The death of Nex Benedict, a 16-year-old transgender student of Native heritage from Oklahoma who used the pronouns he, him, they and them, has ignited a national debate on several issues, including the rampant bullying LGBTQ+ students face in schools and how Benedict’s death.
A one-page autopsy summary report released by the Oklahoma Office of the Chief Medical Examiner on Wednesday attributing Benedict’s death to suicide by combined fluoxetine (Prozac) and diphenhydramine (Benadryl) toxicity led to public skepticism and demands for more detail. information due to the brevity of the report. Benedict died on February 8, one day after he was attacked by a group of girls in an Owasso High School bathroom. The full report is expected to be released on March 27.
In their response to the medical examiner’s summary report, Benedict’s family, through their legal representation, sought to draw attention to details of physical injuries not fully covered by the original classification of Benedict’s death. They pointed to details from the full autopsy report, which, while stating “No fatal injury,” listed several significant injuries. These included bruising around Benedict’s right eye and on the right side of their faces, minor cuts to their right cheek and ear and scrapes to both ears and left cheek, along with a hemorrhage under the scalp. There is an abrasion and contusion on the teenager’s chest which, along with a specific type of bruising, is likely from attempts to save his life through CPR. In addition, Benedict’s limbs showed a mix of fresh and healing bruises, scrapes and scars, especially noticeable on the back of their left hand, according to the family. By sharing these details, the family aimed to highlight the extent of the physical damage Benedict experienced, countering any suggestion that the assault he faced was minor and calling for a fuller investigation into the events leading up to it. until his death.
GLAAD President and CEO Sarah Kate Ellis urged restraint in reporting findings without the full context of the report.
“Nex’s family accurately notes how the report released this week does not reflect the full picture of what happened to Nex and continues to demand accountability for those who failed to protect Nex and all Oklahoma students from bullying, harassment, assault and most brutally, death,” Ellis said in a statement. “The media must continue to question those who are releasing information prematurely and incompletely in this investigation and demand answers about the appalling response to a horrific attack in a public school bathroom and the state-sponsored bullying that led to it.” Our hearts go out to Nex’s family as they endure their unbearable loss. All families deserve to know that their children’s safety will always come first in their schools and communities.
The lawyer spoke with Dr. Joshua King, medical director of the Maryland Poison Center at the University of Maryland School of Pharmacy, and Dr. Masha Yemetz, a fellow in clinical toxicology at the same institution, to gain insight into the risks associated with fluoxetine and diphenhydramine, especially in overdose scenarios.
Both said they could not comment definitively on Benedict’s death — “Without the full autopsy report and associated toxicology data, we would not be able to comment on the medical examiner’s decision,” Yemetz cautioned — but agreed that both drugs that reported to be in the Benedict System is generally accepted and poses a low risk of dangerous interactions when used properly. Diphenhydramine is an antihistamine that is taken for allergies, and fluoxetine is used for depression and anxiety.
“In general, with therapeutic use, meaning taking it as prescribed or as directed, death, while not impossible, would be very, very unusual,” King said, noting that while most overdoses are not fatal, they can cause significant harm, sometimes requiring the patient to be hospitalized.
“Diphenhydramine and fluoxetine are part of a larger group of drugs that are, for the most part, used safely by millions of people. The risk of death from these drugs, especially when used as directed, is extremely low,” he added.
King explained that while most people do not have adverse effects from these drugs, people with co-morbidities may be at risk.
“It is possible for drugs to interact in someone who has had undiagnosed heart disease, meaning that these drugs can cause a certain type of heart arrhythmia called torsades, but this would be very, very, very rare in normal use. I’m not going to say it’s impossible,” King said, noting that such cases often come to light postmortem when investigation reveals previously unknown congenital or inherited heart disease. He emphasized the rarity of fatal outcomes with normal therapeutic use, but acknowledged the serious risks, associated with overdose, including serotonin syndrome, which can lead to confusion, hallucinations, agitation and, in severe cases, seizures and potentially fatal respiratory complications.” Most of these overdoses are treated. It’s something we do quite often at the poison center,” he added. “The vast majority of these are not fatal, but if you take enough of it, especially with a confounding factor like another sedative, it can.”
