UNODC EWA: Benzodiazepine-type substances, particularly bromazolam, continue to be a primary NPS threat in toxicology casework
VIENNA, Austria – July 2024: The UNODC Current NPS Threats Vol. VII (July 2024) presents recent analysis from the UNODC Early Warning Advisory (EWA) on NPS by combining data from NPS identified in seized material with toxicology information from clinical admission, driving under the influence of drugs (DUID), drug facilitating sexual assault (DFSA) and post-mortem (PM) cases. This allows to identify key developments regarding health threats associated with the use of NPS. Polydrug use continues to be an important feature in NPS casework. Over the data collection period for this issue, 2,801 reports of NPS in a total of 1,955 toxicology cases (21% female, 58% male, 21% unknown/not reported, <1% other) were reviewed, identifying more than 100 individual NPS (Figure 1 and 2).
Figure 1: Types of toxicology cases reported (n=1,955)
Source: Toxicology portal of the UNODC Early Warning Advisory on NPS, 2024.
Figure 2: Substance groups reported across main toxicology case types
Source: Toxicology portal of the UNODC Early Warning Advisory on NPS, 2024.
While fentanyl was the primary substance reported in post-mortem cases (n=333), benzodiazepine-type NPS, particularly bromazolam and clonazolam, were among the top ten reported NPS in post-mortem cases, with bromazolam being the most commonly identified NPS (n=260) (Figure 3).
In addition, a number of NPS with stimulant effects were also identified in post-mortem cases during this reporting period. Among the most commonly identified stimulants were the synthetic cathinones dipentylone and pentylone [1].
Figure 3: Substances most often reported in post-mortem cases
Source: Toxicology portal of the UNODC Early Warning Advisory on NPS, 2024.
Clinical admissions represented the second largest group of toxicology cases during the current reporting period (n=386) involving 639 reports of NPS. The two most commonly reported NPS groups within this case type were benzodiazepines, accounting for 355 reports, followed by 100 reports of stimulants. Bromazolam (n=203), clonazolam (n=39), and desalkylgidazepam (n=36) comprised the top three identified NPS in over 40% of clinical case reports.
In cases related to driving under the influence of drugs (DUID) provided during the current reporting period, there were 191 case reports of NPS almost exclusively from North America with benzodiazepines being identified in 68% of cases. As with other case types, bromazolam emerged as the most commonly reported substance (n=66). Other frequently identified benzodiazepines included flualprazolam (n=31), flubromazolam (n=24), etizolam (n=20), and clonazolam (n=13).
Regarding the relative contribution that the NPS identified in post-mortem cases had in the fatalities, in 21 cases the NPS was deemed causal to the outcome of the event; 76% of cases showed combined consumption of bromazolam with opioids or stimulants such as methamphetamine. Xylazine, kratom, and clonazolam each had a contributory role in a small number of post-mortem events (n=3). Ketamine and acetylfentanyl contributed to a fatal outcome in n=2 cases each.
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[1] Note: Dipentylone and pentylone were detected together in the majority of cases and as pentylone is a metabolite of dipentylone, this should be considered when interpreting such case information.
For further information please see:
UNODC, Current NPS Threats Volume VII(July 2024)
