Designer Benzodiazepines: A Review of Toxicology and Public Health Risks
Abstract
:1. Introduction
2. Results
2.1. Adinazolam
2.2. Clonazolam
2.3. Deschloroetizolam
2.4. Diclazepam
2.5. Etizolam
2.6. Flualprazolam
2.7. Flubromazepam
2.8. Flubromazolam
2.9. Meclonazepam
2.10. Phenazepam and 3-Hydroxyphenazepam
2.11. Pyrazolam
3. Discussion
4. Materials and Methods
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Compound | Study | Age; Sex | Observations | Concentration †/Dose | Co-Exposure Concentration(s) † | Ref. |
---|---|---|---|---|---|---|
3-Hydroxyphenazepam | ED | 29; M | Tremor | Urine screen + | - | [74] |
Adinazolam | Death | 24; F | Multiple drugs | Blood 18 Urine 82.1 | U-47700 blood 1470, urine 3940 SRT blood 89.5, urine 32.5 N-Ethylhexedrone blood 58.1, urine 14 4-CIC blood 8, urine 130 4-CMC blood 1.7, urine 417 | [75] |
Clonazolam | ED | 25; M | Agitation, Aggressivity | 100 mg | BZD urine screen + THC urine screen + | [76] |
28; M | Lethargy | ≅15 mL of a 0.4 mg/mL solution | - | [77] | ||
26; M | Respiratory depression, Unconscious | Serum 6 | MDZ urine screen + U-47700 serum 351 THC serum 3.3, urine screen + THCCOOH serum 121.6, urine screen + CIT urine screen + | [78] | ||
34; M | Confusion, Lethargy | Serum 10.2 | Etizolam serum 281 | [79] | ||
20; M | Ataxia | Urine screen + | MXE urine screen + | [74] | ||
26; F | Coma | Blood 77 (4 h) Blood 15 (8 h) Blood 9 (12 h) | - | [80] | ||
Deschloroetizolam | Death | 31; M | Multi-organ congestion | Blood 11 Urine screen + | LMZ urine 258 LZP urine 115 OXZ urine 17.4 THC urine screen + | [81] |
Self-administration | 56; M | Dizziness, Fatigue, Language disorder, Difficulty concentrating; Took 6 mg | Oral Fluid 6.5 (30 min) | - | [82] | |
Diclazepam | ED | 30; M | Agitation, Confusion, Disorientation, Inability to communicate, Muscular rigidity, Myosis, Tachycardia, Tachypnoea | Plasma 3.5 | DIP plasma 308, urine 631 MPH plasma 3 THCCOOH urine 120 | [83] |
39; M | Agitation, Dilated pupils, Tachycardia | Urine screen + | 3,4-CTMP | [74] | ||
30; M | Mydriasis, Respiratory depression, Unconscious, Withdrawal syndrome. | 240 mg | - | [84] | ||
DUID | 18; M | Considerable impairment | Blood 57 | - | [85] | |
27 *; Not reported | Moderate impairment | Blood 61 | EtOH blood 0.053 g/L | [86] | ||
32 *; Not reported | Blood 45 | EtOH blood 0.084 g/L | ||||
22 *; Not reported | Blood 32 | - | ||||
<20; Not reported | Blood 19 | - | ||||
47 *; Not reported | Blood 16 | LZP blood 63 | ||||
52 *; Not reported | Blood 11 | NZP blood 17 | ||||
22 *; Not reported | Mild impairment | Blood 35 | LZP blood 14 | |||
22 *; Not reported | Blood 7.7 | THC blood 0.7 | ||||
22 *; Not reported | Blood 5.1 | - | ||||
37 *; Not reported | Considerable impairment | Blood 48 | - | |||
27 *; Not reported | Blood 35 | THC blood 1.1 | ||||
32 *; Not reported | Blood 14 | - | ||||
Death | 28; M | Multiple drugs | Blood 70 | Flubromazepam blood 10 U-47700 blood 330 MAMP blood 290 AMP blood 150 DOC blood screen + | [87] | |
Etizolam | ED | 31; M | Bradypnea, Unresponsive | Serum 103 | 6-AM urine 272 MOR urine 1000 COD urine 322 | [88] |
6; M | Ataxia, Drowsiness, Mydriasis | - | - | [89] | ||
9; M | - | - | ||||
10; M | Urine screen + | - | ||||
