Clonazepam (Klonopin) stops my symptoms almost completely

[frozenborderline]

But were they well founded accidental deaths from phrobarbitol? Meaning were they abused or used stupidly or irresponsibly in cases of deaths. Alot of people do stupid stuff like double the fose on their own or mix with things that dont mix or take when they already have respitory depression and arent supposed to. Prescribing barbituated with care may still be a better option than just blindly giving valium to everyone since its more idiot proofed. .

The difference is that barbiturates kill more easily without needing to be mixed with other drugs to kill ..

For example barbiturates can be used in euthanasia *on their own*. They can kill frequently *on their own*. I have never heard of a euthanasia or legal injection regimen using benzodiazepines on their own, and I have never heard of them killing someone on their own...

If this does happen, it must be at extremely high doses that aren't likely to be taken accidentally, unlike with phenobarbital. I mean one can probably find a theoretical ld50 for any drug including the incredibly safe lsd and Marijuana, but it would be orders of magnitude higher than is likely for anyone to take in real life.

 

[frozenborderline]

"There is no known lethal dose of diazepam in humans.

In animal testing, the following lethal doses were found:

rats: 1,200 milligrams per kilogram (mg/kg)
dogs: 1,000 mg/kg
mice: 700 mg/kg
Diazepam is a relatively safe medication because the toxic-to-therapeutic ratio of benzodiazepines is very high.

A toxic-to-therapeutic ratio compares the blood concentration at which a drug is toxic with the concentration at which the drug is effective."
https://www.addictionresource.net/lethal-doses/valium/

Basically when I looked this up it was exactly what I said. There is an ld50, bc you can always find a lethal dose if you give a huge enough amount of any med to animals --in that case Marijuana and LSD have ld50s even though there are no known human deaths--but the ld50 is impossibly high. Look at what 1200 mg per kg (not 1200 mg total, but 1200 mg per kg of body weight) would translate to for humans. I've never heard of people taking valium doses at that level. I've never heard of a successful euthanasia or suicide with only benzodiazepines without any other medications, it could easily be fatal when combined with opioids or alcohol but the standard is as a medication *on its own*.
Maybe the confusion is from the term "overdose ". You can take too much and have a blackout or adverse effects. An overdose doesn't have to be fatal. In fact we refer to Marijuana overdoses too.

I'm not defending benzos as a drug but these are just facts as far as I know.
@Hip may know more than me , as a sort of resident pharmacology expert, but like I said ,I've never heard of such thing as benzodiazepines being fatal in humans on their own. Because of the long half life of diazepam, maybe if someone is also prescribed other meds that cause respiratory depression, and takes valium at a high dose before or soon after those other meds ... maybe, just maybe it's possible for someone to think they're only taking valium and die from it if it overlaps with other meds in their system, but certainly not on its own.

 

[frozenborderline]

It's just as easy to overdose on Xanax, Ativan, or plain diazepam as it is on barbiturates. The only difference is how fast it can kill you.

This is a pretty big claim, bc you aren't just saying it's possible for benzodiazepines to be lethal on their own, you are claiming the therapeutic to lethal dose ratio is similar to barbiturates? I think that's totally wrong. I couldn't find any cases of deaths due to benzodiazepines on their own but even if we found a few , it's clear that the therapeutic dose to lethal dose ratio would be something in the ballpark of 1:1000 or 1: >1000 ... something that's higher than most drugs, and certainly higher than barbiturates, which are used for euthanasia bc they are so easy to kill with, and also easy to accidentally exceed the therapeutic to toxic dose limit

 

[frozenborderline]

From the Wikipedia page for benzodiazepine overdose:

"Benzodiazepines have a wide therapeutic index and taken alone in overdose rarely cause severe complications or fatalities.[13][25] More often than not, a patient who inadvertently takes more than the prescribed dose will simply feel drowsy and fall asleep for a few hours. Benzodiazepines taken in overdose in combination with alcohol, barbiturates, opioids, tricyclic antidepressants, or sedating antipsychotics, anticonvulsants, or antihistamines are particularly dangerous.[26] Additionally, emergency department visits involving benzodiazepines compared to other sedative-hypnotics have much higher odds of hospitalization, patient transfer, or death.[27] In the case of alcohol and barbiturates, not only do they have an additive effect but they also increase the binding affinity of benzodiazepines to the benzodiazepine binding site, which results in a very significant potentiation of the CNS and respiratory depressant effects.[28][29][30][31][32]. "

Interestingly while they say that they "rarely" cause fatalities, when I looked at the links for this page, one of the examples of fatalities was a) broken, so i couldn't look at the case study, and b) involved an uncommonly used benzo, which was said to be less safe (triazolam) than benzos prescribed outpatient and used in the way clonazepam and diazepam are used.

I wish I could find that case study, but even if there are examples, I'm not convinced that benzos are commonly dangerous in overdose without combination with other drugs. All the overdose stats for institutions like NIDA et. AL bundle benzo overdose with combinations of other drugs in a way that is either intentionally or unintentionally misleading.

If we looked at the actual amount of overdose deaths in the literature and find, say,two or three cases of true benzodiazepine death on their own, without any other drugs in system, I would bet that it involves preexisting conditions like critical illness, very elderly patients prone to hypotension, etc..., and even if we found something like that, it would make benzos one of the safest drugs in terms of overdose [on their own, they're certainly incredibly unsafe combined combined other drugs ] in terms of amount of overdoses, maybe only behind psychedelics and Marijuana... I'm sure there are far more cases of acetaminophen or even ibuprofen overdose deaths than benzos ... in fact I'd bet there are far , far more overdose deaths using solely diphenhydramine /benadryl , than diazepam or any benzos.

It seems like there are some case studies of people lapsing into a coma which they recover from with no damage, with benzos , I mean they are a sedative that can produce twilight sedation, so that makes sense. These cases were with *extremely high doses*. The therapeutic to toxic dose ratio with benzos is *way better* than with barbiturates. And I'm pro barbiturate legalization but I still am not going to downplay their danger. We should be honest about specific risks of every drug

 

[YippeeKi YOW !!]

I'd imagine the ld50 or lethal dose would certainly be far higher compared to therapeutic doze than the ratio would be with barbiturates ?

Absolutely true. Barbiturates were rapidly displaced by diazepam exactly because they were so potentially deadly, with or without combining them with other substances, as I said in my first post about this.

But I was responding to your statement that it was impossible to die from benzos unless they were combined with other drugs. This is just not true. Valium / diazepam is also a CNS and respiratory depressant, and while someone would have to put more effort into it, it absolutely is possible to OD on it.

 

[YippeeKi YOW !!]

bc you aren't just saying it's possible for benzodiazepines to be lethal on their own, you are claiming the therapeutic to lethal dose ratio is similar to barbiturates?

That is absolutely NOT what I said. You need to read posts more carefully before throwing around inaccurate restatements of their content.

And I'm pro barbiturate legalization but I still am not going to downplay their danger. We should be honest about specific risks of every drug

Please read my first post about barbiturates vs benzos. You have misinterpreted almost everything I wrote in that, and I'm too cranky today to want to enter into this "You said ..." ...."No, I didn't..." battle. Been there, done that, it's ao wn.

It's clear that you have strong reasons for defending your claims, and I have neither the energy nor the interest to beat myself bloody against a brick wall.

Rock on ...

 

[frozenborderline]

Please read my first post about barbiturates vs benzos. You have misinterpreted almost everything I wrote in that, and I'm too cranky today to want to enter into this "You said ..." ...."No, I didn't..." battle. Been there, done that, it's ao wn.

It's clear that you have strong reasons for defending your claims, and I have neither the energy nor the interest to beat myself bloody against a brick wall.

A) the part you quoted about being honest about the dangers of barbiturates wasn't predominantly directed toward you , there was someone else in this thread, I forget their name, saying that barbiturates were unfairly vilified .

