Bromazolam is a newly emerging benzodiazepine drug which is not licensed for medicinal use. It may be sourced as a New Psychoactive Substance (NPS) for its desired effects or be consumed unknowingly via counterfeit Xanax® or Valium® preparations. As part of our Coronial workload, we observed an increase in the detection of bromazolam from September 2021 to November 2022. We report a series of 96 cases in which bromazolam was quantitated by high resolution accurate mass - mass spectrometry (HRAM - MS) in post-mortem blood. The mean (SD) post-mortem blood bromazolam concentration from our case series was 64.6 ( ± 79.4) µg/L (range <1-425 µg/L). Routine toxicological screening results have also been reported; the most commonly encountered drugs taken in combination with bromazolam were cocaine, gabapentinoids and diazepam. In 48% of cases at least one further designer benzodiazepine drug was also present (etizolam, flualprazolam, flubromazolam, flubromazepam). It is essential that laboratories providing toxicological investigations are aware of the limitations of their assays; and inclusion of bromazolam within targeted screening panels using LC-MS/MS is encouraged. Bromazolam has not been associated with death in isolation from resulting toxic concentrations; however, it is likely to enhance adverse clinical effects when taken in combination with stimulant and/or centrally-acting depressant drugs (poly-drug deaths). Bromazolam, similar to other benzodiazepines, may also impair cognition and decision making skills.
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With a recent rise in Bromazolam in the news, it’s important to look at what synthetic benzodiazepines are and how they can be dangerous.
What is Bromazolam?
Triazolobenzodiazepine is a synthetic benzodiazepine drug also known as bromazolam. It was originally developed in 1976, but it was never sent to market. It is considered a Novel Psychoactive Substance (NPS), meaning it does have some psychoactive effects along with the sedative effects of other benzodiazepines1.
Bromazolam is sold as tablets or powders, which means it can be used to adulterate drugs such as fentanyl or Alprazolam (Xanax®). Novel psychoactive substances belonging to the benzodiazepines class are usually purchased on the online drug market under various street names, such as “legal benzodiazepines”, “designer benzodiazepines” and “research chemicals”1. The trends from the European Monitoring Centre for Drugs and Drug Addiction showed warning signs for Bromazolam being sold illicitly on the streets in 20162.
Learn more about designer benzodiazepines in our blog post by USDTL’s Research and Development Coordinator, Amy Racines.
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Benzodiazepines and Pregnancy
The FDA has categories for drugs and related pregnancy risks. Benzodiazepines are considered a category D, which means that positive evidence of risk exists, but there are benefits from use that may outweigh the risk1. These drugs include Alprazolam, Chlordiazepoxide, Clonazepam, Diazepam, and Lorazepam. Drugs that are contraindicated in pregnancy, or should not be given to pregnant women, are estazolam, fluazepam, quazepam, temazepam and triazolam1.
Neonatal withdrawal reactions have been observed in newborns after maternal benzodiazepine use in the last weeks of pregnancy. There is also concern that neonatal exposure during breastfeeding may lead to central nervous system depression1. Since Bromazolam is a benzodiazepine, it is important to keep these FDA categories in mind as there is more exposure to it.
Bromazolam in the News
There have been more articles highlighting the incoming danger of bromazolam being sold illicitly in the United States, sometimes falsely marketed as Xanax or Alprazolam. As of this blog post, here are three relevant news articles:
References
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