Overdose - The Alprazolam Overdose Thread

[Laudaphun]

Originally Posted by Ididnotinhale

A normal recreational level really depends on the tolerance of the user. For newbies to benzo's swim would say a "normal" level would be anything under 3mg or so, but as tolerance builds 15 mg could easily be a "normal level". Sorry that swim did not make that clear earlier.

As panther stated, Quilan got put into permanent Coma, but once again it wasn't benzo's alone, she alcohol along with her downers. Additionally according to wikipedia
She "took a tranquilizer, believed to be phenobarbital, but perhaps valium or methaqualone " So possibly it wasn't even a benzo, but rather a barbiturate, which is far easier to OD on even without any "help" from alcohol or other downers.

Newbies??? a 3mg alprazolam dose normal for newbies? ... SWIM has taken xanax for well over a decade, and in her younger years would take very large doses... Don't seemed to remeber a bottle of 90 lasting more than a weekend.

Now, SWIM's normal, once daily dose is 2mg... 3-4mg occasionally. One rare occasions. Do not confuse "newbie" with using medication responsibly. SWIM could easily let herself take 15mg/day if she wanted... but she knows that would be like walking into a lion's den and then running as fast as she could.

So is SWIM a newbie because she seldom take over 2mg alprazolam per day, or perhaps 2mg clonazepam others, depending on SWIM's mood? Would SWIM like to take more? YES, but SWIM chooses not to. Becareful when you word newbies in that context.

Reputation Comments on this post:

Weel said

[purplehaze]

I would suggest only having one dose available, be it 5mg etc, at one time. Do not have these things in the house with you after dosing, it can be taken way to lightley and people think ah that wont happen to me, but after you pop them you are going to forget you took them and if you have more you will keep taking them. Panthers explained this well one time, it is very true, when playing with benzos only have what your going to take available to you.

[thomasj]

Well, Alprazolam has a long half life so, I would say dose according to half life. It also has different active routes i.e., oral, rectal, insufflation, and i.v. The highest rate of metabolization will take place via rectal suppository. Avoid drinking grape fruit juice, it works as an antagonist of a receptor that effects metabolic rates.(can't quite remember which one but, positive of it) I, personaly, would not exceed 8 mg but also have been on it for atleast 4 years. 3 mg seems sufficient for you but, of course im just guessing because I don't know how much you weigh and even that will cause rapid motor skill loss. I have a dui to prove it. Don't drive, don't drink. Just relax.

[Ididnotinhale]

Thomas, did you get the DUI for benzo's alone?

Also insufliation of benzo's really doesn't work better than oral. Just not enough mucus membranes. Luckily there are far more mucous membranes in the anus.

Many people suggest using benzo's to save money, but if you choose to do so decrease your amount by 30%

Swim is still wondering, has anyone found a source of death from benzos alone?

Also, the half life isn't that long, it's about 12 hours. Just because a half life may be 12 hours, does not mean that one will feel the effects for 12 hours. For instance, marijuana has a half life of 1.3 days, but one definetly doesn't feel high for over a day.

[thomasj]

Originally Posted by Ididnotinhale

Thomas, did you get the DUI for benzo's alone?.

Yes, but not Alprazolam it was called temazepam.
And read this, it might answer your question. Results of Australia but, there diazepam is prescribed more often than alprazolam.
"There were 2063 single benzodiazepine overdose admissions: 131 alprazolam overdoses, 823 diazepam overdoses and 1109 other benzodiazepine overdoses. The median LOS for alprazolam overdoses was 19 h which was 1.27 (95% CI 1.04, 1.54) times longer compared with other benzodiazepines by multiple linear regression. "
http://www.pubmedcentral.nih.gov/art...?artid=1884537

[radiometer]

Originally Posted by Ididnotinhale

Swim is still wondering, has anyone found a source of death from benzos alone?

