Journal article
Occult bromazolam exposure in patients presenting with opioid or stimulant overdose
Clinical toxicology (Philadelphia, Pa.), Vol.63(5), pp.330-336
05/04/2025
DOI: 10.1080/15563650.2025.2490831
PMID: 40387680
Abstract
Introduction
Bromazolam is a benzodiazepine, not approved for use in any North American or European jurisdiction that has emerged as an adulterant in the United States illicit drug supply.
Methods
This is a case series of seven patients treated for an acute overdose and found to have bromazolam in their blood despite no self-reported exposure. Patients were enrolled from June 2023 to January 2024 as part of the Drug Overdose Toxico-Surveillance Reporting Program, a multi-center, prospective project including patients aged 13 years and older with a suspected life-threatening opioid and/or stimulant overdose. This case series is drawn from a single emergency department from that project. Patients were interviewed on their drug use, and clinical data were collected from electronic medical records. Whole blood was obtained and tested qualitatively for over 1,200 psychoactive substances using liquid chromatography quadrupole time-of-flight mass spectrometry and quantitative measurements using liquid chromatography-tandem quadrupole mass spectrometry.
Results
Patients presented with acute signs of excessive sedation (six of seven) or agitation (one of seven). The median blood bromazolam concentration was 29 µg/L (range <5–84 µg/L). Three patients were admitted to hospital or observed for more than 24 h in the emergency department. The reasons for admission/observation were advanced pregnancy, prolonged sedation, and the need for social services. No patients were placed in a critical care unit and all patients survived. During the structured interview, none of the patients reported bromazolam use.
Discussion
This case series demonstrated no poor clinical outcomes in patients with acute overdose who had detectable bromazolam concentrations despite no reported bromazolam use. In all cases of sedation, patients responded to naloxone (in all cases the patients admitted to taking opioids, which was confirmed analytically), and there was no ongoing sedation attributed to the detected bromazolam.
Conclusions
Substances unknown to patients are present in the drug supply. Toxico-surveillance programs are essential to obtaining information about community patterns of drug use that cannot be obtained from patient history or from medical charts.
Details
- Title: Subtitle
- Occult bromazolam exposure in patients presenting with opioid or stimulant overdose
- Creators
- Adenine Cembellin-Kao - Johns Hopkins UniversityKim Aldy - American College of Medical ToxicologyJeffrey Brent - University of Colorado DenverRachel Culbreth - American College of Medical ToxicologyCrystal LaBozzetta - Johns Hopkins UniversityMiguel Alexander Turcios - Johns Hopkins UniversityPaul Wax - American College of Medical ToxicologyChase Yonamine - Johns Hopkins UniversityAndrew Stolbach - Johns Hopkins UniversityStephanie Abston - American College of Medical ToxicologyJennie Buchanan - Hospital AuthoritySharan Campleman - American College of Medical ToxicologyMichael Chary - Cornell UniversityAlyssa Falise - American College of Medical ToxicologyJonathan Ford - University of California, DavisCharlotte Goldfine - Brigham and Women's HospitalRobert Hendrickson - Oregon Health & Science UniversityDavid Jang - University of PennsylvaniaDana Jorgenson - University of IowaAndrew King - Wayne State UniversityJacob Lebin - University of Colorado DenverMichael Levine - University of California, Los AngelesDavid LissMaryann Mazer-Amirshahi - Georgetown UniversityMichael Brett Marlin - University of Mississippi Medical CenterDaniel McCabe - University of IowaAndrew Monte - Washington Poison CenterHoan Nguyen - University of California, DavisTravis Olives - Hennepin Healthcare Research InstituteJeanmarie Perrone - University of PennsylvaniaAnthony Pizon - University of PittsburghEvan Schwarz - University of California, Los AngelesCraig Smollin - University of California, San FranciscoMeghan Spyres - Banner - University Medical Center TucsonAlex Krotulski - Fredric Rieders Family FoundationBarry Logan - Fredric Rieders Family Foundation
- Resource Type
- Journal article
- Publication Details
- Clinical toxicology (Philadelphia, Pa.), Vol.63(5), pp.330-336
- DOI
- 10.1080/15563650.2025.2490831
- PMID
- 40387680
- NLM abbreviation
- Clin Toxicol (Phila)
- ISSN
- 1556-3650
- eISSN
- 1556-9519
- Publisher
- TAYLOR & FRANCIS LTD
- Grant note
- Food and Drug administration: 75F40122D00028/75F40123F19002
The Toxicology investigators Consortium Drug Overdose Toxico-surveillance Reporting Program is partially funded by Food and Drug administration [Contract #75F40122D00028/75F40123F19002].
- Language
- English
- Electronic publication date
- 05/19/2025
- Date published
- 05/04/2025
- Academic Unit
- Emergency Medicine; Pharmacy Practice and Science
- Record Identifier
- 9984824284202771
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