OD | 23; M | Tolerance, Withdrawal syndrome | 2.5 mg/day for 1 month | - | [90] | |
32; M | Catatonia, Withdrawal syndrome | 4 mg/day for 2 months, abruptly stopped | - | [91] | ||
30; M | Bradypnea, Loss of consciousness, Seizures, Withdrawal syndrome | Took 50 mg/day to 100 mg/day for several months Urine screen + | LZP urine screen + | [45] | ||
DUID | 27 *; Not reported | Mild impairment | Blood 210 | - | [86] | |
<20; Not reported | Blood 120 | TMD blood 71 | ||||
42 *; Not reported | Considerable impairment | Blood 110 | - | |||
37; M | Delayed comprehension and reaction time, Impairment, Incoordination, Lethargy | Blood 40 | AMP blood screen + | [71] | ||
20; F | Blood 88 | THC blood 11 | ||||
35; M | Blood 330 | MAMP blood screen + AMP blood screen + | ||||
Death | 59; F | Suicide | Blood 264 | αOH-Etizolam blood 9.4 8OH-Etizolam blood 9.3 | [92] | |
42; M | Multiple drugs | Blood 86 | PB blood 5082, urine 1736 PMZ blood 107, urine 806 CPZ blood 144, urine 1437 | [93] | ||
42; M | Multiple drugs | Blood 300 Urine 100 | MDVP blood 46, urine 1300 PEN blood 160, urine 1200 EPH blood 68 OLZ blood 4200 MIR blood 570 | [94] | ||
48; M | Accidental death, Multiple drugs | Serum 4 | MTD serum 381 EDDP serum 86 MOR serum 290 COD serum 47 PGB serum 14 PAR serum screen + | [95] | ||
40; M | Serum 17 | MOR serum 44 COD serum 7 COC serum screen + BE serum 1536 | ||||
29; M | Serum 40 | DZP serum screen + Nor-DZP serum 18 OXZ serum screen + MTD serum 133 EDDP serum 7 THC serum 2.4 THCCOOH serum 17 PGB serum 19 CYC serum 78 | ||||
38; M | Serum 44 | DZP serum 55 Nor-DZP serum 131 OXZ serum 11 MTD serum 886 EDDP serum 121 SRT serum 6 PMZ serum 57 PGB serum 13000 | ||||
48; M | Blood 4 | DZP blood 99 Nor-DZP blood 316 TMZ blood 15 OXZ blood 29 MOR blood 6 COD blood 83 AMP blood 394 AMI blood 307 NTP blood 283 PAR blood screen + | ||||
34; M | Blood 8 | Diclazepam blood 2 COD blood 108 CIT blood 423 Nor-CIT blood 93 | ||||
23; M | Blood 8 | EtOH blood 0.77 g/L ALP blood 300 Nor-DZP blood 5 MOR blood 5 COD blood 16 BE blood screen + SRT blood 19 PPL blood 8 | ||||
55; M | Blood 7 | DHC blood 1681 COC blood 317 BE blood 5135 AMI blood 1859 NTP blood 582 PGB blood 22300 | ||||
39; M | Blood 45 | MTD blood 377 COC blood 18 AMI blood 885 PGB blood 6500000 | ||||
38; M | Blood 172 | DZP blood 6 Nor-DZP blood 22 LZP blood screen + MTD blood 1233 EDDP blood 129 MOR blood 16 COD blood screen + COC blood 10 BE blood 299 THCCOOH blood 11.2 MIR blood 27 PGB blood 35900 | ||||
32; F | Blood 9 | DZP blood 306 MTD blood 86 MOR blood 1292 COC blood 7 MIR blood 6 PAR blood 22000 | ||||
43; M | Blood 93 | DZP blood screen + ZPC blood 65 MTD blood 2297 COC blood screen + MIR blood 8 PGB blood 3700 | ||||
42; M | Blood 85 | DZP blood 16 MOR blood 880 | ||||
37; M | Blood 85 | MTD blood 189 PGB blood 8500 | ||||
32; M | Blood 4 | DZP blood 107 MOR blood 273 AMP blood 859 CPA blood screen + GBP blood 2600 PGB blood 10300 PAR blood screen + | ||||
35; M | Blood 16 | MOR blood 269 COC blood screen + SRT blood 24 CBZ blood 2300 PGB blood 23,500 | ||||
39; F | Blood 1 | DZP blood 431 MTD v blood 634 PMZ blood 56 MIR blood 61 QTP blood 26 VPA blood screen + PGB blood 22,800 PAR blood screen + | ||||