Sure, this is just one paper I found via 10 seconds of googling...

http://www.ncbi.nlm.nih.gov/pubmed/15725773

Wolf BC, Lavezzi WA, Sullivan LM, Middleberg RA, Flannagan LM.
Office of the Medical Examiner, Palm Beach County, West Palm Beach, Florida, USA. bwolf@leegov.com

Alprazolam-related deaths in Palm Beach County.

Alprazolam is a commonly prescribed benzodiazepine. The abuse of benzodiazepines is most frequently seen in conjunction with the abuse of other drugs. Only rare fatalities have been attributed to alprazolam alone. We undertook a retrospective review of cases investigated by the Palm Beach County Medical Examiner's Office in which postmortem toxicologic studies indicated the presence of alprazolam, to further study the pattern of alprazolam abuse. Our review consisted of 178 cases, including 87 in which death was attributed to combined drug toxicity, 2 to alprazolam toxicity alone, 44 to trauma, 12 to natural causes, and 33 to another drug or drugs. Cocaine and methadone were the most common cointoxicants in the cases of combined drug toxicity, while heroin was less frequently detected. There was considerable overlap in the postmortem blood alprazolam concentrations among the groups. The overlapping ranges of concentrations of alprazolam detected indicate that it may be difficult to define a lethal alprazolam range, and that it may not be possible to determine the actual role of alprazolam as a causal factor in cases of combined drug toxicity. This study confirms that alprazolam alone is rarely a cause of death, and that alprazolam abuse usually occurs within a polydrug use pattern. The high incidence of cocaine as a cointoxicant has not been previously reported.

Emphasis added.

I find this reported incidence of death associated with a combination of alprazolam and cocaine rather interesting...

[stoneinfocus]

some of thse have a ceiling effect, so it´s impossilbe to kill yourself with them, that´s why they´re still around.

Try, as a normal leathal person, getting a script for anything, in a size ir quantities, which could kill you...impossible, not available to adults anymore, just for doctors onyl, maybe in america with barbs but not in europe anymore.(except slin, but they can´t let you die of diabetes) -okay a bit exaggerated, some opoid patches might sdo the trick, but you´d have to be close to death anyway,wf or being prescribed one of those or have a very intimate realtion to your doc.

[Solinari]

Overdose will be a subjective term and i imagine the vast majority of 'overdoses' will be over the prescribed dose. I bet most overdoses were due to someone finding some one else that was heavily intoxicated, on the floor, unresponsive or unable to look after themselves. Then that person taking the intoxicated person to hospital rather than letting them sleep it off which is what i imagine would happen if they were never found in the first place.

[stoneinfocus]

Overdose is not a subjective term, overdose is a defined medical term, i.e. a dose of more than the prescribed one and many other criteria.

[thomasj]

Originally Posted by stoneinfocus

Overdose is not a subjective term, overdose is a defined medical term, i.e. a dose of more than the prescribed one and many other criteria.

Yes but that defines more around the term of drug abuse than overdose. I think overdose would be considered the state in which your liver can not process the excess amount resulting in toxicity. The term overdose is very tangible though as with many other things in the medical field, it is up to the md treating it to make the proper diagnosis.

[Solinari]

What i was trying to say is if someone took enough diazepam (or whatever) to cause them to black out or pass out and wake up the next day, they wouldn't say they overdosed and nearly died. Where as someone who took a lot of heroin and passed out would be in a dangerous situation and probably lucky to wake up if no one intervened, then that person would say they overdosed.

In a lot of peoples mind, they equate overdose to death or near death, but with a lot of things that doesn't always happen, benzodiazepines is one of them. Taking more than the prescribed or maximum recommenced dose, doesn't necessarily mean an overdose as such, tolerance has a large part to play in it as well.

[moda00]

These are all good points. I think Solinari's point about different drugs is a good one (ie. heroin is more likely to be called an "overdose" than pharmaceutical benzodiazepines, for both social/cultural reasons and also because it is probably true imo that heroin is more dangerous and more likely to result in death if one loses consciousness from it- but this also has to do with routes of administration) Also, the fact that a situation like that happens probably much more frequently than is recorded, and whether or not the incident is remembered or termed an "overdose" likely depends less on physical measurements of health, blood concentration, dose, etc. and more on whether other people were around to respond, call emergency services etc. With certain drugs, benzos being one of the big ones, GHB too, there are doses that will "knock you out" without usually causing any significant health problems- but if this occurs with others around, it is more likely that they will involve emergency medical services, not wanting to be responsible for an overdose or death and doing nothing. The perceptions of those observing the event affect how it will be labeled.