Maybe you think I've misconstrued something you've said... I've certainly tried not to. If you look at what I wrote I didn't construe motivations, and so i don't know why you think it's okay to do that for me. I have no idea what the motivations or internal thought process of anyone else posting on the internet on this forum is and I'm not trying to analyze why people say any claim, I think it's rude to do so.

I simply respond to the content. Maybe I'm wrong about some specific content , but you don't need to respond to that by inferring motivation.

I was also responding to multiple people, one of whom was implying barbiturates were unfairly vilified.

Additionally, I found strong evidence that benzodiazepines are almost impossible to die from in overdose without combination... I had initially believed it was literally impossible, now after looking at the evidence I believe it may have happened, but is so rare as to be negligible . I haven't found many case studies , or really any case studies, showing the direct deaths from benzodiazepine toxicity, and the ld50 I posted from animals is so high that it is certainly impossible to reach accidentally.

If we're having a small semantic disagreement that is fine.
Certainly haven't found any actual direct case studies of people dying from benzo overdose (not withdrawal) with no other drugs, directly. Wikipedia quoted a case study of this, with triazolam (I haven't seen any with diazepam) , but when I tried to follow the link to find a primary source, it was broken. So I couldn't find literally anything on an actual case study of a death that's a primary source. But sure, based on what they said , I believe it's in theory possible. Every source I've found says that it's incredibly rare. I would like to know the actual amount of people who have died from this , because if it's as rare as being struck by lightning or something, I don't know that it's really a concern for most people, especially when , unlike other drugs, it requires deliberately taking doses hundreds or thousands of times the therapeutic dose.

I am open minded always to changing my mind with evidence about these things. It's a worthwhile discussion to have. And something I am genuinely curious about. That's why I asked you about a case study of it happening. It wasn't a gotcha.

 

[frozenborderline]

That is absolutely NOT what I said. You need to read posts more carefully before throwing around inaccurate restatements of their content.

I am just confused! I initially said that benzos were far safer than barbiturates in terms of being difficult to OD on, you said I was wrong, so I thought you meant that they are not safer than barbiturates in terms of overdose.

 

[frozenborderline]

Absolutely true. Barbiturates were rapidly displaced by diazepam exactly because they were so potentially deadly, with or without combining them with other substances, as I said in my first post about this.

But I was responding to your statement that it was impossible to die from benzos unless they were combined with other drugs. This is just not true. Valium / diazepam is also a CNS and respiratory depressant, and while someone would have to put more effort into it, it absolutely is possible to OD on it.

Okay, I think we mostly agree . When you initially disagreed with me, I thought it was based on a disagreement of benzos being less possible to OD on than barbiturates.

So we agree on thay and the only disagreement is about whether it is "impossible to od on".

I have learned some from reading into it. This is pretty interesting territory, as most sources say it's either not possible or nearly impossible. Wikipedia says in rare cases it's happened but the links to the case studies regarding the deaths from triazolam were not working so I still haven't found a single case study on it. Again, this is something that would interest me to learn about.
But even the most conservative rephrasing of what I said, if I said instead of impossible , would be that it is nearly impossible. I can't find statistics for how much it actually happens as the statistics nida has for benzo deaths are bundled with other drug combinations with benzos in them... it seems extraordinarily rare. The ld50 in animals is over 1000 mg PER KILOGRAM of body weight, well over the equivalent of 1000 x the Therapeutic dose... so not only would someone have to put effort into it, they'd have to put a lot of effort into it and there's absolutely no guarantee it would even work even IF they put effort into it.

Anyway, the difference between what we're saying seems small and semantic, now that I understand we agree about barbiturates, ans that it would be difficult to OD on benzos alone. I do think that it would be interesting to learn of these supposed benzo overdose deaths, as the animal ld50 seems sonhard to even meet in humans with the sheer amount of pills to swallow etc... that I wonder if they had major pre-existing conditions... like when people Have had heart attacks after smoking weed, but that doesn't get counted as an Od. again, I've actually searched for thsse case studies , and it's hard to find them...

