Driving Impairment Cases Involving Etizolam and Flubromazolam

Abstract

This study describes 12 cases of drivers stopped for impaired driving, where a designer benzodiazepine was detected, specifically etizolam or flubromazolam. Etizolam was detected in three cases, with blood concentrations ranging from 40 to 330 ng/mL. Two of these cases had low concentrations of methamphetamine and/or amphetamine, and in the third case tetrahydrocannabinol (THC) was detected. Flubromazolam was detected in nine cases; in all cases, at least one other drug was detected, with THC being the most prevalent. The mean blood concentration of flubromazolam was 16.3 ng/mL and had a median concentration of 17.0 ng/mL, ranging from 7.0 to 31 ng/mL. The low concentrations of designer benzodiazepines that produce pharmacological effects may allow many of these drugs to go undetected using routine testing in laboratories; therefore, it is necessary to include these novel compounds within validated analytical methods to reduce the chance of reporting false negative results. The prevalence in which laboratories are detecting the presence of novel benzodiazepines in impaired drivers illustrates the increased threat to public safety. These case studies demonstrate the importance of investigating agencies and forensic laboratories to be vigilant in monitoring the emerging novel psychoactive substances in their region.

Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, 2017–2020: A Review

“…In Wichita, KS, 12 DUID cases involved use of a designer benzodiazepine etizolam in three cases and flubromazolam in nine ( 186 ). Apart from one case, etizolam and/or flubromazolam were the only benzodiazepines, routine or novel, detected in blood samples.…”

What's in fake ‘Xanax’?: A dosage survey of designer benzodiazepines in counterfeit pharmaceutical tablets

“…7 DBZDs have been detected, typically in combination with other drugs, in a growing number of drug-related deaths in multiple countries, and have been associated with numerous other adverse health events and instances of driving impairment. 11,[15][16][17][18][19] As limited information is available on the dosage of DBZDs encountered in counterfeit tablets, 6 a rapid survey was undertaken between April and September 2020 using an established method for toxicology screening to analyse seized tablets. This short communication reports information on the packaging, identified drugs and dosage survey for counterfeit benzodiazepine tablets seized in Queensland, Australia.…”

New psychoactive substances—Designer benzodiazepines

“…Data on blood or serum concentrations of designer benzodiazepines found in authentic samples is limited to a few compounds so far (clonazolam, diclazepam, flualprazolam, flubromazepam, flubromazolam, and pyrazolam) (Heide et al, 2020; Hoiseth et al, 2016; Huppertz et al, 2018; Kriikku et al, 2020; Moosmann et al, 2014; Moosmann, Huppertz, et al, 2013; Moosmann, Hutter, et al, 2013; Papsun, Krotulski, Homan, Temporal, & Logan, 2020; Rice, Hikin, Lawson, Smith, & Morley, 2020; Rohrig, Osawa, Baird, & Youso, 2020; Sommerfeld‐Klatta et al, 2020; Wagmann, Manier, Felske, et al, 2020).…”