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High-potency benzodiazepine misuse in opioid-dependent patients: use naloxone with care
  1. Rajendra Raman
  1. Emergency Department, Victoria Hospital, NHS Fife, Kirkcaldy, UK
  1. Correspondence to Dr Rajendra Raman, Victoria Hospital, Emergency Department, NHS Fife, Kirkcaldy, KY2 5AH, UK; rajendra.raman{at}


The misuse of highly potent benzodiazepines is increasing in the UK, particularly among the opioid-using population in Scotland. Differentiating opioid from benzodiazepine toxicity is not always straightforward in patients with reduced level of consciousness following drug overdose. Patients on long-term opioid substitution who present with acute benzodiazepine intoxication and are given naloxone may develop severe opioid withdrawal while still obtunded from benzodiazepines. This situation can be difficult to manage, and these patients may be at increased risk of vomiting while still unable to protect their airway. Fortunately, the short half-life of naloxone means that the situation is generally short-lived. Naloxone should never be withheld from patients with life-threatening respiratory depression where opioids may be contributing, particularly in community and prehospital settings; however, where appropriate clinical experience exists, naloxone should ideally be administered in small incremental intravenous doses with close monitoring of respiratory function. Increased awareness of the potential risks of naloxone in opioid-dependent patients acutely intoxicated with benzodiazepines may reduce the risk of iatrogenic harm in an already very vulnerable population.

  • poisoning
  • toxicology
  • clinical management
  • drug overdoses

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  • Handling editor Gene Yong-Kwang Ong

  • Contributors RR is the sole contributor to this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.