath on a respirator was like everything in me screaming not to do it. Our body has some pretty strong instinctive responses.


live4thagame t1_jeh2my2 wrote

Oh my gosh, not the same but similar, went snorkeling for the first time last year and It was SO hard to make myself breathe while my head was underwater


scnottaken t1_jegwjit wrote

Unfortunately I'm very well practiced in this mechanism. It's how I get rid of hiccups lol


rich1051414 t1_jegtik3 wrote

I do sometimes when I have to swallow a pill. My brain forgets how to swallow long enough for the pill to melt in my mouth and ruin the next hour of my life.


dman2316 t1_jegrfca wrote

Alright, maybe an example that you should know what it feels like, you know when your foot/hand/arm is dead asleep and you try to move it but no matter how much effort you put into it you just can't get it to move until it's not asleep anymore? Like that.


BalineseCatLady t1_jegxgpf wrote

My autonomic nervous system doesn't function properly, and so I get feeling of "forgetting" to breathe. Like my body isn't automatically doing that for me anymore. Even mild depressants like alcohol or benadryl can trigger it. Is that the feeling you had but amplified?


TBSchemer t1_jeh46kf wrote

I feel that way several times a week. I don't know why. It's really scary, and all I can do is just remind myself that the feeling will pass in an hour or so.


Wolvenmoon t1_jegtqc1 wrote

Have you tried a genomind genetic test for medication efficacy? My mom has lots of similar issues and while it seemed like BS at first, the results have actually been really helpful for her to navigate different pain medications and have accurately predicted which ones she'll rapidly metabolize and which ones will stick around for longer.


dman2316 t1_jegtz1p wrote

I'm definitely going to look into that, thanks man. It is a pain in the ass like no other trying to convince these doctors that no, i'm not a drug addict, i just tolerate opioids and plenty of other meds well.


myfapaccount_istaken t1_jeh26ov wrote

The genomind help with some of the drug interactions I have having. I have also having a hard time staying awake even w/o drugs but sleeping ok, but not narcolepsy (sp) Turns out I needed a specific type of b vitamin and but my body didn't process it so I had to get a special compound and while it's a bit $ I feel loads better.

I've only seen shrinks order it but I'm sure some GPs do as well. THey do a sliding scale since it's usually not covered by insurance. I was making like 45k and it only ran me like $60


Attempt101 t1_jeh51fn wrote

Woah. Didn’t even know there was a test that did that… I’m sure my insurance won’t cover it and I can’t even see my PCP, but now I’m curious if you can just get that test on your own and how much it would cost… because I’m relatively tiny, docs assume that I needed the smallest dose of anything, but it varies across the board… and I’m more curious if its a vitamin deficiency or something else because I’ve had all sorts of speculation…


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globaloffender t1_jegumhp wrote

Can you tell us more about the condition? That sounds terrifying. No problem if too personal. Good luck friend


dman2316 t1_jegvgrv wrote

Which condition, the interaction of the 2 meds or the reason i'm on the doses of opioids that i am? Either way i don't mind explaining, just wanted to make sure i knew which one you're asking about.


globaloffender t1_jegw5f2 wrote

You’re right, I wasn’t being clear. I’d like to know why so much pain.


dman2316 t1_jeh5lkp wrote

So there's 2 reasons. The first is when i was 17 i got hit by a car while on my bike and i broke several ribs in several places, broke my jaw, broke a femur and cracked my skull and had a ton of soft tissue damage, and as time went on the pain was just not getting any better and i was diagnosed with a condition where essentially the physical injuries themselves fully healed, however for some reason my nervous system/brain never got that message and so is still sending out the pain signals as if the injuries were fresh from yesterday, so basically i'm still in just as much pain 10 years later as the day after i was hit. The second reason is i have a rare type of kidney stone that behaves very differently from normal kidney stones so i end up passing a ton of them, like it's not unreasonable to expect me to pass close to 20 in a week.


Timmymac1000 t1_jeh3sxb wrote

Do you by any chance have red hair? Redheads notoriously require more pain relievers/anesthesia than non red heads.


thecaramelbandit t1_jeglxr2 wrote

> Benzodiazepines don't depress respiratory function on their own

They absolutely do, but nothing like the way opiates do.


PussyStapler t1_jegxlxo wrote

>Benzodiazepines don't depress respiratory function on their own,

I don't know where you're getting that. Benzos can cause respiratory depression on their own.


