About two years ago, Danielle took some “down”—a street name for fentanyl—and woke up in an underground parking lot behind the wheel of her car.
Danielle, who does not want her real name used because she uses drugs, has used opioids on and off for decades, but she wasn’t accustomed to passing out while driving. It happened several times.
“I was driving asleep, literally. I would wake up in places, in underground parking lots, like, ‘How did I get here?’ And it’s super dangerous, yet you can’t figure it out,” she told VICE World News. “It was horrifying.”
It was only later that Danielle began to suspect the drugs she’d taken contained benzodiazepines. She is one of many Vancouver-area drug users who has unintentionally taken “benzo dope”—drugs laced with benzos, or tranquilizers. The trend, which typically sees fentanyl cut with synthetic benzos, has spread in British Columbia since 2019 and is showing up in Toronto and certain pockets of the U.S., experts told VICE World News.
One of the main problems, according to those working in harm reduction, is opioid users typically aren’t expecting benzos in their drugs. Benzo dope has been linked to reports of physical and sexual assault, robberies, and car crashes because people are asleep for so long. It’s also causing people to experience more severe withdrawal and overdoses. That’s partly because naloxone, used to revive people from opioid overdoses, cannot reverse a benzo overdose.
As VICE World News previously reported, a cluster of atypical overdoses reported at one of Vancouver’s overdose prevention sites in April 2019 first tipped people off to the dangers of benzos contaminating the opioid supply.
“The whole supply is just so absolutely fucked.”
According to the B.C. Centre on Substance Use, 21 percent of opioid samples processed at drug-checking services between April 1 and Nov. 1, 2021 tested positive for benzodiazepines. Of samples of drugs analyzed from fatal overdoses in the province between July 2020 and September 2021, 43 percent contained at least one benzo. (In July 2020, just 15 percent of samples contained a benzo.) Etizolam, a potent benzo analogue that has fueled drug deaths in Scotland, is most commonly detected.
“The whole supply is just so absolutely fucked at this point,” said Ryan McNeil, assistant professor of medicine and director of harm-reduction research at Yale University, describing the prevalence of benzos in B.C.’s drug supply as “terrifying.”
A report published in Morbidity and Mortality Weekly Report in August looked at 141 samples from people who died of fatal overdoses in Missouri, New York, Oregon, and Pennsylvania; it found that 21 percent of people tested positive for illicit benzos. McNeil said it’s possible that some of those people took benzo dope, though he said the lack of drug-checking services in the U.S. makes it difficult to say for sure.
While the most commonly known benzos are pharmaceuticals like Xanax, Valium, and Ativan—often used to treat anxiety and insomnia—the benzos flooding the illicit drug supply can be stronger and more unpredictable. In Toronto and Philadelphia, xylazine—an animal tranquilizer—is showing up in more drug samples and is being linked to more fatal overdoses. McNeil said it’s hard to know why benzos are infiltrating the market, but one possibility is that they can mimic or extend the effect of opioids like fentanyl.
“We were already operating in a situation that was a crisis in terms of the fentanyl in the drug supply and the overdoses that followed,” said Dr. Paxton Bach, co-medical director at the B.C. Centre on Substance Use. “I don’t think it’s dramatic to say that the arrival of benzos in the unregulated drug supply is as significant as the arrival of fentanyl was originally.”
When Karen Ward took a hit of crack cocaine in October 2020, she realized within seconds that the effect wasn’t what she wanted. “I could not find the wherewithal to lift my eyelids.”
Ward, a drug policy adviser with the City of Vancouver, said she was knocked out on her couch for 48 hours, with “no sense of time.”
Drug users who’ve experienced benzo dope told VICE World News it was a deeply unsettling experience. “I’ve used benzos in the past, and this was not anything of the same order,” Ward said. For weeks afterward, her head felt foggy.
The contamination also means people who wouldn’t otherwise use benzos are now developing a dependency on them and are even seeking out more benzo dope.
“She literally walks bent in half.”
Keisha, 32, a B.C.-based drug dealer who asked not to use her full name due to privacy concerns, said she knows one long-term benzo dope user who will fold up and sleep for hours after taking a hit, then wake up and repeat the process.
“Her comfortable position is being bent in half, so she literally walks bent in half,” Keisha said.
She said since benzo dope hit the drug market, “a lot of the people that I know can’t even put a fucking sentence together.”
Keisha said the drug has earned the nickname “robbery dope” because people are being given a hit and then robbed of their money and drugs once they pass out.
Experts and harm reduction workers who spoke to VICE World News said women are also reporting an increase in physical and sexual assaults after taking benzo dope.
McNeil previously did a qualitative study on gendered violence in the context of fentanyl overdoses. It found the rapid onset and severity of intoxication that comes from taking fentanyl made women more vulnerable to sexual assault.
One woman, who is homeless and Indigenous, said some men were offering women fentanyl for the purpose of knocking them out to sexually assault them. She said she took some opioids offered to her by a stranger and awoke to find she’d been sexually assaulted and robbed.
McNeil said similar reports are starting to surface around benzo dope.
“Any time there’s a transition in the drug supply like this, it amplifies all of the other ways in which people are vulnerable,” he said.
“Suddenly it’s so much less safe to use in a particular way that people are accustomed to… That can be such a period marked by extreme vulnerability to things like violence, sexual assault, theft.”
The combination of benzos and opioids also makes reversing an overdose more challenging and increases the likelihood of a person experiencing respiratory depression.
“It’s a terrible combination,” said Sarah Blyth, executive director of the Overdose Prevention Society in Vancouver.
Typically when someone is given naloxone after a fentanyl overdose, they come back within a few minutes. But naloxone only works on opioids, so the benzo portion of the overdose means a person might be out all day long. (There is a drug called Flumazenil that can reverse benzo overdoses, but it’s risky and can cause seizures, so it’s rarely used.)
“When people are out for long periods of time like that, it’s way more concerning,” Blyth said, adding it’s more stressful for harm reduction workers.
Benzo withdrawal can also range from mildly uncomfortable to life-threatening, according to Bach. Symptoms may include insomnia, nausea, or vomiting, or seizures on the more extreme end of the scale. According to the B.C. Centre for Disease Control, etizolam dependence can occur within four weeks of taking it.
While detoxing for opioids is a “fairly quick process,” Bach said benzos are one of the “most challenging” physical dependencies to break. “It can take weeks or months and months to get people off of benzos. It’s profoundly uncomfortable for patients,” he said.
He said he’s now seeing patients who didn’t want to use benzos in the first place having to deal with a benzo dependency on top of managing an opioid addiction.
“We feel very, very, very ill-equipped to deal with this.”
The rise of benzo dope is another reason why governments should give people access to a supply of safe, regulated drugs, such as prescription opioids, the experts said.
It also makes a case for widely accessible drug testing, as people who get their drugs checked may be able to find out if there are benzos in them before they take any. Benzo and fentanyl testing strips are available online through harm reduction organization Dancesafe, though they may not pick up on benzo analogues like etizolam and they can’t tell you which benzos are present.
“I can tell you as a physician who treats people who use drugs, you feel helpless in the face of this next phase in the evolution of the toxic, unregulated drug supply,” Bach said.
“We feel very, very, very ill-equipped to deal with this.”
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