 

[frozenborderline]

When I kept searching for info on deaths from benzos ALONE without a combination of drugs , it was very hard to find this... there were no academic sources I found and very few sources period.



Here's one quote from an addiction recovery website that, while being a secondary source, does actually extrapolate from the ld50s I mentioned earlier to what would be a lethal dose for a human:
"
How Much Valium Does It Take to Overdose?
Typically, adults are prescribed a Valium dosage that ranges from 2 mg to 10 mg. To treat anxiety, Valium can be taken two to four times throughout the day for a total of up to 40 mg per day. The amount of Valium required for an overdose varies, depending on whether other substances are also being consumed within the same time frame.
When Valium is taken without other drugs, lethal overdoses are uncommon. While some benzodiazepines can be lethal when taken in large amounts, a lethal dose of Valium would be very large. There have been cases of attempted suicide where people ingested 2,000 mg of Valium and recovered without medical treatment. Based on lab animal studies, a lethal dose of Valium alone for a 150-pound human would be more than 80,000 mg"

I'm not great at mental math, but 80,000 mg is 2000x the maximum daily dose, and 8000x a normal therapeutic dose... so about 8000 pills, that's gotta be more than a few full months of bottles of pills, I can't even imagine swallowing g that many. I don't think that it's possible possible have an accidental overdose with a toxic dose like that

 

[Hip]

It's just as easy to overdose on Xanax, Ativan, or plain diazepam as it is on barbiturates. The only difference is how fast it can kill you.

I don't believe that is the case.

I have never heard of people using benzodiazepines to commit suicide, and I am sure you would hear stories if benzos were an effective method of ending your life, since they relatively easy to obtain and relatively cheap.

The Rolls Royce method of suicide/euthanasia has always been barbiturates. These gentlely put you to into a pleasant sleep, and then you die in your sleep by respiratory depression. If you travel to Switzerland to obtain legal euthanasia from organizations like Dignitas, they will use this Rolls Royce barbiturate method.

However, barbiturates are almost impossible to obtain. Some people pay up to $1000 for barbiturates from China, for suicide/euthanasia purposes. Many people may not want euthanasia immediately, but when they are suffering, and when they fear that the suffering may get even worse as their terminal disease progresses, it gives some people a sense of comfort to have access to an easy and pleasant means to end it all. So that's why they will seek out a pleasant and effective euthanasia method like barbiturates.

Unfortunately, some of these barbiturates bought from China turn out to be fake.

Australian Dr Philip Nitschke has performed a lot of research into home suicide methods, as he believes it is immoral to prevent those with nasty terminal chronic diseases from access to a pleasant death. He has looked at large range of home euthanasia methods, and published a book detailing his methods, but benzodiazepines are not included in his book.

In fact Nitschke's book specifically says :

These modern sleeping tablets are members of a drug class known as benzodiazepines and are not usually lethal, even if taken in large amounts. Note: no modern day sleeping tablets are considered to be lethal and it is important to stress this.

 

[IThinkImTurningJapanese]

access to a pleasant death.

That's disturbing. There's nothing pleasant about death. We need improvement in quality of life, anything less is abject failure.

 

[YippeeKi YOW !!]

I have never heard of people using benzodiazepines to commit suicide,

Nor did I say they did. You might want to reread my first post.

The Rolls Royce method of suicide/euthanasia has always been barbiturates. These gentlely put you to into a pleasant sleep, and then you die in your sleep by respiratory depression.

Which is EXACTLY what I said in my first post, which I again suggest you might want to re-read. Just for clarity on what I actually said.

But the belief that benzos can't kill you as a stand-alone drug is .... interesting. They're also respectable CNS and respiratory depressants, and, if I'm remembering correctly, it takes between 7 AND 12 GRAMS, not milligrams, of phenobarbital to kill you, based on various googlings, which seems way over the mark.

One of the dangers with benzos, and what makes them potentially lethal (aside from their effects on the CNS and respiratory systems) is diazepam's extremely long half-life which lands somewhere between 30 to 70 hours, and depending on your system and the clearance rate of your isomeric CYP450, can be as high as 120-plus hours, sometimes more. Constant redosing and piggy-backing of doses in tolerance withdrawal can put you in a coma, with hypotensive shut down.

