I’ve always enjoyed using benzodiazepines. These depressants—the best known are pharmaceutical brands like Xanax, Valium and Ativan—produce a distinct type of sedation, as well as physical benefits like relieving muscle spasms and reducing seizures. For me, they can switch off anxiety like no other drug.
I started using benzos at 16. My high school in Halifax, Nova Scotia, had a steady supply of 10 mg Valium pills, known as “blueberries.” I used them like they were going out of style, popping them morning, lunchtime and night. Back then, pharmaceutical benzos were widely available on the streets of Halifax. I would consider that I was addicted to them, but I did avoid serious problems at the time.
Things are different these days. The supply is full of unregulated “designer” benzodiazepines, misleadingly sold as “Xanax.” What’s more, our opioid supply also now commonly contains benzos—“benzodope”—which is a high-risk combination.
I know that firsthand, when I’ve overdosed off of benzodope a few times. On different occasions I ended up blacking out for multiple days, losing everything I owned, and being hospitalized.
I’m lucky to be alive. But what I want to describe here is something strange that happened a number of times when I was withdrawing from benzos. It’s information that could be useful to others, including some who might not even know that their dope contains benzos. And although I’ve worked in harm reduction for years, it didn’t make sense to me until I heard it explained on a podcast recently: I was experiencing delirium from quitting benzos cold turkey.
I was extremely disoriented, and it was hard to walk in a straight line. I had strong hallucinations. It felt like I was in this long, scary dream.
John Hopkins Medicine describes delirium as “an altered state of consciousness, characterized by episodes of confusion, that can develop over hours or days.” Depending on which type of delirium, people may experience disorientation around time or location; lethargy; memory issues; extreme emotions like anxiety or euphoria; or hallucinations. They may hold delusional ideas, among other symptoms.
“The physical cause of delirium is not yet well understood,” the article notes. It may often be a combination of factors, and “tests may show a problem with the chemical messengers that help the brain and body communicate.”
Delirium is seen more often in older adults, and conditions associated with it include oxygen deprivation, organ failure and dementia, among others. Case studies have also noted delirium in patients withdrawing from benzodiazepines.
That matches my own experience. On occasions when I’ve been withdrawing from any type of benzodiazepine, I experienced this bizarre feeling. I was extremely disoriented, and it was hard to even walk in a straight line. I had strong visual and auditory hallucinations. It felt like I was in this long, scary dream but I was awake, though drowsy and trying to sleep.
The intensity of these symptoms rose and fell for up to three days. I had no idea what was happening to me and was frightened, so I really wanted to find out.
“Delirium is not a disease as such, right? Like the way that pneumonia or another very specific disease is,” Dr. Samuel Hickcox, an addiction medicine physician of many years’ experience with Nova Scotia Health in Halifax, told Filter. “It’s really a description of a disturbed state of mind or of consciousness.”
“People lose the ability to understand where they are, to recognize and identify really who they are and who those are around them,” he continued. Additionally, “people may be in a very agitated state. So they might actually end up being very irritable, angry outbursts, they can get combative with people, aggressive.”
I asked Hickcox what kind of things we should look out for if we’re concerned that someone we’re with might be experiencing delirium.
“Difficulty maintaining focus,” he replied. “They may change the subject frequently in a conversation, have a lot of difficulty with memory and the ability to retain any new information. So you can’t really just talk to someone and for them to really even remember what you’re saying to them.”
“The two most significant substances that would lead to that kind of state in terms of withdrawal would be benzodiazepines and alcohol.”
“Some patients have visual hallucinations as well. That’s the next thing,” he added. “And then finally, I would say that what’s really important is that this sort of level of change in consciousness fluctuates. That’s one of the really key features that as a physician we look for: Is it coming and going, almost in waves? It’s like this morning they seemed okay and kind of a little more with it, and then a couple hours later they seem really disoriented.”
So how can this condition arise from withdrawal from certain drugs?
