<i>Notes from the Field:</i> Seizures, Hyperthermia, and Myocardial Injury in Three Young Adults Who Consumed Bromazolam Disguised as Alprazolam — Chicago, Illinois, February 2023
Paul F. Ehlers, Amy L. Deitche, Leslie Wise, Sarah Patrick, Alfreda Holloway‐Beth, Ross Ellison, Jordan Trecki, Roy Gerona, Michael Wahl
Abstract
Bromazolam is a "designer" triazolobenzodiazepine synthesized in 1976 but never approved for therapeutic use (1).Since its first detection in Sweden in 2016, a significant increase has persisted in both the toxicologic identification of bromazolam in combination with fentanyl and its identification in counterfeit benzodiazepine preparations (2).The number of law enforcement seizures in the United States that involved bromazolam increased from no more than three per year during 2016-2018 to 2,142 in 2022, and 2,913 in 2023.*In Illinois, bromazolam-involved deaths increased from 10 in 2021 to 51 in 2022. Although human studies with clinical data are limited, animal models suggest bromazolam acts predominantly as a sedative, similar to other benzodiazepines, and to date, no signal for hyperthermia, myocardial injury, or seizures attributable to bromazolam intoxication exists (3).Although mostly detected alongside fentanyl or other opioids (88%-100% of tested samples), consumption of bromazolam can be life-threatening even in the absence of other drugs.This report discusses a cluster of three young adult patients who were treated at local emergency departments for hyperthermia, seizures, and myocardial injury after consuming bromazolam disguised as alprazolam.This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.*** The National Forensic Laboratory Information System (NFLIS) is an important resource in monitoring illicit drug trafficking, including the diversion of legally manufactured pharmaceuticals into illegal markets.NFLIS-Drug is a comprehensive information system that includes data from forensic laboratories that handle approximately 98% of an estimated 1.5 million distinct annual federal, state, and local drug analysis cases.NFLIS-Drug includes drug chemistry results from completed analyses only.Query date was December 14, 2023; data for 2023 are still being reported.https://www.nflis. deadiversion.usdoj.gov/ A case was categorized as bromazolam-involved if bromazolam was listed as a contributing cause of death on the death certificate in the Illinois Vital Records system. https://dph.illinois.gov/data-statistics/vital-statistics.html