32; M | Blood 18 | DZP blood 131 MOR blood 34 DHC blood 6413 HCOD blood 96 AMI blood 310 PGB blood 10,200 | ||||
49; M | Blood 1.5 | Flubromazepam blood 33 DZP blood 89 MTD blood 685 MOR blood 44 MIR blood 12 PGB blood 38,100 | ||||
54; F | Blood 12 | DZP blood 90 MTD blood 973 TMD blood screen + COC blood 12 AMI blood 67 MIR blood 280 PGB blood 12,900 | ||||
39; M | Blood 4 | EtOH blood 0.24 g/L DZP blood 68 MOR blood 1076 COC blood 184 CE blood 22 MIR blood 121 QTP blood 16 PAR blood screen + | ||||
49; M | Blood 12 | CZP blood screen + TAP blood 500 MOR blood 331 PGB blood 15,200 MIR blood screen + | ||||
28; M | Blood 29 | EtOH blood 1.1 g/L DZP blood 16 THC blood 57.5 MIR blood 39 PGB blood 2900 | ||||
39; M | Blood 3 | DZP blood 238 LZP blood 10 MOR blood 75 SRT blood 92 GBP blood 6700 PRO blood 598 PAR blood 15,700 | ||||
33; M | Blood 14 | Flubromazolam blood 1 DZP blood screen + MOR blood 56 COC v blood 46 PRO blood 186 CLO blood 2060 Nor-CLO blood 1629 MIR blood 257 LTG blood 5800 GBP blood 24,600 PAR blood screen + | ||||
49; M | Accidental death, Multiple drugs | Blood 770 Central blood 2820 Hair 0.107 | EtOH blood 0.19 g/L THCCOOH urine 192 THC hair 0.19 ng/mg AMP hair 3.37 ng/mg CAF blood 190,000 COC hair 0.22 ng/mg BE hair 0.068 ng/mg | [96] | ||
29; M | Accidental death, Multiple drugs | Central blood 45 Urine 13 Vitreous humor screen + | EtOH c blood 0.023 g/L, vitreous humor 0.014 g/L ALP c blood 228, urine 238, vitreous humor 17 α-OH-ALP c blood and urine screen + Nor-DZP c blood, urine and vitreous humor screen + FEN c blood 6, urine and vitreous humor screen + Nor-FEN c blood and urine screen + CDP c blood screen + DOX urine and vitreous humor screen + | [97] | ||
34; M | Blood 9 Central blood screen + Urine screen + Vitreous humor screen + | EtOH blood 0.023 g/L, vitreous humor 0.028 g/L Nor-DZP blood and urine screen + Desalkyl-FZP blood, urine and vitreous humor screen + 6-AM blood 11, c blood, urine and vitreous humor screen + MOR blood 185, c blood, urine and vitreous humor screen + COD p and c blood and vitreous humor screen + HCOD c blood and vitreous humor screen + CIT p and c blood, urine and vitreous humor screen + DPH p and c blood, urine and vitreous humor screen + | ||||
36; M | Blood 10 Urine 8 Vitreous humor screen + | Flubromazolam urine and vitreous humor screen + ALP blood 27, urine and vitreous humor screen + α-OH-ALP urine and vitreous humor screen + 7-Amino-CZP urine screen + FEN blood 31, vitreous humor screen + Nor-FEN blood and vitreous humor screen + MTD blood and vitreous humor screen + EDDP blood and vitreous humor screen + MAMP blood 1212, vitreous humor screen + AMP blood and vitreous humor screen + | ||||
28; M | Blood 15 Central blood 15 Urine 20 | ALP blood 179, c blood 235, urine screen +, vitreous humor 92 DZP p and c blood, urine and vitreous humor screen + Nor-DZP p and c blood, urine and vitreous humor screen + TMZ c blood and urine screen + Nor-FEN c blood and vitreous humor screen + HCOD urine screen + MAMP p and c blood, urine and vitreous humor screen + AMP c blood, urine and vitreous humor screen + BE urine screen + DOX p and c blood, urine and vitreous humor screen + PMZ c blood and urine screen + CPA p and c blood, urine and vitreous humor screen + | ||||