Thewhopper256 t1_jegz1ct wrote

I don’t think I would understand half of this comment if I wasn’t in medical school, much less if I was 5 years old lmao


Dorintin t1_jegzxta wrote

This doesn't feel like it's meant for a five year old. Please speak to me like I'm 5


SkyARKy t1_jef4h4o wrote

Benzos have a limit to their function. They depend on a neurotransmitter called GABA which is a CNS depressant. Once GABA is depleted then any additional Benzos will have no effect, therefore no overdose. Unfortunately, if you compound this effect with other depressants (who operate on a different mechanism) you can get respiratory depression which can be fatal.


Youwillgotosleep_ t1_jeflcph wrote

As someone with a working knowledge of pharmacology and anesthesia, this right here.

Edited for terminology and corrections: The GABA receptor has a maximum effect that can be elicited from benzos. Once the receptors on it are bound by benzos there can be no further action, a ceiling effect. When other substances are added such as alcohol and narcotics they cause respiratory depression by means of other receptors, in the case of narcotics the opioid receptors, mu, kappa and delta. In the case of alcohol it ties up a different receptor on the same GABA neurotransmitter so it potentiates the effects caused by GABA activation. Other substances can also have the same effect as alcohol. This is essentially what happened to Anna Nicole Smith.


anvuu t1_jegmtti wrote

Is that why in status seizures - once we hit the midazolam ceiling there's no point giving more and use another drug?


Youwillgotosleep_ t1_jegogd7 wrote

I’m not familiar with this particular treatment but drugs are only so effective. Once you hit a particular concentration you are no longer getting meds to the appropriate receptors since they are saturated. Additional medication will just cause side effects since increased concentrations of drugs will just start causing side effects by interacting on other receptors. Using a different medication allows you to get the same action but without the increased drug concentrations.


j_ohnsonson t1_jegr22o wrote

I believe that Is tied to the fact that when a status epilepticus goes on for some time, the GABA receptors start being pulled away (in a process called endocytosis) from the synapses. So You Need to rely on drugs that use other mechanisms to get the neurons to stop firing. Happy to be corrected if someone has more up to date or precise info


WarriorNat t1_jeh4nol wrote

This must be why in the hospital we can give such high doses of benzos to people in alcohol withdrawal with so little risk. I know they mimic the effect of alcohol for people who drink around the clock, but it still feels crazy giving 4mg lorazepam every hour (often with little effect) when most of us would get 8 hours sleep on 0.5mg


Llohr t1_jegrghn wrote

I'd like to add to this: While benzos on their own are rarely fatal if overdosed, withdrawal from them is one of the most dangerous forms of withdrawal, and can itself be fatal.

I've known some people who would read that they're so rarely fatal high doses and think, "wow I can take all the benzos I want! Benzos are safe!"


werq34ac t1_jegsm89 wrote

Also adding to this, Flumazenil is basically the Narcan of benzos, and can reverse benzo overdose. We basically never use it because it can easily send someone into status epilepticus whilst simultaneously rendering the first-line treatment of status epilepticus (benzos) completely ineffective.


Terribletwoes t1_jegvqlu wrote

To add, correct, or be pedantic:

Benzos increase the frequency or likelihood of an inhibitory chloride channel opening. Barbiturates open it.

This is why barbiturate overdoses are far more likely than benzos to result in death - unless another sedative agent is added like alcohol or narcotics. And why we can induce general anesthesia with barbiturates but rarely benzos alone.

-Peds gas passer


TetrisTm t1_jef415p wrote

unlike barbiturates they do not (directly) impede breathing function, thats why they replaced barbs.


Hammerpamf t1_jef5q5t wrote

Barbiturates are still very much used. I regularly give phenobarbital to people in alcohol withdrawal.


congoLIPSSSSS t1_jegauyf wrote

My hospital's alcohol withdrawal protocol is Librium and Valium, never once have I given phenobarbital to a detox patient.


terraphantm t1_jegjge2 wrote

Phenobarb is getting more popular for withdrawal protocols. Works much better in my experience. + Ketamine in those really bad cases.


Averagebass t1_jeges4x wrote

I only did it in one hospital, but it seemed to be as effective as Ativan. I had been in 4 different hospitals and only one of them did it.


TetrisTm t1_jef7soz wrote

they have been largely eradicated. being replaced by benzos and z-drugs, phenobarbital is not a recreational substance in my opinion, if you were handing secobarbital out like candy it would be something else entirely. rethink the “very much”.


Hammerpamf t1_jefrwmh wrote

It's given multiple times a day, every single day in the ED where I work.


[deleted] t1_jegirg7 wrote

The person you're talking to is obviously referring to large societal trends, not saying they literally ceased to exist.

Barbiturates are used at a much lower rate today compared to the past, partially because they've been replaced by benzos in many cases. You're being needlessly pedantic


werq34ac t1_jegsvjd wrote

Why is he suddenly talking about recreational drug use in a discussion about the usage of barbiturates for medical treatment?


