By Freepik© Studio

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.

By Freepik© Studio

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:

• August 29, 2023 – Indiana health officials warn about ‘emerging threat’ of drug Bromazolam
  • https://fox59.com/news/indiana-health-officials-warn-about-emerging-threat-of-drug-bromazolam/
• August 29, 2023 – ‘Fake Xanax:’ A worry to law enforcement, often mixed with deadly fentanyl
  • https://www.wane.com/top-stories/fake-xanax-a-worry-to-law-enforcement-often-mixed-with-deadly-fentanyl-and-its-in-fort-wayne/
• June 10, 2023 – Deadly drug just ‘a click away’, warns grieving Ontario family
  • https://www.cbc.ca/news/health/bromazolam-online-sales-warning-1.6869577

References

1. Critical Review Report: Bromazolam, World Health Organization
2. European Drug Report 2023: Trends and Developments

Updated: 1/22/24:

We are running behind, but working overtime to get you results.

1. Due to weather conditions on Friday (1/12/24), we experienced a power outage at the laboratory. Our instrumentation, network (email, phones, etc.), and web portal were down late into the evening.  Unfortunately, this means we experienced delays in receiving and processing specimens into the laboratory, causing delays in reporting some results. 

2. FedEx is experiencing weather and other service delays, causing issues with getting specimens to our laboratory. You can learn more about FedEx delays here.

3. This morning, a pipe burst in the lab, adding more delay to our ability to process specimens.

This unfortunate collection of events has been challenging, but rest assured we are doing our best to process specimens as quickly as we can and get your reports to you as soon as possible.

Thank you for understanding. If you are also affected by the weather conditions, please be safe out there

Tianeptine is an atypical tricyclic antidepressant, commonly referred to as Gas Station Heroin or Za Za. Its use, linked to serious harm and death, has been making headlines. Tianeptine is not approved in the United States but is legal in other countries to treat depression or anxiety. Reports in the United States about severe harm due to tianeptine have been increasing, leading the FDA to issue a formal warning about the drug¹.   

The clinical effects of tianeptine are very similar to opioids, leading some opioid users to switch to tianeptine as an opioid alternative1. Other users have turned to tianeptine to self-treat depression or anxiety. Tianeptine users experience dependence, withdrawal, and overdose when used at concentrations above the therapeutic doses prescribed in other countries¹. However, when tianeptine is used in small doses consistent with therapeutic treatments, no negative side effects have been reported. Several case studies have shown that tianeptine toxicity mimics that experienced from opioids and that naloxone is an effective therapy^2,3. 

The Centers for Disease Control reports that tianeptine use is on the rise. From 2000 to 2014, there were 11 calls to poison control regarding tianeptine, but from 2014-2017, there were over 200 calls⁴. Nationally, tianeptine is not scheduled, though Alabama and Michigan have added the drug as a Schedule II substance. Tianeptine is readily available online, typically in tablet or powder form⁵. 

References:

1. Tianeptine Products Linked to Serious Harm, Overdoses, Death | FDA 
2. Acute Toxicity From Intravenous Use of the Tricyclic Antidepressant Tianeptine – PubMed (nih.gov) 
3. Amitriptyline and tianeptine poisoning treated by naloxone – PubMed (nih.gov) 
4. Characteristics of Tianeptine Exposures Reported to the National Poison Data System — United States, 2000–2017 | MMWR (cdc.gov) 
5. Tianeptine (usdoj.gov)