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Bromazolam Prevalence Surging Across the United States Driven In Part by Increasing Detections Alongside Fentanyl

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This document announces public health and safety, law enforcement, first responders, clinicians, medical examiners and coroners, forensic and clinical laboratory personal, and other related communities about new information regarding the emergent benzodiazepine bromazolam; the document provides a summary of bromazolam's characteristics as well as charts and graphs with information about the drug’s blood concentration numbers, molecular structure, bromazolam cases and positivity rates in the U.S., and geographical distribution; it also provides lists of recommendations for public health, medical examiners and coroners, laboratories, and clinicians.


This document provides background information on the novel psychoactive substance (NPS) of benzodiazepines, referred to as novel or designer benzodiazepines; it states that they are synthetically manufactured drugs with unknown biological effects and health risks. NPS benzodiazepines are of public health and safety concern due to the potential for high potency at low doses, producing strong sedation and amnesia. Other adverse effects include loss of coordination, drowsiness, dizziness, blurred vision, slurred speech, muscle relaxation, respiratory depression, and, in some cases, death. These factors make their presence in forensic cases of high importance, paired with increasing concerns over combinations of benzodiazepines with opioids, colloquially known as “benzo-dope”. The document notes that NPS benzodiazepines can appear in various drug preparations, including powders, tablets, liquids, and blotters. The document also provides a history of drug and its development, and notes that bromazolam is the brominated counterpart to the chlorinated drug alprazolam. Bromazolam is commonly reported in combination with other drugs, including the opioid fentanyl. As of June 2022, bromazolam has been identified in more than 250 toxicology cases submitted to NMS Labs, including both antemortem and postmortem investigations. Bromazolam has been identified in more than 190 toxicology samples tested at the Center for Forensic Science Research and Education (CFSRE), and co-detections with fentanyl have increased to more than 75% for bromazolam positive samples.

Date Published: January 1, 2022