‘Benzo-dope’ wave complicating fight against opioid epidemic

A wave of sedatives is adulterating Toronto’s illegal opioid market, raising risks for users and imposing extra burdens on a COVID-stretched emergency response system.

“Benzo-dope” now represents more than half of all fentanyl samples brought to Toronto’s Drug Checking Services, which offers free tests of samples brought into the city’s five safe-injection sites. Two years ago, 38 per cent of fentanyl samples tested contained benzodiazepines. That number jumped to 81 per cent in the last three months of 2020 and was at 65 per cent in the fourth quarter of 2021. Conversely, in “expected fentanyl” substances, pure fentanyl was only found 5 per cent of the time. This pervasive contamination and its effects are exacerbating Canada’s toxic drug crisis.

Benzo-dope has been showing up as far west as Vancouver, as well as in pockets of the United States. A coroner’s report from British Columbia saw a rise in the presence of benzodiazepines in drug toxicity deaths to 53 per cent in October 2021 from 15 per cent in July 2019.

Benzodiazepines, a class of drugs commonly prescribed as sedatives, slow brain activity by acting on the brain’s inhibitory GABA receptors, causing reduced reaction to stimulus. Common brands include Valium (diazepam), Xanax (alprazolam) and Ativan (lorazepam). Benzos are particularly dangerous when mixed with opioids, according to Health Canada. The combination increases the risk of overdose, as well as side effects including dizziness, confusion, drowsiness and seizures. 

The arrival of benzos in the drug supply complicates life for health-care workers fighting the opioid epidemic. While a standard fentanyl overdose lasts between 10 and 20 minutes, a benzodiazepine overdose can last hours. At a time where the medical system is already stretched thin by COVID-19, pharmacists, nurses and harm reduction workers struggle to find the six to eight hours of monitoring required for these complex cases. 

“We can rouse people a little bit. But this person is so sedated, they may walk into traffic, or pass out on the street. People on opioids, if they’re rousable, they can generally be pretty safe on their own. With benzos, that is not the case at all,” says Matt Johnson, a health promoter for the Safe Consumption Site at Parkdale Queen West CHC.

And when opioids are combined with benzodiazepines, the naloxone kits that can be lifesaving tools to combat overdose become less effective at best and can cause users discomfort at worst. If naloxone is repeatedly administered to a person overdosing on benzo-dope, there is potential for that user to enter into opioid withdrawals while still suffering the effects of the benzo-overdose.

Hayley Thompson, project manager of Toronto’s Drug Checking Service, is particularly concerned about the volatility of the unregulated supply.

“For a long time, people didn’t know benzos were in their fentanyl,” she says. “Some still don’t. Benzodiazepine dependency is problematic because if the unregulated drug market shifts, which we know it does frequently, and benzos were to no longer present in fentanyl, we would have a large group of people who (would be) going through benzodiazepine withdrawals. If things change, it could drastically change people’s lives.” 

Current literature suggests that patients co-dependent on opioids and benzodiazepines have more severe withdrawal symptoms and that opioid withdrawal symptoms are exacerbated in the co-dependent group. Unlike opioid withdrawal, which can be done in outpatient care, benzodiazepine withdrawal must be done in a hospital setting. Urine drug screenings typically take five days to be processed, and until then it is impossible for health-care professionals to know from what exactly the patient is withdrawing. Even if a patient wants to withdraw from drugs, medical professionals have a delayed and incomplete picture of what the patient’s drug history is and what the withdrawal process should look like. 

There are two likely explanations for the arrival of benzos into the opioid supply. First, dealers may be intentionally introducing benzos into the supply to create a longer lasting and more intense high. They can mimic and even enhance an opioid’s effects, allowing less opioid to be used for the same street-value sample. Second, benzos are less strictly monitored and therefore easier to manufacture than are opioids.

Benzos can also make their way into the supply before it reaches the hands of dealers. This is highlighted nowhere more clearly than in the pervasiveness of Etizolam, a benzodiazepine-analogue, in Ontario. In 2021, Etizolam was the most common benzodiazepine found in fentanyl samples analyzed by Toronto’s Drug Checking Service. Etizolam is banned in Canada and the U.S., meaning it may be blended with opioids long before it reaches North America. 

“You can’t trust your drug dealer anymore,” says Mark Barnes, a pharmacist on the front lines of the opioid epidemic and an advocate for safer supply in Ontario. “We’ve had drug dealers themselves come in and say ‘Can I have three naloxone kits? I have no idea what I’m selling.’”

One thing many experts agree on is the myriad problems that benzo-dope can cause come down to unregulated supply. While measures like naloxone kits and safe consumption sites can work as lifesaving interventions, the volatility in the contents of street drugs force medical personnel to be working partially blind and put an unnecessary burden on a health-care system already on the brink.

“There’s only one way forward, which is decriminalization of all drugs,” says Johnson. “Across the board, safe supply needs to be standardized in medicine. There’s a philosophical shift that needs to happen. We need to stop looking back at what we’ve done, at what has failed us.”