Once when swim was young and reckless, she got drunk and was puking, and went home to her parents' house. While she could have slept it off, her mom freaked out and took her to the hospital- thus her version is "alcohol poisoning/could have died" whereas swim's perception is "should not have drank so much and gone home, but certainly was not near death."

However, the OP refers to a LETHAL dose of alprazolam, which would be an overdose resulting in DEATH (as opposed to an overdose resulting in temporary or lasting adverse health effects), for clarification. So while overdose certainly can be ambiguous, we can talk about overdoses in terms of factors which can increase or decrease the chance of a fatality as a result.. And since benzos can result in memory problems ("blackouts") or over-sedation ("pass-outs") fairly frequently and usually without any adverse health effects, this issue could certainly use more clarification in general..

[stoneinfocus]

Jep, so for this reason you should probably have had the last few senteces emphasised? ;-)

to elaborate on the overdose issue a bit; it´s, like "bause" all related to medical practice and these practice always relates to the term "overdose" to conditions, where the effect of the drug can be controlled and monitored for achieving the desired drug-effect.

Example given: A preson in his privacy is prescribed a drug at a dose, which is said to provide the desired drug-effects, with the lest unwanted drug-effects, he´s not overdosing, he is, when he takes his pills and passes out on the street, which is definately not wanted in this setting.

A person recieving a dental surgery is given midazolam at a dose, that he passes out and maybe gets an amnesia from it. Both is desired and it´s not an overdose, for said reason.

The term "abuse" is rather subjectively used and imho can´t be logically related to any setting of use (with one exception, mentioned later-on), even moreso, abused by inferior judging of medical professionals, caused by inferior determination of the word "abuse" and should therefor be abandoned completely, as it´s only holding some value, when abuse gets equal to an overdose-scenario, which then is sufficient to describe real world problems and can be nailed as a valuable approach to a solution of the very issue of "abuse".

[radiometer]

Originally Posted by stoneinfocus

Jep, so for this reason you should probably have had the last few senteces emphasised? ;-)

No, because although interesting, it is not relevant to the topic of this thread.

[Panthers007]

I can see that cocaine and alprazolam/diazepam/etc. could put quite a strain on the heart - among other things. Rather like a "speedball" does. And cocaine, being cocaine, would tend to invite use of benzodiazepines.

[thomasj]

Originally Posted by Panthers007

I can see that cocaine and alprazolam/diazepam/etc. could put quite a strain on the heart - among other things. Rather like a "speedball" does. And cocaine, being cocaine, would tend to invite use of benzodiazepines.

That is the most truthful statement ive heard so far. Alot of people who can't take coming down use a benzo. Or non benzos like zolipidem. Definitely alot more toxic than a benzo by itself.

[davestate]

Originally Posted by Panthers007

I can see that cocaine and alprazolam/diazepam/etc. could put quite a strain on the heart - among other things. Rather like a "speedball" does. And cocaine, being cocaine, would tend to invite use of benzodiazepines.

IIRC was there not a recent thread on here debating the dangers(or lack of) of combining an upper with a downer?

[Solinari]

Yea, that is what i was saying, the intervention by someone else can make what would have been a black/pass out turn in to an "overdose" simply by finding that person in a state.

Edit: That's the second time i have missed multiple pages, i was replying to Moda00's last post.

[Ididnotinhale]

Everyone is different, swim has taken up to 17 mg of Klonopin in one night and really didn't feel to much, but he has been 3mg a day for about a year.

[Laudaphun]

Originally Posted by Ididnotinhale

Everyone is different, swim has taken up to 17 mg of Klonopin in one night and really didn't feel to much, but he has been 3mg a day for about a year.