30; M | Blood 187 Central blood 214 Urine 64 Vitreous humor 33 | EtOH blood 0.002 g/L, vitreous humor 0.003 g/L Flualprazolam p and c blood, urine and vitreous humor screen + Flubromazolam blood 619, c blood 878, urine 552, vitreous humor screen + ALP p and c blood, urine and vitreous humor screen + DLP p and c blood, urine and vitreous humor screen + LZP p and c blood and urine screen + 7-Amino-CZP urine screen + FEN blood 17 Nor-FEN p and c blood, urine and vitreous humor screen + MAMP p and c blood, urine and vitreous humor screen + AMP p and c blood, urine and vitreous humor screen + | ||||
Flualprazolam | ED | 16; M | Lethargy, Slurred speech | Urine 72.1 | Nor-DZP urine screen + THC-COOH urine screen + | [98] |
16; F | Urine 3 | Nor-DZP urine screen + | ||||
16; M | CNS depression, Mild respiratory depression | Blood 14.6 Urine 19.4 | Nor-DZP urine screen + | |||
18; M | Unconscious | Blood 8 | COC blood screen + THC blood screen + | [99] | ||
DUID | 37 *; Not reported | Considerable impairment | Blood 15 | TMD blood 65 | [86] | |
Not reported | Considerable impairment | Blood 4.3 | DZP blood 25 BRP blood 1 FEN blood 6.2 COC blood 57 | [100] | ||
31; M | Delayed comprehension and reaction time, Driving impairment, Incoordination, Lethargy | Blood 4.4 | THC-COOH blood screen + LEV blood screen + | [101] | ||
22; M | Blood 8.3 | EtOH blood 0.01 g/L | ||||
31; M | Blood 8.9 | Etizolam blood screen + ALP blood screen + DLP blood screen + Nor-BUP blood screen + THC blood screen + | ||||
51; M | Blood 10 | OXY blood screen + OXM blood screen + | ||||
47; M | Blood 11 | CFN blood screen + FEN blood screen + MTD blood screen + COC blood screen + | ||||
24; M | Blood 13 | - | ||||
30; M | Blood 39 | BE blood screen + MTG blood screen + | ||||
20; M | Blood 46 | EtOH blood 0.003 g/L | ||||
40; M | Blood 46 | BPP blood screen + | ||||
20; M | Blood 65 | THC blood screen + | ||||
26; M | Blood 68 | Etizolam blood screen + MTD blood screen + | ||||
Death | 28 *; Not reported | Suicide | Blood 28 ng/g | MIR blood 200 ng/g VEN blood 520 ng/g | [102] | |
Blood 68 ng/g | EtOH blood 0.04 g/L BUP blood 0.94 ng/g, urine 17 ng/g Nor-BUP blood 0.83 ng/g, urine 15 ng/g | |||||
Suspected overdose, Multiple drugs | Blood 4 ng/g | VEN blood 1300 ng/g PGB blood 16000 ng/g | ||||
Blood 18 ng/g | MTD blood 150 ng/g | |||||
Blood 17 ng/g | EtOH blood 0.67 g/L, urine 1.33 g/L BUP blood 2.8 ng/g, urine 90 | |||||
Blood 19 ng/g | - | |||||
Blood 14 ng/g | LPM blood 60 ng/g | |||||
Blood 21 ng/g | - | |||||
Blood 11 ng/g | BUP blood 0.9 ng/g, urine 40 NBUP blood 0.2 ng/g | |||||
Blood 36 ng/g | BUP urine 120 ng/g NBUP urine 7.4 ng/g PGB blood 1700 ng/g | |||||
Blood 30 ng/g | EtOH blood 0.68 g/L BUP blood 1.1 ng/g, urine200 ng/g 3F-AMP blood 10 ng/g MAMP blood 190 ng/g AMP blood 1000 ng/g | |||||
Blood 13 ng/g | EtOH blood 1.9 g/L | |||||
Blood 33 ng/g | N-ethyl-3F-AMP blood screen + 3F-AMP blood screen + | |||||
53; M | Suspected overdose, Multiple drugs | Blood 50 | FEN blood 3.4 Nor-FEN blood 0.36 4-ANPP blood screen + ITZ blood screen + BRP blood 10, urine 23 6-AM blood 1.5 MOR blood 66 COD blood 6.6 CIT/ESC blood 76 | [100] | ||
45; M | Blood 2.5 | FEN blood 5 4-ANPP blood screen + TMD blood 33 BRP blood 1, urine 1.9 THC blood 0.62 | ||||