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  • Leslie Hardy says:

    Sub is strong enough, please stay away from methadone or hydromorphone

  • Le says:

    Thank you so much for your article. I am an opiate addict that was doing well and stable on methadone for 12yrs. During Covid I had a 2yr relapse with fentanyl (I did not use fentanyl only other opioids prior to this relapse) I am currently 5 days clean and have been going through a withdrawal like I’ve never experienced before. With some prior knowledge that most dope is cut with benzos I discovered that the sevete withdrawl Im experiencing this time is due to opiate AND benzo withdrawl. I’ve gotten clean many times over the years but this is by far the worst withdrwl I have EVER experienced!!! It was more than comforting to come across your article and know that I’m not crazy this is very real, and absolute hell!!
    Thanx again.

    • Karli says:
      I am currently going through the same uncomfortable process that is absolutely and inexplicably challenging to say the very least! Horrifying, in fact, and compounded with the benzo’s hidden within the fentanyl really creates a dangerously extreme, physically devastating set of circumstances. I am sure that without the grace and fortune of the environment I am blessed to be in, that it would be all too possible to have symptoms of withdrawal so severe that they may even lead to death (ironically enough, considering that fact that the most concerning statistic involving the number of deaths from this opioid crisis is from the complete opposite; overdose). My recommendation, if not going down the medically assisted route to recovery in the hospital, is a care package gathered before the time of abstinence begins MAKING SURE you plan to prepare before the inevitable cycle of recovery runs its course.
      My personal Care Package to Recovery:
      -Immodium or similar for relief of diarrhea
      -Pedialyte or similar electrolyte replenishing with vitamins AND minerals which are needed for your body to absorb the vitamins. I usually go for the single dry packets to add to water bottles to save $$ since you get more
      -couple cases of H20
      -tylenol or advil for the pain
      -epsom salts for hot baths which help lots OR check my personal DIY bath bomb recipe at the end of this list
      -playing a frequency through your headphones like binaural or chakra frequencies (233 Hertz)
      -listening to Hillsong or similar music
      -having a friend there to help you incase of vomiting or involuntary bathroom emergencies
      -burning sage or lemon grass
      -Tiger Balm or A535 for topical relief, and if you add Turmeric though it stains yellow does help reduce inflammation I use behind my knees and elbows
      – a vibrating massage device paired with a Lymph-node massage *see bottom*
      -and as hard as it is, if you have friends or support systems to help force you up and moving for routine exercise followed by a reward to help retrain your brain to associate physical activity with pleasure via dopamine receptors in your brain
      -tea of many types , chamomile, green tea, other helpful natural detox or cleansing teas
      -those detox foot pads you can stick on the soles of your feet to suck out toxins that turn black and are disposable
      -lots of fruits and veggies , blackberries and blue berries are great as well as carrots and broccoli and spinach, best if eaten raw or fresh
      -deep diaphragm breathing guided meditations on YouTube, especially if you use the drug by smoking
      -stretching in bed like knees to chest or touching your toes to help with the restless legs
      -daily foot rubs are helpful for almost all nerve endings in the body are located in the soles of your feet
      -soft blankets made of silk or your favourite things because YOU are unique and YOUR favourites release the most dopamine
      -keeping your mind busy with instruments, writing, or other learning projects or taking a course that has a flexible schedule , maybe a bunch of library books with a notepad
      -prayers and keeping positive calendars with stickers or other means of progress tracking that is proven to have many neurological benefits
      -finding a safe and supportive community to keep connected to either virtually or in person , either friends, family, professionals, or peers that are aware of your circumstances

      DIY Bath Bomb Recipe:
      Ingredients : collected and dried lavender from plants around town NOT chemically treated ,baking soda, sea salt, and oatmeal as well as a pair or two of nylon stockings or pantyhose.
      Step 1 : blend the dry ingredients in a magic bullet. I use 2 cups oatmeal, 2 Tbsp of salts, a handful of dried lavender, 2 tbsp baking soda and feel free to add any other spices you might enjoy like sage or clove, all these measurements are estimated, you just want a majority of oatmeal
      Step2 : fill a panty hose stocking up with the blended powder about 1cups worth or a healthy heaping handful, and tie it shit with a knot
      Step3 – take a twine or string and attach it in a loop around the pantyhose and hang on the front of the bathtub tap before you fill it with warm water.
      Step4 – Squeeze the homemade sachet as the bathtub fills, I find it very relaxing ad it makes sure the colloidal oatmeal bath mixture gets properly dispersed into the bathwater and you can wish good intentions for yourself and positive vibes filling the water (there are DBT techniques for filling a bath which can be used with this method that I have found very beneficial)
      Steo5- enjoy! Love yourself and know that I love you too and that you are not alone1
      Step6- store any leftover blended powder ins an airtight container, and if you are using a pantyhose stocking for the second one just tie a tight knot at the bottom before Step 2 and so forth)

