Recent data from the U.S. Centers for Disease Control and Prevention (CDC) highlights an alarming increase in the use of Bromazolam, a street drug increasingly detected in the United States. Bromazolam is associated with severe health complications, including prolonged seizures, myocardial injuries, comas, and extended intensive care unit stays.
A designer benzodiazepine, Bromazolam, is synthesized in laboratories and lacks medical sanction. The Center for Forensic Science Research and Education (CFSRE) first identified its presence in European recreational drugs in 2016, followed by its emergence in the U.S. Marketed under various names like “XLI-268,” “Xanax,” “Fake Xanax,” and “Dope,” it is available in tablet, powder, or gummy form and often used with fentanyl. Frequently, it is misrepresented as Xanax or combined with other counterfeit substances to enhance potency.
In the context of substance abuse, counterfeit drugs are those misrepresented and often passed off as more expensive or desirable drugs. These may contain incorrect dosages, no active ingredients, or dangerous substances like fentanyl. The latter, a potent, cheap synthetic opioid, is added to increase potency or as a cost-effective substitute. The imprecise production in illegal drug labs and potential cross-contamination can lead to unintentional mixing of fentanyl into various drugs, heightening overdose risks. These drugs are produced without regulatory oversight or quality control, with estimates suggesting that 25% to 50% of street-purchased drugs are counterfeit, varying by drug type and location.
A CDC report in the Morbidity and Mortality Weekly Report (MMWR) detailed the plight of three young adults who ingested Bromazolam, mistaking it for alprazolam. Found unresponsive, they were unreactive to naloxone and unconscious upon emergency department arrival, exhibiting hypertension, tachycardia, hyperthermia, and generalized seizures, necessitating intensive care and intubation. Elevated troponin levels and positive benzodiazepine results were observed in urine tests. The aftermath varied from an 11-day hospital stay to mild auditory issues and a persistent comatose state, despite antiepileptic treatments. Toxicology tests by the Drug Enforcement Administration confirmed Bromazolam levels ranging from 31.1 to 207 ng/mL, with no fentanyl or other opioids detected. The CDC stresses the need for increased awareness among public health officials, regional poison centers, clinicians, and first responders. In treatment protocols for seizures, myocardial injuries, or hyperthermia following illicit drug use, Bromazolam consideration is advised.
The rise in Bromazolam’s presence is concerning. As of mid-2022, over 250 toxicology cases involving Bromazolam were reported to NMS Labs, and CFSRE tested more than 190 samples positive for the drug. From early 2021, where only 1% of samples tested positive, the figure rose to 13% by mid-2022, with 75% also testing positive for fentanyl.
Global health authorities warn about Bromazolam risks, noting that the overdose reversal agent naloxone is ineffective against benzodiazepine overdoses. In December 2022, New Brunswick, Canada, reported its detection in several sudden death investigations, often with fentanyl. The Northwest Territories government issued similar warnings in May 2023. In the U.S., the Indiana Department of Health alerted about increasing Bromazolam detections, with 35 overdose cases testing positive in the first half of 2023.
U.S. law enforcement seizures of Bromazolam have escalated significantly, from a maximum of three annually during 2016-2018 to 2142 in 2022, and even higher in 2023. Illinois has noted a rise in Bromazolam-related deaths, from 10 in 2021 to 51 in 2022.
These findings, published online on January 4, 2024, in the MMWR, underscore the urgent need for increased surveillance and public health interventions to combat the challenge posed by Bromazolam and similar substances.
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