Yemets added, “Most of the time when poison control centers are called, there is something that was found at the scene or something that was reported by a family member, a caregiver, the patient themselves that makes it clear that there was an exposure or ingestion.” This information allows medical professionals to assess the situation and tailor their responses accordingly and accurately. She pointed out that without such initial reports, determining the exact cause of symptoms can be challenging, although the lack of this information does not preclude the use of standard medical interventions.
King gave a nuanced explanation of the progression of deterioration after an overdose involving drugs like the ones in question. “Death is again very rare from these poisons, but we would say that in the event of an overdose, the common complications can lead to convulsions and aspiration. Aspiration means that the vomit goes down into the lungs, which can quickly lead to death. However, the most rapid cause of death can be arrhythmia,” King said, pointing to the rapid onset of severe symptoms that can occur within an hour or two of ingestion.
He emphasized the importance of thorough medical examinations and toxicology reports in such cases: “I think any way you cut it, it’s a terrible tragedy. It is crucial to determine how much of this tragedy is due to the circumstances we have heard about, or how much is a matter of suicide prevention.”
Since Benedict’s death, the Rainbow Youth Project, a non-profit organization that supports LGBTQ+ youth, has seen an exponential increase in calls to crisis lines from LGBTQ+ youth seeking support.
Regarding young people being prescribed antidepressants such as fluoxetine, in addition to those who may be using diphenhydramine for allergies, King stressed the need to avoid alarming patients and their caregivers. Discontinuing prescription drugs because of fear caused by individual cases can cause more harm than the drug itself, he noted. “It would be more dangerous if someone got this drug for depression and heard about this case and said, ‘This is dangerous.’ I’m going to stop taking it,’ and then I got a complication from untreated depression,” he said.
He also stressed the need to wait for the full autopsy report for a more precise understanding: “It seems unlikely that such findings would be in the medical examiner’s report without some access to analytical data. The levels found usually give us an indication of whether there was an overdose or regular use, information that is crucial but not yet reported,” he said.
The degree of danger of overdose varies greatly from person to person, he added. “It’s different for everyone and it depends on the person. But in general, we’re talking about multiple doses,” King explained. He cautioned against the misconception that doubling a dose may be safe, explaining that there is a significant difference between accidentally taking two or three times the prescribed dose and consuming a handful of pills. “Most of the serious poisonings we see involve taking 10 times or more of the prescribed dose. However, it is impossible to predict exactly how someone will react because different bodies react in different ways,” he said.
Overdoses of drugs like diphenhydramine and fluoxetine are a weekly occurrence at the poison control center where he works, King said.
April 2023 Weekly Morbidity and Mortality Report from the Centers for Disease Control and Prevention sheds light on the alarming trend of suspected suicide attempts by poisoning among young people following the COVID-19 pandemic, highlighting the involvement of common medications such as fluoxetine and diphenhydramine. These two drugs are among the most important substances that contributed to these overdose cases. The analysis reveals a significant increase in overdoses with these drugs, with diphenhydramine overdoses increasing by 24.2 percent in 2021 and 35.8 percent in 2022.
This frequent reporting is influenced by how often these drugs are prescribed and used, King explained. The regular appearance of these drugs on the lists does not necessarily mean they are more dangerous than others, he said. Instead, he suggested that their prevalence in overdose reports is mainly due to how accessible they are. “People will usually overdose on what they have available,” he said.
While Benedict’s family calls for action against bullying and hate in schools, the community awaits the full autopsy report for more definitive answers.
If you or someone you know needs mental health resources and support, please call, text or chat with the 988 Lifeline for Suicide and Crisis or visit988lifeline.org for 24/7 access to free and confidential services. The Trans Lifeline, designed for transgender or gender nonconforming people, can be reached at (877) 565-8860. Lifebuoy also provides resources to help with other crises, such as domestic violence situations. The Trevor Project Lifeline, for LGBTQ+ youth (ages 24 and younger), can be reached at (866) 488-7386. Users can also access chat services on TheTrevorProject.org/Help or send SMS START to 678678.
