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

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.