Bromazolam is a synthetic compound belonging to the triazolobenzodiazepine class, initially synthesized in the 1970s as a potential medication. It was never approved for medical use in any country and is not a prescription drug. Instead, it is commonly encountered in illicit drug markets, often categorized as a “research chemical” or a novel psychoactive substance (NPS). Its presence in the illicit drug supply was first documented in Sweden in 2016, and it later appeared in the United States in 2019.
Pharmacological Profile
Bromazolam exerts its effects by acting on the central nervous system, specifically as a positive allosteric modulator of the gamma-aminobutyric acid type A (GABA-A) receptor. GABA is a primary inhibitory neurotransmitter in the brain, functioning to reduce neuronal excitability. When bromazolam binds to the GABA-A receptor, it enhances GABA’s ability to open chloride ion channels, leading to central nervous system depression.
The interaction with GABA-A receptors produces effects characteristic of benzodiazepines, such as anxiety reduction, sedation, and muscle relaxation. Users report sleep-inducing, sedative, and muscle-relaxing effects. Other reported effects include euphoria, increased confidence, and empathy. The onset of these effects typically occurs within 15 to 45 minutes after oral ingestion, with a duration of action estimated to be between five and eight hours.
Reported Non-Medical Uses
Bromazolam is frequently used in non-medical settings, often obtained through online drug markets. Individuals may seek out bromazolam for self-medication purposes, attempting to alleviate symptoms such as anxiety or insomnia. This unsupervised use is a significant concern, as it bypasses professional medical evaluation and guidance for these conditions.
Bromazolam is also used recreationally for its sedative and euphoric effects. Its potency, which can be comparable to or even higher than some prescription benzodiazepines like alprazolam (Xanax), contributes to its appeal in illicit markets. It is also used as a substitute for prescription benzodiazepines when regulated medications are inaccessible.
The substance is sold in various forms, including tablets, powders, and sometimes as “gummies.” It has been detected in formulations that combine multiple benzodiazepines or are falsely labeled as legitimate prescription drugs, such as alprazolam or diazepam. This misrepresentation adds to the unpredictable nature and danger of using illicit bromazolam.
Associated Risks and Harms
The use of bromazolam carries a range of potential negative consequences, from common side effects to severe, life-threatening events. Common side effects reported by users include drowsiness, impaired coordination, dizziness, and memory issues, specifically problems retaining new memories. These effects can significantly impair cognitive and motor functions, increasing the risk of accidents.
A substantial risk associated with bromazolam use is the potential for dependence and severe withdrawal symptoms following chronic use. Withdrawal can be severe, including psychosis and hallucinations. The danger of overdose is particularly high, especially when bromazolam is combined with other central nervous system depressants like alcohol or opioids. This combination can lead to dangerously slow and shallow breathing, known as respiratory depression, which can progress to coma and death.
Bromazolam has been increasingly detected in toxicology cases, including post-mortem samples, with a notable rise in co-detection with fentanyl. The unregulated nature of illicit bromazolam means its purity and potency are highly variable, making it impossible for users to know the actual dose or what other substances might be present. This unpredictability heightens the risk of adverse outcomes, including accidental overdose.
Regulatory Status and Public Health Concerns
Bromazolam is not under international control by the World Health Organization. However, due to its status as a novel psychoactive substance (NPS) and lack of medical approval, many jurisdictions have implemented or are considering strict controls. For instance, it is classified as a Schedule IV substance under Canadian law and is regulated under psychoactive drug control regulations in Germany and the United Kingdom. In the United States, bromazolam is not federally scheduled under the Controlled Substances Act, but several states have moved to classify it as a Schedule I controlled substance.
The emergence and increasing prevalence of unapproved and unregulated substances like bromazolam pose significant public health challenges. The uncontrolled supply chain means that substances sold as bromazolam can vary wildly in content and potency, often being mixed with other potent drugs like fentanyl. This unpredictability makes it challenging for healthcare providers to treat overdoses effectively, as reversal agents like naloxone, while effective for opioid overdoses, do not reverse the effects of benzodiazepines. Law enforcement also faces difficulties in controlling these substances due to their evolving chemical structures and often undefined legal status.