Keep in mind that someone whose body has become accustomed to benzos can often handle exxagerated doses. Someone who hasn't taken clonazepam, alprazolam, or whatever benzo you're talking about is going to be in a world of trouble at doses that high. SWIM is also prescribed 3mg clonazepam and/or alprazolam daily (not to be taken at the same time). Overall SWIM takes 2-3mg daily of one or the other, or both. With rare exception does SWIM exceed either 3mg of one or the other, or 3mg combined. SWIM tends to lay off of the alprazolam during the academic setting as there tends to be more pronounced amnesia. However, when in more social situations SWIM resorts to the alprazolam (which her marmoset is considering phasing out).

On rare occasion, the marmoset will take multiple doses (nothing near 17mg), but doses at which would have caused a blackout in the marmoset years ago before daily use began. When the marmoset was young, didn't not take a benzo regularly, and her primary interest was recreation, doses at around 6mg were about the upper limit before blacking out (and that was combined with no other substances)... Addition of any other substance, namely ethanol usually made it highly likely that something bad would happen to her marmoset. Maybe some think that 6mg is a low dose to be blacking out at, well every marmoset is different as stated in the above post.

However, SWIM is confident that most people who do not have a tolerance for benzos would be considered in a state of overdose if found by a medical personel after having consumed 3-7mg alprazolam (with 3mg being conservative and depending on individual sensitivity). SWIM can recount several marmosets being treated for an overdose after consuming "estimation" between 6-8mg alprazolam. While not particularly toxic, (alprazolam is slightly more toxic in regards to benzos in general) a state of unresponsiveness is cause enough for alarm.

Granted, in these cases (we're talking 6-8mg) no treatment was necessary other than close medical supervision. Basically, the hospital just let the marmosets "sleep it off" if confident that the marmoset was not in any immediate danger of death.

At least one marmoset did have his stomach pumped (at a dose of 7mg? if SWIM remembers correctly). SWIM did not witness this marmoset's "episode" and is going on the marmoset's own story, recounted to SWIM by the marmoset. Don't remember if other drugs were involved (SWIM is inclined to think that alprazolam at 7mg was the only substance involved, if her memory serves her correctly and the marmoset who told her the story was 100% honest). This particular marmoset got into a lot of trouble over this by his parents, and SWIM remembers thinking that it seemed odd that so much trouble came out of consumption of 7mg alprazolam. But SWIM had never exceeded 5-6mg (to her own recollection), so she just figured that a mg or two could mean a big difference. The marmoset in mention was a young kid whose drug of choice was methamphetamine but not yet a full blown addict, as he had not progressed to regular use(not to say that everyone will end up as an addict because SWIM has no firsthand experience with methamphetamine nor been around many other marmosets who have). From what SWIM has seen, it seems to be an epidemic in very isolated regions.

Up until that particular incident, SWIM had never heard this marmoset talk about any benzo, nor expressed interest in any depressant type drugs. This marmoset was scared enough from the experience that when his and SWIM's paths parted ways, he was completely against all drugs. Maybe 16 or 17 years old at the time, SWIM remembers this particular marmoset as being a real nice kid and hopes very much so that this marmoset has stuck to his resolution to never touch drugs again. SWIM still worries that the marmoset's initial scare with an alprazolam overdose wore off and he resumed his use of methamphetamine and cocaine. LOL SWIM was still "wet behind the ears" at that age... not for long though.

The point SWIM is trying to make is that doses that experienced benzo users view as nothing special, might end up getting some other SWIM into a lot of trouble. Fortunately for safety's sake, benzos have a low toxicity. The drugs which benzos have largely replaced would likely do more than just get one of these random SWIM's out there into a heap shit-pile of trouble, but often times prove to be fatal. Barbiturates or methaqualone would be much more capable of proving fatal to a non-tolerant SWIM if taken at doses frequently taken by regular, tolerant users. Even tolerant users of these older drugs, could reach a tolerance at which an overdose could occur due to their low lethal/effective therapeutic dose ratios. Despite the greatly increased saftey of benzos in overdose, extreme caution still needs to be exercised as if you are in a state of blackout, greatly reduced inhibitions, and have an alprazolam(or other benzo) dose in your system large enough to cause such, you are putting yourself at risk if you do not have a very sober and responsible "sitter" looking out for you.

