Toxicity of designer benzodiazepines: A case of etizolam and cocaine intoxication

• Published in: Forensic science international Vol. 336; p. 111324
• Main Authors: Drevin, Guillaume, Briet, Marie, Ferec, Severine, Abbara, Chadi
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.07.2022; Elsevier Limited
• Subjects: Adult; Aggressiveness; Benzodiazepines; Case reports; Central nervous system; Chromatography; Chromatography, Liquid - methods; Cocaine; Consumption; Designer benzodiazepines; Diazepam - analogs & derivatives; Drug abuse; Drug dosages; Drug Overdose; Emergency medical care; Etizolam; Excitation; Forensic chemistry; Forensic sciences; Heroin; Humans; Intoxication; Liquid chromatography; Male; Mass spectrometry; Mass spectroscopy; Metabolism; Metabolites; Morphine; New psychoactive substances; Overdose; Physical restraints; Plasma; Prescription drugs; Scientific imaging; Toxicity; France; Etizolam; New psychoactive substances; Designer benzodiazepines
• ISSN: 0379-0738; 1872-6283
• DOI: 10.1016/j.forsciint.2022.111324

During the last decade, only few cases of acute etizolam intoxication have been detailed. Little is known about the toxic effects of etizolam overdose. Here, the authors report the case of a 42-year-old man who was admitted to the emergency department for intense agitation following etizolam and cocaine consumption. Detection and determination of etizolam and cocaine (including metabolites) were achieved using liquid chromatography tandem mass spectrometry. Etizolam and benzoylecgonine (BZE) were detected in plasma at 64 and 10 ng/mL, respectively. The level of cocaine was below the limit of quantification (< 5 ng/mL). To the authors’ knowledge, the only report detailing an etizolam overdose was provided by O’Connell et al. and was characterized by the presence of central nervous system (CNS) depression signs. Interestingly, here, there were no signs of CNS depression but only signs of CNS excitation. With regard to cocaine and BZE plasma concentrations, the clinical presentation cannot be only explained by the co-consumption of cocaine. It may be hypothesized that the clinical presentation was related to a paradoxical reaction to etizolam overdose. To date, no case of paradoxical excitation related to etizolam use has been reported in adults. The case presented here appears particularly interesting, given the limited data relating to high-dose etizolam toxicity. •Only few cases of acute etizolam intoxication have been detailed.•Little is known about the toxic effects of etizolam overdose.•Here, the case of an etizolam-cocaine intoxication is reported.