{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:34:31Z","timestamp":1791599671167,"version":"4.3.4"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA048009"],"award-info":[{"award-number":["R01DA048009"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Simultaneous exposure to both benzodiazepines and opioids can lead to synergistic respiratory depression, complicating overdose management. Our objective was to report on the detection of prescription and novel benzodiazepine co\u2010exposures among patients treated in emergency departments (EDs) with suspected opioid overdoses. We aimed to describe novel benzodiazepine exposures in this population and to compare the clinical severity of co\u2010exposure to benzodiazepines and opioids versus opioids alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study utilized data from the Toxicology Investigators Consortium (ToxIC) Fentalog Study, an observational study at 10 ED sites (Sept 2020\u2013Dec 2023). Waste serum samples were analyzed using liquid chromatography quadrupole time\u2010of\u2010flight mass spectrometry (LC\u2010QTOF\u2010MS) for the presence of over 1200 novel psychoactive substances (NPS), drugs, therapeutics, and metabolites. Analyses included demographics, clinical severity, and outcomes among those with prescription benzodiazepines, novel benzodiazepines, or no benzodiazepines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the patients with opioids present (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091427), 29.0% of patients had detectable benzodiazepines. 20.5% of patients had detectable prescription benzodiazepines, and 8.5% of patients had detectable novel benzodiazepines. The most commonly detected prescription benzodiazepine was alprazolam (39.3%); the most common novel benzodiazepine was bromazolam (46.3% of novel benzodiazepines). The median age of those with novel benzodiazepines was 34, which was younger than those without benzodiazepines (40) and those with prescription benzodiazepines (41;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Patients without benzodiazepines received naloxone more frequently (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), while novel benzodiazepine co\u2010exposure was associated with higher naloxone nonresponse rates (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). Patients with novel benzodiazepines (compared to the opioid\u2010only group) had increased odds of requiring mechanical ventilation (aOR: 2.14; 95% CI: 1.07, 4.05) after adjusting for age, gender, race and ethnicity, and the presence of prescription benzodiazepines and\/or fentanyl.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly a third of patients with confirmed opioid overdose presenting to the ED also had concomitant benzodiazepine exposures. Those with novel benzodiazepines had significantly higher odds of intubation, suggesting greater severity of overdose.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70104","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T10:48:54Z","timestamp":1752576534000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Benzodiazepine Co\u2010Exposure Among Patients Presenting to the Emergency Department With a Confirmed Opioid Overdose"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5059-7851","authenticated-orcid":false,"given":"Adrienne","family":"Hughes","sequence":"first","affiliation":[{"name":"Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3740-8854","authenticated-orcid":false,"given":"Hannah","family":"Spungen","sequence":"additional","affiliation":[{"name":"University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Culbreth","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Aldy","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix Arizona USA"},{"name":"Baylor University Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1775-1882","authenticated-orcid":false,"given":"Alex","family":"Krotulski","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Research and Education, Fredric Rieders Family Foundation  Horsham Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5998-3908","authenticated-orcid":false,"given":"Robert G.","family":"Hendrickson","sequence":"additional","affiliation":[{"name":"Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Amaducci","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network\/USF Morsani College of Medicine  Allentown Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Judge","sequence":"additional","affiliation":[{"name":"Corewell Health, Michigan State University  Grand Rapids Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Meaden","sequence":"additional","affiliation":[{"name":"Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane P.","family":"Calello","sequence":"additional","affiliation":[{"name":"Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9855-8915","authenticated-orcid":false,"given":"Jennie","family":"Buchanan","sequence":"additional","affiliation":[{"name":"Denver Health and Hospital Authority  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Shulman","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Brent","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine  Aurora Colorado USA"},{"name":"Toxicology Associates  Littleton Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Wax","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix Arizona USA"},{"name":"University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharan","family":"Campleman","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3866-0509","authenticated-orcid":false,"given":"Michael","family":"Levine","sequence":"additional","affiliation":[{"name":"University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Schwarz","sequence":"additional","affiliation":[{"name":"University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex F.","family":"Manini","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, Center for Research on Emerging Substances, Poisoning, Overdose, and New Discoveries (RESPOND), NYC Health + Hospitals\/Elmhurst  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6712a1"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7006a4"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2019.305053"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14878"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.07.004"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010019\u201005545\u2010y"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.2361"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6934a1"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.46426"},{"key":"e_1_2_9_11_1","unstructured":"A.Krotulski D.Papsun andS.Walton \u201cBenzo\u2010Dope: An Increasingly Prevalent Drug Combination of Significant Toxicological Relevance \u201dPresented at: Society of Forensic Toxicology Conference (2022) https:\/\/www.cfsre.org\/resources\/presentations\/benzo\u2010dope\u2010an\u2010increasingly\u2010prevalent\u2010drug\u2010combination\u2010of\u2010significant\u2010toxicological\u2010relevance."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7034a4"},{"key":"e_1_2_9_13_1","volume-title":"National Drug Threat Assessment: 2019","author":"Drug Enforcement Administration","year":"2020"},{"key":"e_1_2_9_14_1","volume-title":"National Drug Threat Assessment: 2020,","author":"Drug Enforcement Administration","year":"2021"},{"key":"e_1_2_9_15_1","volume-title":"National Drug Threat Assessment: 2022,","author":"Drug Enforcement 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Trend Reports,","author":"Krotulski A. 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