48; M | Blood 5.4 | CZP blood screen + FEN blood 4.7 Nor-FEN blood 1.6 Acetyl-FEN blood 1.2 4-ANPP blood screen + BRP blood 0.1, urine 0.2 MOR blood 8 DPH blood 190 | ||||
47; F | Blood 13 | FEN blood 190 Nor-FEN blood 5.4 Acetyl-FEN 0.15 4-ANPP blood screen + BRP blood 6.7, urine 2.1 6-AM blood 12 MOR blood 85 COD blood 7 MAMP blood 580 AMP blood 55 XYL blood 170 | ||||
53; M | Blood 20 | FEN blood 19 Nor-FEN blood 4.2 4-ANPP blood screen + BRP blood 0.2 MOR blood 15 XYL blood 30 | ||||
29; M | Blood 3.6 | 7-Amino-CZP blood 5.2 FEN blood 37 Nor-FEN blood 1.3 4-ANPP blood screen + TMD blood 70 BRP blood 1.1, urine 0.8 MAMP blood 42 AMP blood 10 DPH blood 490 | ||||
22; M | Suspected overdose, Multiple drugs | Blood 3.2 | EtOH blood 0.017 Desmethyl-LPM blood screen + | [101] | ||
53; M | Blood 2.1 | FEN blood screen + MTD blood screen + COC blood screen + GBP blood screen + | ||||
32; M | Blood 2.2 | BE blood screen + THC blood screen + MTG blood screen + CBP blood screen + HYZ blood screen + GBP blood screen + | ||||
29; M | Blood 4.1 | ITZ blood screen + MAMP blood screen + AMP blood screen + | ||||
35; F | Blood 5.2 | EtOH blood 0.008 g/L BE blood screen + THC blood screen + | ||||
38; M | Blood 6.2 | ITZ blood screen + FEN blood screen + MAMP blood screen + AMP blood screen + HYZ blood screen + | ||||
23; F | Blood 9.9 | FEN blood screen + 4-ANPP blood screen + BE blood screen + THC blood screen + MAMP blood screen + AMP blood screen + | ||||
23; M | Blood 15 | FEN blood screen + 4-ANPP blood screen + | ||||
21; M | Blood 29 | FEN blood screen + MAMP blood screen + AMP blood screen + THC blood screen + | ||||
36; M | Blood 63 | MTD blood screen + | ||||
40; M | Suicide | Blood 26.5 | DZP blood 9 Nor-DZP blood 4 MTD blood 736 EDDP blood 149 PGB blood 1900 | [103] | ||
30; M | Suspected overdose, Multiple drugs | Blood 3 | DZP blood screen + 6-AM blood screen + MOR blood 196 COD blood 11 THC blood screen + MIR blood screen + PGB blood 12000 | |||
44; M | Blood 35 | DZP blood screen + MTD blood 549 MOR blood screen + COC blood screen + BE blood screen + MDMA blood 29 MDA blood screen + MIR blood 58 GBP blood screen + PGB blood 18,100 | ||||
40; F | Blood 14.5 | MTD blood 711 EDDP blood 67 4F-MDMB-BINACA blood screen + MDMB-4en-PINACA blood screen + MIR blood 3229 PGB blood 7900 | ||||
37; M | Blood 14.1 | Etizolam blood 85 CBZ metabolites blood screen + MTD blood 189 5F-AMB metabolites blood screen + THC metabolites blood screen + PGB blood 8500 | ||||
51; M | Blood 3.1 | ALP blood 68 DZP blood 367 Nor-DZP blood 364 OXZ blood 45 TMZ blood 19 MTD blood 694 EDDP blood 365 MOR blood 62 COD blood 14 BE blood screen + SRT blood 31 PGB blood 47,000 RSP blood 35 | ||||
57; M | Blood 5.7 | COC blood 41 BE blood 718 CIT blood 707 | ||||
42; F | Blood 15.1 | MOR blood 410 COD blood 19 PGB blood 9900 | ||||
42; M | Blood 9 | ALP blood 35 CZP blood 7 DZP blood 61 Nor-DZP blood 82 NZP blood 16 BUP blood 0.5 MOR blood 197 COD blood 11 COC blood screen + BE blood 258 MIR blood 23 PGB blood 900 | ||||
Flubromazepam | ED | 25; M | Agitation, Aphasia, Ataxia, Confusion, Dysarthria, Hypertension, Hyposthenia | Blood 411 | BZD urine screen + THC urine screen + MXP blood 247 | [104] |
