Ontario's Chief Medical Officer of Health and Chief Coroner issued a notice to public health units this week to raise awareness about an increased detection of xylazine and benzodiazepines in Ontario’s unregulated drug supply.

The increase in xylazine and frequent benzodiazepine presence in Ontario’s unregulated drug supply is concerning as it may contribute to an increased risk of overdose. These substances are also often present together with opioids. The risk of overdose increases further when benzodiazepines, xylazine, and other depressants such as opioids or alcohol are taken at the same time. Symptoms of xylazine and benzodiazepine toxicity can be similar to those associated with opioids, but neither will respond to naloxone. However, administering naloxone is still advised as the substance may also contain opioids.

Benzodiazepines or “benzos” can be obtained through a prescription or through the unregulated drug market. Some prescription benzodiazepines are Alprazolam (Xanax), Lorazepam (Ativan), Clonazepam (Rivotril), and Diazepam (Valium).

Benzodiazepines (and benzo-related drugs) like etizolam and flubromazolam are being found in the unregulated drug supply. They can be cut (mixed) into opioids and other drugs that are sold in the unregulated supply.

Benzodiazepines can slow down brain activity, and they can change the way people think, move, speak, and breathe.

Symptoms of benzodiazepine toxicity and overdose can include:

  • Extreme sleepiness or passing out
  • Dizziness, poor balance, and poor movement control
  • Slurred speech
  • Memory loss
  • Loss of consciousness or “blackouts”

These symptoms can last for hours.

Xylazine is not approved for human use. It is a drug typically used by veterinarians for sedation, muscle relaxation, and pain relief for animals. It is sometimes referred to as a “horse tranquilizer”.

Significant harmful effects from xylazine can include:

  • Severe skin lesions, such as ulcers or abscesses by people who inject drugs
  • Blurry vision, confusion, dizziness, drowsiness, difficulty moving, slurred speech and fatigue
  • Very slow, or irregular breathing (or not be breathing at all)
  • Low blood pressure, slower heart rate
  • Death

How to respond to xylazine and/or benzodiazepine toxicity

  • In all cases of suspected overdose, call 9-1-1 right away for emergency help.
  • Give naloxone if you have it(link is external). While naloxone will not have an effect on benzodiazepines or xylazine, it can temporarily reverse the effects of an opioid overdose and can be safely given to people who have taken non-opioid drugs (like benzodiazepines or xylazine).
  • Perform chest compressions and/or rescue breathing, or CPR as needed.
  • Stay with the person until emergency help arrives. The Good Samaritan Drug Overdose Act(link is external) provides some legal protection for people seeking emergency support during an overdose.

Fact sheet about Benzodiazepines

source: Ottawa Public Health


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