Search

As novel psychoactive substances (NPSs) have continued to emerge over the past decade, NPS benzodiazepines have likewise increased in prevalence. They pose an evolving threat to public health and safety with regard to postmortem cases, particularly when used in combination with opioids. Bromazolam was first detected in Travis County, Texas, in April 2021. Given the recent onset of the fentanyl epidemic in this region, the international rise of bromazolam, and increased reports of "benzo-dope," a retrospective study was conducted to characterize bromazolam-positive deaths in Travis County and surrounding counties from 2021 to 2023. Bromazolam was identified in 112 deaths from 2021 to 2023, accounting for 1.57% of cases submitted for toxicology testing (n =  7129). During that interval, a 7.5-fold increase in postmortem bromazolam-related drug toxicities from 2021 (n  = 7) to 2023 (n  = 53) was observed. Fatalities primarily occurred in men in their early 30s. Postmortem concentrations ranged from 21 to 220 ng/mL, with mean (median) concentrations of 69.4 ± 48.4 (53.5) ng/mL. Polydrug use was present in 99% of bromazolam-positive deaths with co-occurrence with other drugs and drug classes widely varying over time. Bromazolam was attributed as the sole cause of death in one case with a postmortem blood concentration of 23 ng/mL. Polydrug use in bromazolam-related drug toxicities commonly involved fentanyl (82%), methamphetamine (41%), and cocaine (28%). Similarly, cases where bromazolam was an incidental finding and noncontributory to the cause of death often involved methamphetamine (38%), alprazolam (33%), and cocaine (33%). In light of the significant increase in fentanyl-related deaths in Travis County, the increasing prevalence of bromazolam accompanying fentanyl was particularly alarming due to the heightened risk of toxicity when used in combination. Identifying and evaluating bromazolam-related deaths clarify the impact of bromazolam on this population, promote awareness, and aid in identifying meaningful harm reduction strategies to decrease bromazolam-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

The opioid epidemic has affected the United States (US) for decades with fentanyl and its analogs accounting for a recent surge in morbidity and mortality. Currently, there is a relative lack of information characterizing fentanyl‐related fatalities specifically in the Southern US. A retrospective study was conducted to examine all postmortem fentanyl‐related drug toxicities in Travis County, Texas, encompassing Austin (one of the fastest‐growing cities in the US), from 2020 to 2022. Fentanyl contributed to 2.6% and 12.2% of deaths submitted for toxicology between 2020 and 2022, respectively, representing a 375% increase in fentanyl‐related deaths over this 3‐year period (n = 517). Fentanyl‐related fatalities primarily occurred in males in their mid‐30s. Fentanyl and norfentanyl concentrations ranged from 0.58 to 320 ng/mL and 0.53 to 140 ng/mL with mean (median) concentrations of 17.2 ± 25.0 (11.0) and 5.6 ± 10.9 (2.9) ng/mL, respectively. Polydrug use was present in 88% of cases, with methamphetamine (or other amphetamines) (25%), benzodiazepines (21%), and cocaine (17%) representing the most frequently identified concurrent substances. Co‐positivity rates of various drugs and drug classes widely varied over time. Scene investigations reported illicit powder(s) (n = 141) and/or illicit pill(s) (n = 154) in 48% (n = 247) of fentanyl‐related deaths. Illicit oxycodone (44%, n = 67) and illicit "Xanax" (38%, n = 59) pills were frequently reported on scene; however, toxicology only identified oxycodone and alprazolam in 2 and 24 of these cases, respectively. The results of this study provide a better understanding of the fentanyl epidemic in this region creating an opportunity to promote increased awareness, shift focus to harm reduction, and aid in minimizing public health risks. [ABSTRACT FROM AUTHOR]

The article focuses on using the Intoxilyzer 8000C in measuring breath alcohol in healthy subjects under social drinking conditions. The influence of residual mouth ethanol on breath alcohol concentration (BrAC) and the precision of replicate measurements with minimal influence from metabolic effects were examined. Venous blood samples were drawn after drinking cessation. The device was able to provide precision that is well within the standards limits adopted in Canadian jurisdictions.