24; M | Agitation, Coma, Delirium, Mydriasis, Rigidity, Tachycardia, Tremor | Urine screen + | - | [74] | ||
47; M | Urine screen + | 3OH-Flubromazepam urine screen + | ||||
45; M | Urine screen + | 3OH-Flubromazepam urine screen + | ||||
DUID | 37; M | Mild impairment | Blood 600 | - | [85] | |
Death | 24; M | Apnea, Coma, Rattling breath, Hypothermia, Myosis, Tachycardia, Unconscious | Plasma 830 | U-4770 plasma 370 | [105] | |
Flubromazolam | ED | 27; M | Coma, Cyanosis, Hypotension, Unconscious, Respiratory depression, Tachycardia | Serum 59 Urine 105 | - | [106] |
20; M | Ataxia, Coma, Disorientation, Lethargy, Hallucinations, Hypotension, Miosis, Mydriasis, Seizures, Slurred speech, Tremor, Unconscious | Urine screen + | - | [74] | ||
18; F | Urine screen + | - | ||||
65; M | Urine screen + | - | ||||
26; M | Urine screen + | Meclonazepam urine screen + | ||||
15; F | Urine screen + | - | ||||
23; M | Urine screen + | - | ||||
49; M | Urine screen + | - | ||||
27; M | Urine screen + | - | ||||
20; F | Urine screen + | - | ||||
17; F | Urine screen + | - | ||||
17; F | Urine screen + | - | ||||
19; F | Urine screen + | - | ||||
23; M | Urine screen + | - | ||||
18; M | Urine screen + | Meclonazepam urine screen + | ||||
35; M | Urine screen + | - | ||||
18; M | Urine screen + | - | ||||
18; M | Urine screen + | - | ||||
DUID | 20, M | Mild impairment | Blood 0.48 | - | [85] | |
19; M | Considerable impairment | Blood 100 | - | |||
17; M | Driving impairment, Lethargy, Lack of balance, Slurred speech | Blood 17 | THC blood 6.1 | [71] | ||
18; M | Blood 18 | THC blood 2.2 | ||||
21; M | Blood 19 | BE blood 348 THC blood 1.5 | ||||
17; F | Blood 14 | EtOH blood 0.014 g/L | ||||
19; F | Blood 21 | COC blood screen + BE blood 749 | ||||
19; M | Blood 7 | CZP blood 7 7-Amino-CZP blood 26 OXY blood screen + THC blood 27 | ||||
22; F | Blood 12 | THC blood 2.9 | ||||
35; F | Blood 31 | THC blood 4.1 | ||||
21; F | Blood 8.2 | BE blood 356 THC blood 1 | ||||
Death | 34; M | Multiple drugs | Blood screen + | DZP blood 200 Nor-DZP blood 180 TMZ blood 11 MAMP blood screen + AMP blood 70 3-FPM blood 2.4, central blood 2.6 AMI blood 440 NTP blood 290 | [107] | |
39; M | Multiple drugs | Blood 70 | EtOH blood 0.24 g/L Etizolam blood 4 DZP blood 68 Nor-DZP blood 365 TMZ blood 6 OXZ blood 22 6-AM blood screen + MOR blood 1149 COD blood 289 COC blood 184 BE blood 525 CE blood 22 QTP blood 16 MIR blood 121 | [108] | ||
49; M | Blood 33 | Etizolam blood 1.5 DZP blood 89 Nor-DZP blood 575 OXZ blood 13 TMZ blood 5 MTD blood 685 EDDP blood 100 6-AM blood screen + MOR blood 73 COD blood 18 MIR blood 12 PGB blood 38.1 | ||||
33; F | Blood 1 | Etizolam blood 14 7-Amino-CZP blood screen + MOR blood 91 COC blood 46 BE blood 2573 CLO blood 2060 Nor-CLO blood 1629 GBP blood 24.6 LTG blood 5.8 PRO blood 186 | ||||
Self-administration | 44; M | Considerable impairment, delayed comprehension and reaction time, lethargy, muscle relaxation, partial amnesia, sedation | 0.5 mg oral ingestion Serum 7.4 (5 h) Serum 8.6 (8 h) Serum 5.2 (30 h) Hair 0.44 pg/mg (2 w) Hair 0.60 pg/mg (4 w) | BZD urine screen + | [109] | |
Meclonazepam | ED | 31; M | Agitation, Non-reactive pupils | Urine screen + | - | [74] |