“It’s really a matter of how disruptive the substances are to a person’s cognition and in particular substances which have significant withdrawal symptoms,” Hickcox said. “Those with withdrawal symptoms that really provoke a lot of excessive fight-or-flight response in the brain—that kind of emergency alarm, hyperactive, hyper-aroused kind of state. The two most significant substances that would lead to that kind of state in terms of withdrawal would be benzodiazepines and alcohol.”
“States of intoxication that really disrupt the brain can also lead to delirium,” he added. “I would say that most commonly we would see that in benzodiazepines. So ironically, taking benzos for some people can lead to delirium. If you have a lot of tolerance to them, that’s a different story. If you’re young and otherwise healthy, less likely.”
Sometimes, it seems, the substance-related triggers for delirium during treatment may be hard to pin down. “When we’re treating people for alcohol withdrawal, who are maybe more prone to developing delirium, we’re gonna treat that alcohol withdrawal with benzos,” Hickcox explained. “One of the things that can happen is they can develop a delirium that may be from the alcohol withdrawal or may be from prescribing the medications we use to treat alcohol withdrawal.”
What’s the difference between delirium and psychosis?
One thing I really wanted to ask about was the difference between delirium and psychosis. During my benzo withdrawals, I worried that I’d developed psychosis—increasing my anxiety, ironically—when the symptoms can be quite similar. So what is the difference?
“Unfortunately it’s a little gray,” Hickcox admitted. “First of all, there are many causes of psychosis. If you look at psychosis from someone who’s having an exacerbation of schizophrenia, typically that kind of psychosis will have a much longer time course and will be less obviously characterized by fluctuations.”
“Psychosis itself is basically a way of describing a state of consciousness where a person has really lost connection with certain aspects of reality,” he continued. “It’s characterized in particular by two categories of symptoms: So the first are delusions, which are these false fixed beliefs about reality like major paranoia, and the other would be hallucinations.”
“Typically though, with delirium, you’re gonna see much more of that kind of fluctuating level of consciousness,” he clarified. “You could still have some suspiciousness or paranoia, and particularly with people who have agitated delirium where they’re really kind of combative.” However, “usually the sort of delusions that people have are more pronounced in psychosis versus delirium. Whereas with delirium, it’s almost like people really are out of it, they can’t really follow you.”
When I heard that I felt a sense of relief, because then I felt certain that what I’d experienced was delirium, and it helps to know for sure.
Now we know what delirium is and what it’s associated with, what should we do if we think we, or someone we know, is experiencing it?
For drug users, health care settings are often unwelcoming places.
According to Johns Hopkins Medicine, “There is not a specific medicine or treatment that gets rid of delirium.” But seeking medical care could still enable you to receive “calming medications” if needed, and for doctors to look at any other meds you’re on in case they’re making things worse. Getting plenty of sleep, if possible, can help. So can reassurance. “Having family and friends nearby can help a person with delirium feel safer,” the article states.
That’s a call for us to look out for one another. But for drug users, health care settings are often unwelcoming places.
During one of my benzo withdrawals, I was admitted to a psychiatric ward for three days. The care I received helped me, and as soon as the delirium stopped, I was discharged.
But last time I tried to seek treatment for what I now identify as delirium, I saw my doctor and she suggested I go to the emergency room. I went, and the emergency room doctor said he had never seen anything like me in 40 years. He referred me to the psychiatry department.
I waited 12 hours to be seen by the psychiatric department. I was in the waiting room, in and out of delirium, and people just ignored me as they passed by. After 12 hours they put me in a room, spoke with me for 10-15 minutes, and then discharged me with information on a recovery support center. As soon as they heard there were drugs involved, they wanted nothing to do with me and basically left me to fend for myself.
That experience left such a bad taste in my mouth, and I know many other drug users seeking health care for all kinds of reasons have experienced similar or worse.
The good news is, for people experiencing delirium for drug-related reasons, the symptoms will be temporary, even if three days felt like a hell of a long time to me. Our knowledge of the condition is still incomplete. But it helps us to look out for each other if we’re aware of what it is, what it isn’t, what might cause it and what might help.
Photograph of “benzodope” by Matthew Bonn
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