Granted, as I said in my first post (did I mention that you might want to get a clearer understanding of that? It would really help reduce .... misunderstandings), it's a LOT easier to OD and die with phenobarbital, but that doesn't mean that it's impossible to OD and die on benzos.

 

[YippeeKi YOW !!]

That's disturbing. There's nothing pleasant about death. We need improvement in quality of life, anything less is abject failure.

I agree, but the fact remains that if you're in horrible pain, or facing that as an absolute given with, say an aggressive cancer, I believe that each of us has the right to determine how much agony we have to go thru, and put our loved ones thru, and whn it's wiser and kinder to find a gentle exit.

 

[YippeeKi YOW !!]

Okay, I think we mostly agree . When you initially disagreed with me, I thought it was based on a disagreement of benzos being less possible to OD on than barbiturates.

No, you're right. On the basics we're in total agreement .

EDIT .... minor typo that created a whole new, indecipherable, word ....

 

[IThinkImTurningJapanese]

I agree, but the fact remains that if you're in horrible pain, or facing that as an absolute given with, say an aggressive cancer, I believe that each of us has the right to determine how much agony we have to go thru, and put our loved ones thru, and whn it's wiser and kinder to find a gentle exit.

ME/CFS is not an aggressive cancer. It's a treatable illness, and it's time we stop giving up when it comes to providing relief.

I understand what you're saying, I almost stepped off of a 10 story building. That would have been an incredibly stupid decision.

 

[YippeeKi YOW !!]

I understand what you're saying, I almost stepped off of a 10 story building. That would have been an incredibly stupid decision.

Oh, C. Cat .... I totally get you.

By the third year of the nearly six years that I was bedbound, semi-comatose, and uselessly non-functional, I read Final Exit cover to cover, several times. This was really hard for me, I could barely decipher the words, but I was driven forward by my then-need to find a clean way out that wouldn't leave a big mess for DB, or hopefully raise a lot of inconvenient inquiries. It took over a year before I gave up ....

I'm so flucking grateful that I didn't have the cognitive ability to figure anything out, even when it was right in front of me, in clear written form, practically with diagrams.....

I wasn't thinking of ME, tho, and I agree with you, as bad as it is and can get, and as hopeless as it can leave the suffering patient and their families, there's almost invariably some hope, however thin and fragile, and some degree of function....

I was thinking more of cancers and other devastating illnesses where, once you're beyond a certain point (aggressive stage 4 in most cancers, tho not all), and you're in unbearable, indescribable pain, watching your family suffer and being left on the edge of homelessness, I would hope that there would be a merciful, gentle way to end the agony, and maintain some dignity as a human being ....

I'm so glad that neither one of us was successful ....

 

[frozenborderline]

But the belief that benzos can't kill you as a stand-alone drug is .... interesting. They're also respectable CNS and respiratory depressants, and, if I'm remembering correctly, it takes between 7 AND 12 GRAMS, not milligrams, of phenobarbital to kill you, based on various googlings, which seems way over the mark.

Okay, I would leave it at this: I don't know why pharmacologically benzos are so much safer wrt respiratory depression than barbiturates , and I'm not sure whether they can kill on their own. I believe they can contribute to a death ... even Marijuana can make a heart attack more likely in someone who is susceptible, we don't necessarily count that as a Marijuana induced heart attack.
I haven't read the case studies on the pure benzo induced deaths , but every single thing I read suggested that even if there are deaths, they are extremely rare from benzos ALONE. I don't know why a cns depressant that can exacerbate respiratory depression when combined with other drugs *wouldn't* cause respiratory depression on its own, but the pharmacology explanation of that is separate from whether it happens empirically. I've found examples of people that have lapsed into a coma from benzos and recovered eith no medical treatment, and this was at doses of 2000 mg...

