On 17 January, the Welsh drug testing service WEDINOS received a sample of what was purchased off the illegal market as diazepam, a benzodiazepine commonly prescribed on the legal market. However, drug testing detected instead a novel benzodiazepine inside it: ethylbromazolam. This is, to our knowledge, was the first ever detection of this drug on the illegal benzodiazepine market.
This would not be the last time it was tested from samples originating from across the UK; since January, there’s been a steady increase in its detection, with 26 samples of the substance found in May alone. Its appearance is not solely a British specific phenomena: in February, it was found in Canada mixed with fentanyl; soon after, it was found in Australia, New Zealand and the US. Ethylbromazolam seems to be well inserted in the global benzo market.
But what exactly is ethylbromazolam? And how wary should we be of this new drug in the supply?
What we know about ethylbromazolam
Ethylbromazolam is a derivative of benzodiazepines: it is structurally similar to them, with distinct central nervous system depressant effects. With a history going back to the 1960s, benzodiazepines have become some of the most prescribed medications across the world, widely used to treat panic disorders, seizures, and insomnia, among many other things. They also feature heavily in the recreational drug market worldwide due to their sedative effects, as well as issues with habit-forming consumption after long or excessive benzodiazepine use.
Considering these risks, many doctors are wary of prescribing benzodiazepines to people who are already dependent on benzodiazepines, alcohol or other drugs, which may push consumers to buy them off unregulated street markets that carry their own risks. A pill bought as “Valium” or “Xanax” may actually contain a variety of benzodiazepines, opiates, or even completely unrelated medicines.
“[We’ve seen] only a very small sample [of the illegal benzodiazepine market]. But even within that small sample, it’s incredibly dynamic,” Blake Curtis, a chemist working at the Australian drug testing organization CanTEST, told TalkingDrugs about the street benzodiazepine supply.
“We’ve seen benzodiazepines mixed with analgesics like Pregabalin or opioids like Tapentadol and nitazenes. We’ve even seen anti-Alzheimer’s drugs mixed in there as well.”
As with the case of many classes of drugs, such as cathinones, the legal crack down on the benzodiazepine market has pushed producers to explore and market new substances that are not prohibited or less controlled. This is where ethylbromazolam comes in. Molecularly, it is a small modification of bromazolam; bromazolam itself already a designer benzodiazepine that grew in global popularity since its first detection in Sweden in 2016.
On the surface, it seems that ethylbromazolam’s recent popularity stems from the fact it’s simply not controlled yet. It joins the long list of novel benzodiazepines constantly popping up on markets pressed and sold as branded diazepam or alprazolam in authentic looking blister packs. Ethylbromazolam’s surge may be a reaction to the Chinese ban of bromazolam in July 2024. While China is a known producer of many new psychoactive substances and research chemicals, there’s evidence that illegal benzodiazepine production happens across the world. Bromazolam’s scheduling in the UN control conventions in December 2024 may be a more likely trigger for ethylbromazolam’s appearance, which may have triggered a global search for an easily modified alternative to it. It’s a good candidate to fulfil the hole left by bromazolam’s ban.
Potential dangers
While ethylbromazolam may not be the first novel benzodiazepine to enter the global market – others like etizolam and nimetazepam have done the rounds for years – there’s a chance for new risks with a new drug; complacency must be avoided.
While there has been no clinical testing of ethylbromazolam’s potency against other benzodiazepines, new benzodiazepines have historically been associated with a spike in drug harms and deaths. In Scotland, the introduction and rapid spread of etizolam into the drug supply in 2012 led to a substantial rise in drug-related deaths. In 2012, etizolam was found in 0.2% of drug-related deaths; this rose to 60% by 2020. Etizolam and other benzodiazepine analogues were the most commonly mentioned benzodiazepines in cause of death reports in Scotland from 2013 to 2020.
Novel benzodiazepines tend to have little to no history of regular use, meaning little is known about its dosage, long-term health risks or their interactions with other drugs. At the moment, there is very little known about ethylbromazolam: there are no studies on it on Pubmed or Google Scholar. One of the very few studies into it was published in 1986, comparing it to bromazolam. While preliminary, this study found differences in the rate of convulsion when comparing ethylbromazolam to bromazolam, indicating that while chemically similar, the drugs may act differently. This lack of information combined with its potential global spread should be cause for concern.
With benzodiazepines, understanding its appropriate dosage is essential for safe use. An unexpectedly strong dose can easily cause an overdose, which can lead to loss of consciousness and shallow breathing. Prolonged use, particularly of strong benzodiazepines, can result in potentially fatal withdrawal symptoms. Reducing its use needs to be properly managed with a tailored tapering schedule, ideally developed alongside an expert. The risks can expand even further when we consider polydrug use. Mixing benzodiazepines, particularly with other substances with similarly depressive effects, can be particularly dangerous.
“Benzos by themselves are usually very hard to overdose on,” Fraser Parry, a Drugs Advocate working at Release in the UK, and who has supported many people struggling with benzodiazepine dependency, told TalkingDrugs.
“However, there are significant risks when using them along with other drugs – particularly other central nervous system depressants like alcohol, opiates or GHB. Combining depressants hugely increases the chance of overdose.”
For this group, those using both benzodiazepines and opioids, the fatal health risks of new benzodiazepines may be the highest. With etizolam use in Scotland, concurrent opioid use was the most common cause of adverse effects and fatalities. The harms of this concurrent drug use are exacerbated by the rising presence of nitazenes within the global benzodiazepine supply. This means that some people using benzodiazepines may be using a new opioid-new benzodiazepine combination of unknown potency without their knowledge.
Drug checking needed more than ever
Unless something significant is done to crack down on its production, ethylbromazolam is more than likely to join the list of illegally produced benzodiazepines in circulation. Its presence is a reminder of the importance of drug checking services; they can help raise people’s awareness of what’s in their own drug supply and across their region, along with access to non-judgemental care, and taper prescriptions for habitual consumers. Drug checking is essential to keep people safe from a contaminated drug supply.
When asked, AJ Martin, a researcher from the British Benzo Research Project, highlighted the need for involvement also with the people who take drugs in their own care:
“The development of any initiative aiming to reduce harms from benzos must involve the people that take them. Drug support and mental health services desperately need reinvestment, as our research showed that many young people take benzos to manage mental health symptoms.”
As benzodiazepines are some of the psychoactive substances that are most used for non-medical purposes, there’s a pressing need to develop clear information on what’s in illegally produced pills, and what’s the appropriate dosage of new substances. The appearance of ethylbromazolam is a reminder of the fatal risk of not knowing what you’re using and how much is relatively safe to consume. While there’s very little that can be done to stop new substances from appearing on the market, there’s ways for us to be informed and keep each other safe and alive.
