All staff working in emergency services and health care should be vigilant for the presentation of patients with benzodiazepine toxicity.

They should look out for:

• decreased blood pressure
• decreased consciousness
• decreased mental activity
• decreased pulse
• decreased respiration
• decreased temperature

The most common clinical features of bromazolam toxicity in the ASSIST emergency department toxicology study were reduced consciousness, airway compromise and agitation.

Be aware that testing used by clinical services is varied and as substances change these may not always be picked up by existing urine and saliva test kits. Non-detection of benzodiazepines does not mean that newer benzodiazepines are not present, and a person’s clinical history is also important to determine appropriate prescribing and psychosocial interventions.

Build links with your local drug services and liaison team and in all your contacts with patients, encourage them to access support and take-home naloxone. 

For further advice, medical professionals can use the National Poisons Information Service 24-hour telephone service on 0344 892 0111, or its online database, TOXBASE.