I think we mostly agree , there are small semantic disagreements , I'm not in a bad mood over this, I I genuinely am curious, can someone die SOLELY from a benzo overdose. Where are the primary sources? It's hard to search for this in the literature bc there are lots of results for benzo overdose thay have other drugs.

And there should be no suggestion that I'm personally motivated bc of having any favorable opinion toward benzos, I think benzos are very dangerous , in terms of dependence and changing the brain. But I just am unconvinced they can kill on their own, or at least kill onbtheir own enough to be notable.

@Hip , with what you're saying about benzos and euthanasia, you may be interested in this article from the nytimes archive : https://www.nytimes.com/1987/02/11/us/valium-often-a-suicide-step-seldom-works.html
It's about how people are trying to commit suicide using valium and failing a lot, bc valium rarely (or never) kills on its own ? Maybe people who grew up when barbiturates were still a thing and then benzos were phased in weren't aware that these "sleeping pills" or sedatives of the newer class were safer and just assumed swallowing benzodiazepine "sleeping pills" was the same as swallowing the older barbiturates sleeping pills, which did actually work

Anyway yeah, the ideal for euthanasia has always been barbiturates. But there are lots of different protocols in the absence of access to thay thay have been published by various organizations. Some of them involve the heart med digoxin, some involve benzo, but never alone, only as an adjunct to sedate while other drugs do their thing , some involve beta blockers to in overdose lower the heart rate and bp while respiration is also decreased by morphine and benzos , and they all include anti emetics

Anyway, benzos on their own either very rarely kill or not at all. I cant decide which bc there aren't first person case studies I've found. But even if they do kill on their own it has to be so rare that it's not something anyone who isn't swallowing multiple full bottles of them or combining them with any drugs , should be worried about. Of course if they are combined with other depressants things quickly become dangerous. And the withdrawal is nasty. I hope flumazenil becomes utilized more in the USA to help with benzo dependence as it has in Italy. It really is a miracle drug for that and not only helps with acute withdrawal but with the post acute withdrawal symptoms. I wonder how difficult it would be to get it there as an expat or tourist or emigrant.

 

[frozenborderline]

The Rolls Royce method of suicide/euthanasia has always been barbiturates. These gentlely put you to into a pleasant sleep, and then you die in your sleep by respiratory depression. If you travel to Switzerland to obtain legal euthanasia from organizations like Dignitas, they will use this Rolls Royce barbiturate method.

However, barbiturates are almost impossible to obtain. Some people pay up to $1000 for barbiturates from China, for suicide/euthanasia purposes. Many people may not want euthanasia immediately, but when they are suffering, and when they fear that the suffering may get even worse as their terminal disease progresses, it gives some people a sense of comfort to have access to an easy and pleasant means to end it all. So that's why they will seek out a pleasant and effective euthanasia method like barbiturates.

Yeah, I think it is too bad barbiturates were phased out for a few reasons. One is I think that even older medicines which have been supplanted by safer ones should be kept around for use by psychonauts and anyone who wants to experience them, like in a museum of medications sort of way. And they may still have some unique medical value, I've heard they can be better for alcohol withdrawal than benzos.

Plus the whole euthanasia thing. To just talk about it generally and not break anyrules, I do just think it should be generally available for anyone who needs it. It's too bad the organizations that do it formally and peacefully and quickly are so expensive. And btw Pegasos is another org and they use iv barbs so things are over in seconds , not minutes to an hour like with dignitas.

Apparently it's hard to get the strongest babiturate , I think I'm thinking of the one with brand name nembutal, bc the drug manufacturers didn't want it used in executions in the US, which is fair. I don't know why other companies don't manufacture it , I'd also imagine it has to have some other use ... and they'll still do lethal injections so it's kind of a pointless protest

 

[Hip]

if I'm remembering correctly, it takes between 7 AND 12 GRAMS, not milligrams, of phenobarbital to kill you

Yes that's right, Dr Nitschke says 10 grams of pentobarbital (Nembutal) is a lethal dose. That corresponds to one hundred 100 mg pills.