Detected substances among patients with confirmed bromazolam exposure who present to the emergency department following a suspected opioid and/or stimulant-related non-fatal overdose

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-07-07 DOI:10.1016/j.drugalcdep.2025.112776

Alyssa M. Falise , Amanda Sutphin , Rachel Culbreth , Kim Aldy , Keith Burkhart , Jeffrey Brent , Sharan L. Campleman , Hannah Day , Aprielle Wills , Alex Krotulski , Paul Wax , On Behalf of the ToxIC DOTS Study Group

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Abstract

Background

Bromazolam, an illegal benzodiazepine, has recently increased in toxicological samples in the United States. Little is known about other substances detected with bromazolam and use intentions. This study investigated bromazolam’s prevalence, co-occurring substances, and self-reported substance use among patients with bromazolam exposure presenting to emergency departments (ED) for opioid/stimulant-related non-fatal overdose.

Methods

The Toxicology Investigators Consortium (ToxIC) Drug Overdose Toxico-Surveillance (DOTS) Reporting Program prospectively collected interviews, chart reviews, and toxicological blood analyses among patients presenting to one of 17 EDs following a suspected acute opioid/stimulant overdose. Toxicological analyses were performed qualitatively via liquid chromatography (LC) quadrupole time-of-flight mass spectrometry (MS) and quantitatively with LC tandem quadrupole MS. Sociodemographic characteristics, intended substance use, and detected substances were examined in patients with and without bromazolam exposure (n = 341).

Results

Twenty-eight of 341 patients (8.2 %) were bromazolam positive, with an average concentration of 86.4 ng/mL (range: 3.5–310.0 ng/mL). Fentanyl concentrations were higher among bromazolam-positive patients (positive: mean=11.1 ng/mL; negative: mean=8.9 ng/mL; p = 0.03), although no qualitative significant differences were noted in fentanyl prevalence when stratified by bromazolam exposure (p = 0.22). Among the 20 bromazolam-positive patients reported using only one substance, none intended to use bromazolam, with fentanyl (n = 7, 35.0%) and heroin (n = 6, 30.0%) being the most reported intended substances. Snorting was the most common administration route (55.0%).

Conclusion

Bromazolam exposure was associated with increased fentanyl concentrations compared to those without. Most patients with bromazolam exposure reported intended opioid use prior to their overdose. Future research should investigate bromazolam’s clinical effects and patient outcomes following an overdose.

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在疑似阿片类药物和/或兴奋剂相关非致命性过量后就诊于急诊室的确认有溴唑仑暴露的患者中检测到的物质

背景溴唑仑是一种非法的苯二氮卓类药物，最近在美国的毒理学样本中有所增加。对于与溴唑仑一起检测的其他物质及其使用意图知之甚少。本研究调查了因阿片类药物/兴奋剂相关非致命性过量而就诊于急诊科（ED）的溴唑仑暴露患者中溴唑仑的患病率、共存物质和自我报告的物质使用情况。方法：毒理学调查协会（有毒）药物过量毒性监测（DOTS）报告项目前瞻性地收集了17例疑似急性阿片类药物/兴奋剂过量后出现急诊科的患者的访谈、图表回顾和毒理学血液分析。毒理学分析通过液相色谱（LC）四极杆飞行时间质谱（MS）进行定性分析，并通过LC串联四极杆质谱进行定量分析。研究了有和没有暴露于溴唑仑的患者（n = 341）的社会人口学特征、预期物质使用和检测到的物质。结果341例患者中溴唑仑阳性28例（8.2%），平均浓度为86.4 ng/mL（范围为3.5 ~ 310.0 ng/mL）。芬太尼浓度在溴唑仑阳性患者中较高(阳性：平均值=11.1 ng/mL；阴性：平均值=8.9 ng/mL；P = 0.03)，但当按溴唑仑暴露分层时，芬太尼患病率没有定性显著差异（P = 0.22）。在报告仅使用一种药物的20例溴唑仑阳性患者中，没有人打算使用溴唑仑，芬太尼（n = 7, 35.0%）和海洛因（n = 6, 30.0%）是报告最多的预期药物。Snorting是最常见的给药方式（55.0%）。结论与未暴露于溴唑仑组相比，暴露于溴唑仑组与芬太尼浓度升高有关。大多数暴露于溴唑仑的患者在服用过量之前报告有意使用阿片类药物。未来的研究应该调查溴唑仑的临床效果和患者服用过量后的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.