Phenazepam | ED | 26; M | Ataxia, Lack of balance, Memory impairment, Slurred speech | Blood 1200 | BZD urine screen + VEN blood screen + | [110] |
42; M | Confusion, Disorientation, Mydriasis | Blood 490 | - | [111] | ||
29; M | Unresponsiveness, Tachycardia | Serum 1400 | BZD serum screen + U-47700 serum 240 | [112] | ||
Drug offense | 22 *; Not reported | Moderate motor impairment | Blood 260 | THC blood 0.7 | [86] | |
DUID | 50; F | Behavioral aberrations, Moderate/considerable functional disorders | Blood 270 | - | [113] | |
27; M | Blood 310 | - | ||||
21; M | Blood 3000 | - | ||||
47; F | Blood 230 | - | ||||
47; M | Blood 380 | - | ||||
18; M | Agitation, Amnesia, Disorientation, Lack of balance, Lethargy, Mydriasis, Myosis, Non-reactive pupils, Sedation, Slurred speech, Slow reactivity, Tachycardia | Blood 180 | THCCOOH blood 28 | [114] | ||
27; M | Blood 500 | CBP blood 6.1 | ||||
22; M | Blood 750 | TZD blood screen + | ||||
29; F | Blood 310 | AMP blood 190 QTP blood screen + | ||||
39; M | Blood 170 | THCCOOH urine screen + | ||||
23; M | Blood 140 | GBP blood screen + | ||||
22; M | Blood 3200 | - | ||||
40; M | Blood 40 | - | ||||
24; F | Blood 50 | - | ||||
29; M | Blood 120 | - | ||||
21; M | Blood 80 | - | ||||
24; M | Slurred speech, Lack of balance | Blood 76 | BZD blood screen + | [115] | ||
22 *; Not reported | Moderate impairment | Blood 170 | - | [86] | ||
42 *; Not reported | Mild impairment | Blood 12 | - | |||
Death | 42; M | Accidental death complicated by obesity and asthma, Multiple drugs | Blood 386 | MOR blood 116 COD blood 85, blood screen + HCOD urine screen + | [116] | |
35; M | Multiple drugs | Blood 220 | DZP blood 100 Nor-DZP blood 210 OXZ blood screen + TMZ blood screen + MTD blood 650, urine screen + EDDP blood screen + IBP blood screen + | [117] | ||
35; M | Blood 2520 | EtOH blood 0.06 g/L BZD blood and urine screen + MOR blood 360, urine screen + COD blood 380, urine screen + PAR blood and urine screen + | ||||
Not reported | Multiple drugs | Blood 960 | 3OH-Penazepam blood 230 DZP blood screen + Nor-DZP blood screen + TMZ blood screen + MOR blood 10 MOR-3-glucuronide blood 30 MOR-6-glucuronide blood 10 PRZ blood 500 | [118] | ||
Accidental overdose, Multiple drugs | Blood 960 | 3OH-Penazepam blood 270 DZP blood screen + Nor-DZP blood screen + DHC blood screen + DHC-6-glucuronide blood screen + NIC blood screen + | ||||
46; M | Phenazepam intoxication | Blood 1200 | EtOH blood 0.22 g/L | [119] | ||
26; M | Blood 1600 | DZP blood 160 DHC blood 160 | ||||
Not reported | Multiple drugs | Blood screen + | MTD blood 60 MOR blood 60 COC blood screen + AMI blood 80 GBP blood 30,000 | |||
Blood screen + | Etizolam blood 34 EtOH blood 2.9 g/L MOR blood screen + | |||||
Blood screen + | DZP blood 240 MTD blood 890 MOR blood 30 DHC blood 170 GBP blood 26,000 MIR blood 100 FLX blood 140 | |||||
Blood screen + | EtOH blood 3 g/L DZP blood 70 AMP blood 1500 | |||||
Blood 10 | MTD blood 770 | |||||
Blood 140 | EtOH blood 0.56 | |||||
Blood 20 | MTD blood 1300 | |||||
Blood 20 | EtOH blood 1.4 DZP blood screen + | |||||
Blood 24 | Etizolam blood 120 MTD blood 950 COD blood 60 AMI blood 990 | |||||
Blood 38 | DHC blood 1100 | |||||
Blood 40 | MTD blood 700 MOR blood 50 AMI blood 570 | |||||