Appologies for the length, SWIM has just seen too many other SWIM's get into a lot of trouble from what the majority(NOT all) of the community on this forum view as smallish doses. Even elderly people are prone to have accidents, break bones, etc from therapeutic doses. SWIM watched her own grandfather nearly fall down the steps due to loss of coordination from a Dr. prescribed dose. Had SWIM not caught him...

Laudaphun added 1240 Minutes and 21 Seconds later...

After reading back through, and reading this post a couple of posts, SWIM was reminded of yet one other marmoset who had "overdosed" on xanax (alprazolam) in a similar fashion.

This marmoset was a mother with no history of drug abuse, several kids, and a BF that was a complete ass. This marmoset was abused as a child and and as an adult entered into a relationship with an abusive partner. She took care of and had custody of not only her own children, but her brother's as well as he and his GF were straight up crackhead's not able to take care of children. Obviously someone very, very stressed out.

Anyways, SWIM recounts her telling him the story of the time she was prescribed a bottle of 0.25mg alprazolam. Again, this is a story told to SWIM by the marmoset mentioned, so SWIM is repeating only what she remembers being told. The marmoset remembered taking one (maybe more?) and feeling very relaxed. SWIM can understand why this might have been a very attractive feeling, given the marmoset's difficult life growing up and now as an adult trying to be responsible when all of the others in her life were not. This marmoset told SWIM how she remembers driving and just feeling so relaxed, so she kept taking them. She didn't give any specifics or gestimations as to how many she took, only that she continued to take them as she really liked that relaxed feeling. This is very vague, but as SWIM recalls the marmoset told her that she just remembers driving along and feeling so nice and relaxed that she just kept taking them... SWIM "thinks" she wrecked (not 100% sure), but the next thing the marmoset recalls is being in the hospitol being treated for an overdose.

There is no way to really gauge the dosage she took, but the one thing that really stuck out to SWM about this particular instance is that the dosage units were so small (0.25mg) and the marmoset was not trying to get "messed up" but rather just trying to keep that "relaxed feeling" she initially reported.

Typically a dr. would prescribe a max of 90 tablets to anyone, especially on the first time use of a medication. Assuming that, she would have had at max, 22.5mg at her disposal... very doubtful that this marmoset took anything even close to that, and even that is just an educated guess as to what quantity she was actually prescribed. SWIM doesn't even think this marmoset knew what xanax (alprazolam) was before being prescribed it. Perhaps if SWIM runs into this particular marmoset again, she will ask about it again and get more details and edit this post at a later time.

Reputation Comments on this post:

Excellent harm reduction oriented post

[purplehaze]

it was only by the grace of Buddha and his wonderful friends that swim didnt end up shot dead by Thai police

It could have just as well been another appearance for the noodly appendage of the flying speghetti monster.

Sorry im leaving now.

[schiz0phren1c]

Originally Posted by purplehaze

It could have just as well been another appearance for the noodly appendage of the flying speghetti monster.

Sorry im leaving now.

http://img45.imageshack.us/img45/507...lyappenms5.jpg

[benzofreak]

since we just moved here and i havent found a doc yet- could you take methadone for the help of trying to quit taking the xanax? prob. sounds stupid but i was just curious.. i want my bars but you would think it was bad word around this city. ugg so unfortunately i would sell my kidney for a handful... not really but its hard.. i have been taking them for about ten yrs. i usually take 2 white bars to start then couple hrs later i get greedy and take 2 more.. and so on.. its really stupid..

[Z-rowe]

I've been prescribed Alprazolam 0.25mg as needed for about five years now, and more recently, I've been prescribed Xanax XR 1 mg daily plus the above. My question is: with this history, how much do I need to take to make it final and certain?

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