Etizolam: a rapid review on pharmacology, non‐medical use and harms

Issues
Etizolam is a thienodiazepine derivative, with high affinity for the benzodiazepine site of GABAA receptors. It is often referred to as a new (or novel) psychoactive substance, a ‘designer’ benzodiazepine or a ‘street benzodiazepine’. Increasing reports of non‐medical use, identification of etizolam as an ingredient in counterfeit medications and the common identification of etizolam in drug‐related deaths, highlight the need for a greater understanding of etizolam.

Approach
A rapid narrative review was conducted using PubMed and Google Scholar to synthesise what is known about etizolam to answer two research questions: (i) Does the pharmacological or toxicological profile of etizolam differ from other benzodiazepines?; and (ii) What is the nature and context of non‐medical use and harms related to etizolam?

Key Findings
Etizolam has a higher potency as an anxiolytic but lower lethality compared with diazepam. Few harms are documented with the therapeutic use of pharmaceutical products. Harms appear to be predominantly related to the use of etizolam in illicitly manufactured pills and occur almost exclusively in the context of mixed‐drug toxicity.

Conclusion
In therapeutic doses, there is little to suggest that etizolam is more harmful than other benzodiazepines. Most harms with etizolam appear to be related to the wide availability of illicitly manufactured pills, which are taken in unknown doses and combined with other substances. Current harm reduction advice, including avoiding combining opioids and benzodiazepines, remains relevant and increasingly important within an emerging culture of non‐medical use.