Blood 40 | MTD blood 340 DZP blood 350 | |||||
Blood 40 | MTD blood 390 | |||||
Blood 43 | DZP blood 510 MTD blood 900 MOR blood screen + MIR blood 580 | |||||
Blood 45 | Etizolam blood 73 DHC blood 300 GBP blood 42000 | |||||
Blood 50 | DZP blood 450 MOR blood 450 | |||||
Blood 60 | EtOH blood 0.79 g/L BUP blood 5 AMI blood 70 | |||||
Blood 60 | MTD blood 410 | |||||
Blood 67 | Etizolam blood 380 MOR blood 170 | |||||
Blood 80 | MTD blood 290 | |||||
Blood 80 | Etizolam blood screen + DZP blood screen + MOR blood 590 | |||||
Blood 80 | MTD blood 770 MOR blood 10 | |||||
Blood 80 | Etizolam blood screen + DZP blood screen + MOR blood 590 | |||||
Blood 90 | MOR blood 310 | |||||
Blood 90 | MOR blood 560 | |||||
Blood 100 | MTD blood 590 MOR blood 40 | |||||
Blood 100 | MTD blood 130 DOT blood 580 | |||||
Blood 100 | MTD blood 1200 BEG v blood screen + | |||||
Blood 100 | MTD blood 280 DHC blood 1600 | |||||
Blood 110 | MTD blood 540 MOR blood 40 BEG blood screen + | |||||
Blood 110 | OLZ blood 420 ZPC blood 10 | |||||
Blood 110 | EtOH blood 1.6 g/L BUP blood screen + | |||||
Blood 110 | MTD blood 270 | |||||
Blood 120 | FEN blood 55 TMD blood 1400 DOT blood 3300 GBP blood 23,000 | |||||
Blood 160 | DZP blood 980 MOR blood 430 BEG blood screen + | |||||
Blood 200 | MOR blood 360 DHC blood 990 | |||||
Blood 210 | MTD blood 180 | |||||
Blood 240 | MTD blood 390 MIR blood 60 | |||||
Blood 240 | DZP blood 350 MTD blood 340 | |||||
Blood 240 | MTD blood 510 AMI blood 840 | |||||
Blood 260 | MTD blood 240 COD blood 1100 | |||||
Blood 280 | EtOH blood 3.1 g/L | |||||
Blood 280 | MTD blood 250 PGB blood 8000 | |||||
Blood 330 | MTD blood 750 MOR blood 330 GBP blood 103000 | |||||
Blood 330 | EtOH blood 2.5 g/L Nor-BUP blood 13 | |||||
Blood 460 | MTD blood screen + | |||||
Blood 550 | EtOH blood 3.3 g/L | |||||
Blood 640 | MTD blood 1100 | |||||
Blood 820 | MTD blood 470 | |||||
Blood 900 | DZP blood 120 MTD blood 380 DHC blood 730 AMP blood 110 | |||||
Blood 1700 | DHC blood 4400 | |||||
Blood 1700 | MOR blood 50 | |||||
Blood screen + | DZP blood 170 TMD blood 7800 DHC blood 220 | |||||
Pyrazolam | Death | 27; M | Multiple drugs | Blood 28 Central blood 28 Urine 500 | Diclazepam blood 1, central blood 1, urine 1 DLP blood 100, central blood 250, urine 570 LMZ blood 6, central blood 4, urine 810 LZP blood 22, central blood 22, urine 820 3-FPM blood 10, central blood 9, urine 120 2F-MAMP urine 120 2F-AMP blood 89 MPA blood 2.2, urine 16 AMP blood 21, urine 75 DPH urine 340 | [120] |
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Brunetti, P.; Giorgetti, R.; Tagliabracci, A.; Huestis, M.A.; Busardò, F.P. Designer Benzodiazepines: A Review of Toxicology and Public Health Risks. Pharmaceuticals 2021, 14, 560. https://doi.org/10.3390/ph14060560
Brunetti P, Giorgetti R, Tagliabracci A, Huestis MA, Busardò FP. Designer Benzodiazepines: A Review of Toxicology and Public Health Risks. Pharmaceuticals. 2021; 14(6):560. https://doi.org/10.3390/ph14060560
Chicago/Turabian StyleBrunetti, Pietro, Raffaele Giorgetti, Adriano Tagliabracci, Marilyn A. Huestis, and Francesco Paolo Busardò. 2021. "Designer Benzodiazepines: A Review of Toxicology and Public Health Risks" Pharmaceuticals 14, no. 6: 560. https://doi.org/10.3390/ph14060560