‘New/Designer Benzodiazepines’: An Analysis of the Literature and Psychonauts’ Trip Reports

Abstract

Background: NPS belonging to the benzodiazepine (BZD) class, e.g., ‘legal/designer BZDs’/‘research chemicals’, have recently emerged on the drug (mainly online/virtual) market. Objective: Whilst certain NPS belonging to the BZD class possess pharmacological profiles similar to controlled pharmaceutical BZDs, clinical and pharmacological profiles of current emerging BZDs are still not well-described. Therefore, there is a need to increase clinicians’/public health knowledge/awareness, to incentive harm reduction strategies. Method: A comprehensive overview was carried out by using the EMCDDA/EDND database regularly monitored by our research team, by specifically looking at the ‘new BZDs’ so far notified. Furthermore, given the limitation of peer-reviewed data published so far, a nonparticipant multilingual qualitative netnographic study was conducted to obtain further clinical/pharmacological/toxicological data, including psychonauts’ online trip reports. Results: First designer BZDs appeared as NPS around 2007. So far, 29 designer BZDs have been notified to the EMCDDA, being some of them extremely powerful, also at lower dosages. They are sold as tablets/powder/pellets/capsules/blotters/liquids, at very affordable prices, and variably administered. Some are also sold on the illicit drugmarket as counterfeit forms of traditional BZDs or as either adulterants or diluents in heroin or other synthetic opioids/cannabinoids. Nowadays, there is no guarantee of the quality of designer BZDs composition/purification and, hence, most NPS consumers may be inadvertently exposed to unsafe and harmful compounds. Conclusions: Given the limited information on their pharmacology/toxicity, variations in dosage, onset of effects, combination of substances, potency, and general patient or individual variability, the concomitant use of these substances with other drugs entails several and unpredictable risks.

Coming Off Prescribed Psychotropic Medications: Insights from Their Use as Recreational Drugs

“…Psychonauts are a clinical "niche," and their idiosyncratic levels of medication intake are better scrutinized with the help of the netnographic research approach [26]. This approach should be interpreted as a "magnifying lens," aimed at shedding further light on the putative misuse, abuse, and dependence potential of those psychotropics being prescribed by practicing psychiatrists.…”

“…Exotic BDZs were either tested, but not approved, as medicinal compounds or are derivatives of currently prescribed BDZs. For most of them, only very little pharmacology and toxicity knowledge is available [26]. Most typically, online BDZ purchasers are per definition not aware if they are taking traditional, designer, or counterfeit BDZs.…”

“…nifoxi-and tofisopam; adina-, broma-, clonitra-, clobroma-, clona-, deschloroeti-, eti-, flubroma-, flualpra-, flucloti-, flunitra-, meti-, nitra-, phena-, and pyrazolam, and Ro-07-4065 [26] For phenazepam, the most well-known exotic molecule: it can be ingested, snorted or injected, euphoric effects but also amnesia, drowsiness, dizziness, somnolence, difficulty in waking up, muscle weakness, headache, weakening of attention, incoordination, blurred vision, slurred speech, ataxia, and muscle weakness; at high dosages, delirium and psychosislike behaviour [26,27,29] Similar to traditional BDZ, withdrawal, dependence, and tolerance have been documented The withdrawal syndrome may however be arguably more intense when abruptly discontinuing potent/very potent BDZ Alprazolam: 30 mg or even higher dosages being anecdotally reported Clonazepam ingestion: oral, snorting, intramuscular; dosage: euphoria being achieved with 8-12 mg [53] Phenazepam is 5-10× more potent than diazepam [26,29] Etizolam: being ingested at >4 mg [26] Pyrazolam is 12× more potent than diazepam; dosage: >3-4 mg [26] Flubromazepam: >8-12 mg [26] Meclonazepam: >1-2 mg [26] Flubromazolam: 400-600 µg is considered a very high dosage [24] Z-drugs (zaleplon, zolpidem, and zopiclone)…”

Analyzing the Open/Deep Web to Better Understand the New/Novel Psychoactive Substances (NPS) Scenarios: Suggestions from CASSANDRA and NPS.Finder Research Projects

“…The use of automatic web crawler software such as the University of Hertfordshire (UK)-coordinated NPS.finder has allowed both scanning and identification activities of a constant flow of drug-related data, providing a nearly real-time update [11,12]. Current NPS.finder research project aims include: (a) identifying and describing the large number of novel/new psychoactive substances (NPS) available as identified from a range of psychonauts', NPS-related, online sources; and (b) identifying a methodology which may be able to anticipate, for each class of NPS, the modifications of their availability levels in the real life scenarios.…”

“…Future studies by our group will be expanding drug searches on less accessible areas of the web, such as the deep web and the most elusive darknet [13]. A qualitative/netnographic approach [11] will be needed as well, to better assess the possible psychonauts' preference between NPS analogues and their motivation for use. Furthermore, next NPS.Finder-based research will need to focus as well on specific, popular web languages, e.g., Chinese, Japanese and Arabic.…”