NewPointOfView t1_jegbjix wrote

What are you talking about recreational substances, the other guy is clearly talking about treating alcohol withdrawal


Alternative-Cell8295 t1_jegiz3q wrote

Absolutely. I guess it depends on where you’re working but barbs are absolutely not “very much” used in my work


Alternative-Cell8295 t1_jegins3 wrote

In my country our guidelines are for chlordiazepoxide for alcohol withdrawal and we very rarely ever prescribe barbs, namely only for status or other epileptic seizures


ogbubbleberry t1_jef71ye wrote

The brain has a redundancy system, so to speak. Benzos work on one of the systems, but the other still works enough to keep you going even though you are sedated. Alcohol affects the other redundant system, which is why they are dangerous when taken together, both types of receptors are being affected.


d0rf47 t1_jefon6n wrote

this is wrong. The reason is they actually both act on the GABA system just in a different manner.


CrookedGrin78 t1_jefh5ir wrote

That's really interesting, thanks! This might answer a long-time question I've had, which is why some drugs are worse in combination than a higher dose of them would be on their own. I had always wondered how combining GHB and alcohol could be any worse than doing double the normal dose of either one on its own, but it sounds like maybe this is why?


d0rf47 t1_jefphrh wrote

The reason is these types of drugs (GHB and ethanol) both interact with your brains GABA system which is the bodys inhibitory neurotransmitter. Your body uses it to essentially calm itself. This also has effects on heart rate and respiration. this is why they are dangerous. Since the both activate this system they essentially relax your body to the point where your heart can stop pumping(cardiac arrest) or your lungs stop functioning on their own (respiratory arrest)


Other "depressant" drugs also have dangerous interactions since the systems they work on can also have similar effects on the same systems even though they work using different neurotransmitters, eg being heroin and alcohol. They activate different systems in the body, however these systems have similar effects such as decreased heart rate & lowered respiration. which is why they can also be a dangerous combination.


This is also the reason these drugs are so physically addictive and cause dangerous withdrawl symptom. Since they work with such critical natural bodily responses, when you get dependent on them your body stops operating these systems normally and when the chemical substitute (let say alcohol in the example) is no longer present/available the system goes haywire since the body is no longer capable of regulating the system which is why ppl can suffer strokes or heart attacks if they attempt to detox without medical supervisions.


CrookedGrin78 t1_jeftrgg wrote

Ah, but that sounds different from what other posters were saying, i.e., that combining certain CNS depressants is _worse_ than overdosing on either of them on their own, because they act on _different_ systems. So with GHB and alcohol, is that actually the case? Does one of them depress respiration and the other one does not? Or when people overdose on a combination of GHB and alcohol, is it just that they took a full dose of both and the combination was the same as it would have been if they had taken that big of an overdose of either one?

To put it another way, with certain combinations, it seems like the sum is greater than the whole of the parts (2+2=5), because Drug B is causing Drug A to create an effect that Drug A wouldn't create on its own, even if you overdosed on it.


d0rf47 t1_jefzmsx wrote

its likely that the effects of one are potentiating the effects of the other. The bigger issue is a persons response to the drug and how their body metabolizes it. I am not a physician just some with a keen interest in pharmacology. CNS is your central nervous system, this system control much more than just breathing, certain drugs may affect the heart more while others affect the breathing more. the issue becomes troubling when the cns is suppressed enough that one of sub systems (breathing or heart) becomes so low that it either stop functioning and arrest begins or in some cases it may be that they are both still "functioning" but not properly and hypoxia can set in. My understanding with GHB and alcohol is that its the heart rate dropping which causes the dangerous effect.


Nagi21 t1_jegs3ew wrote

You’re using the wrong math idea. It’s not 3+3=7, it’s 3*3=9


CrookedGrin78 t1_jefu36k wrote

The kind of thing I'm describing is somewhat similar to combining an MAOI with a drug that's metabolized through a pathway that the MAOI suppresses: if you took either drug on its own, it wouldn't be a problem, but when you combine them, it's dangerous. I previously thought that a CNS depressant was a CNS depressant, but it sounds like that's not entirely true, since some CNS depressants inhibit respiration and some do not.


shakn1212 t1_jefj089 wrote

If I remember correctly from my schooling and can translate this to ELI5.

Imagine drugs and neurotransmitters ( chemical signals) like keys and receptors as locks. When a drug fits the correct lock it opens the door and you see the drugs effect.

Benzos still function like this technically, but when it opens it's lock (a secondary lock), it works like adding WD-40 to the primary lock. Now the primary will open easier but it still needs it's key around.