      Lymph Self Massage
      Step 1 – Have 2 or 3 bottles of water ready for after the massage to drink to help flush out toxins, is best used when your body is warm, even in a bath with the above colloidal oatmeal treatment for best results!
      Step2- extend one arm with palm facing the ceiling and with one hand, pinch lightly on your inner skin elbow for 1-3 seconds before releasing and repeating up to 20 times all over your inner arm from mid forearm to halfway to your armpit, remembering that your lymph tissues are between the skin and muscle (very close to the surface of your skin and do not require much pressure to engage these sponge-like squishy balls that are interconnected in a net throughout your entire body in clusters in your neck, underarms, and groin which you may feel have been swollen up in the past when you have gotten sick. The best way to engage these tissues are lightly and with gentle compassionate touches. If you feel your muscles, you may be doing it too deeply/roughly!)
      Step 3- raise your arm up by placing your palm on your shoulder of the same arm and with your thumb, VERY lightly smoosh your underarm and slowly pushing your thumb down your armpit. It is common to feel a sensation in the back of your throat that feels like you need to swallow but that just is a sign that you are doing it right!
      Step 4 – underneath of your chin on the same side of your body using your fingers methodically strum your fingers from behind your ear and below your chin moving from the back of your neck to the front and also from the top of your neck closer to the bottom of your clavicle.
      Step5 – Repeat the steps for your other side
      Step 6 – rub circular motions with your fingers around your groin area and make sure you are breathing deeply and drinking water
      Step 7 , squeeze your thigh (one at a time) with both hands and with a tight grip twist toward your inner thigh from the back of your lg and then keeping the tension push downward without moving your hands and then release. Repeat moving an inch down your leg at a time until you get to your knee
      Step 8 – rub around your knee until it feels like things are flowing easily to your lower legs
      Step 9 – Same process without the twist – gripping the backs of your calves with both hands an squeezing while pulling downwards and releasing before doing it again and again;
      Step 10 – when you reach your ankle focus on squeezing the toxins out of he soles of your feet with the same type of grip and pull motion, and once you feel satisfied with the squeezing out of your foot sole, take your toes and in the final pull and squeeze hold your toes and pull downwards away from your body.
      Step 11 : make sure o finish chugging bottles of water and not to stay in bath water too hot or for too long, and afterwards wrap up in a soft blankey or comfy pj’s and curl up with a nice hot cup of tea or having some fresh fruit to recover.
      Tips: do not be startled if you notice the bathwater turning darker from this – the first time I did it right I saw a black inky substance seeping from the soles of my feet and it is so good! Also for those who smoke cigarettes you may notice a foul odour from this procedure but this is perfectly normal part of the cleansing process!

  • BrianP says:

    We need CLEAN SUPPLY

    As I stated in my healthy debate interview in 2015. I had a major fentanyl addiction but I’m alive. I used prescribed patches and knew my dose! There is no reason ppl need to die from OD or from injecting benzos which usually aren’t water solvable and can’t be reversed by naloxone

  • JC says:

    IF my loved one is currently using this combination of crap, and is more than willing to seek professional help, where would the best place as/in (a hospital setting) based rehab/inpatient program/treatment centre be for her, considering the withdrawal is severe and dangerous the soboxone medication is administered during the day usually in the morning/afternoons, but lasts only for a short period of time before there symptoms/urges of re-using come back full tilt to now having no access to soboxone due to pharmacies shutting there doors at 5:00 or so, what then? what would be the best route to managing a recovery prevention plan or where? Im seeing my partners addiction become worse every day, and i am seriously worried about the safety of/and the overall damage shes putting on herself by using these substances due to the non-rylient circumstances of dealer to dealer sales, all having there own variants to this substance, weather being stronger/weaker and the urgency of constantly gripping/holding the glass pipe all day? is really setting her back, being only 30 yrs of age, and with fighting for our rights as parents along side me (non) user, are having to back track from both of our short/long term goals and financial dependant cies our options as young adults are withering away day by day. And both I and my partner want our lives back, we are being discouraged by the public and the rumours/statistics of the possibility of recovering from this nightmare, and need serious answers and guidance, or even the thought of putting my loved one to sleep for a week or two, until the withdrawal process is over, ive got the means to move her out of harms reach (out of town) with the opportunity of a new start, but just need the guidance/help by assisting in the recovery/withdrawal process….. if anybody could help point us in the right direction we would seriously appreciate it?

    • BrianP says:

      Suboxone may not be strung enough as it is a partial agonist. Has he or she tried methadone or Hydromorphone through the Special Access Program

    • Leslie Hardy says:

      Gallus medical detox in Scottsdale is here to help, please look us up online and call admissions


Gwyneth Boone


Gwyneth Boone is a health-communications professional with training in neuroscience and psychology. She is currently a participant in the Certificate in Health Impact program at the Dalla Lana School of Public Health, University of Toronto.

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