In this case, the primary lock is where you get the serious problems like death.


carrot_bunny_dildo t1_jegf6eu wrote

So yeah that’s right. Benzodiazepines (BZD) are ‘allosteric modulators’ they don’t actually bind the GABA receptor site on the BZD receptor. Instead, BZD’s increase the affinity of the neurotransmitter GABA to bind at the BZD receptor. In other words, if there was no GABA neurotransmitters BZD’s would have no effect.
Additionally, administration on BZD causes rapid withdrawal of BZD receptors from the cell surface, which is another reason that likely increases their safety.


Rakkai t1_jefvixq wrote

Benzos don't surpress the CNS on their own.

They amplify the effects of your natural CNS surpressants (or other articifical ones, which is why they are very dangerous in combination with e.g. ethanol).


crna2023 t1_jegcvo1 wrote

They have a ceiling effect that is theorized to occur because of how they work on the GABA receptor (the receptor that is responsible for its mechanism of action). They are thought to work similarly to many other anesthetics such as propofol however their effect has a dose ceiling. I disagree that it is hard to die from OD, if you have the right comorbidities or are using them along with other drugs such as alcohol it is very easy to OD.


cdickerson09 t1_jegg1gg wrote

Most of them have a really high safety window, so the therapeutic range is large, and hard to go into the toxic range. And unless combined with other substances they don't usually depress your respiratory system.


[deleted] t1_jefumn1 wrote

Well its a simple answer, Benzos aren't CNS depressants they do however make actual CNS depressants much more powerful which is why so many ODs happen when mixing them with opiates and the like.


OPsButthole6969 t1_jeg8hcv wrote

This is so wrong that a simple Google will tell you otherwise. They are CNS depressants.

They literally calm you down or sedate you.


[deleted] t1_jegh1ej wrote

Hmm I suppose you're right I guess I just got the wrong idea because unlike every other CNS depressant Benzos can not kill you by themselves only when mixed with other depressants. Benzos do NOT slow your breathing and heart rate as a direct affect of the drug itself. Just as OP said he took 960mg of etizolam, a drug that can get you extremely high off as little as 2mg. Any depressant besides a benzo that you take 480x the regular dose of you will die no ifs ands or buts about it but there is not a single recorded case of someone dying off Benzodiazepines alone and not mixed with another depressant. They can potentiate other depressants and make their effects exponentially stronger but that's it.

I was assuming CNS depressants specifically lowered heart rate and breathing and therefor benzos werent but I got it wrong my bad. Either way they dont really behave like any other CNS depressant and as OP explained they are not nearly as dangerous as most depressants because they are essentially impossible to OD on. I have seen many cases similar to OPs where as long they dont mix it with anything else like alcohol or opiates you can take just insane doses and still be fine when it wears off.


OPsButthole6969 t1_jegj2vj wrote

Yeah no worries man it happens. Perhaps my comment was a bit too harsh now that I'm reading it again. Benzos are certainly interesting drugs


Uruz2012gotdeleted t1_jegkp9j wrote

Benzos are effective at slowing the frequency and intensity of flases of activity in the brain. Klonopin is used as an anti sezure medication because of this effect. Seizures amount to a confused firing of many areas cascading from one anomalous, intense firing of one area. Flashing lights are a common trigger, for example.

None of that will stop you from breathing, just level out your heartrate and respiratory speed.


[deleted] t1_jegjzd9 wrote



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NF_Optimus t1_jegdb2a wrote

Bzds can cause apnea and cardiovascular collapse. It just happens more often to critically ill patients which have a lower drug distribution volume and other contributing factors. However, in young healthy people without any prior disease history really shows how high doses the body can process and then metabolize before shutting off vital functions.

But trust me, there are indeed patients who have been butchered with midazzle!

I work in the medical field, for reference.


QualityVodka t1_jegk6n6 wrote

Why? Did you fail at a suicide attempt? If so, then I'm sorry life hasn't worked out for you, but there's still time to embrace beauty in the world, my friend.


evedgebah t1_jeh2zbq wrote

Benzodiazepines have a nonlinear respiratory suppression curve. It plateaus. This means that for many people (not all) it's exceptionally difficult to cause terminal respiratory suppression with benzos alone. Everyone's threshold is different though, and that death line can be moved by other factors, such as combining with opioids, alcohol, or other respiratory suppressants.


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Beederda t1_jefrhcy wrote

I just lost my best friend who was extremely depressed addicted to clonazepam and i think he did something like this in a way to suicide…the combined opiates and the benzo to stop his breathing. His mom heard a loud noise upstairs and never went to check on him till morning and found him dead… like buddy said above he was more mad about the loss of product than the attempt…. Thats a huge problem! I find that alarming and hope your doing better buddy! please seek psychedelics! i beg of all that are suffering from addiction and depression 🙏💔