VIENNA, Austria – September 2021. Several drug-testing agencies in Europe and New Zealand reported on falsified Xanax® seizures containing the new psychoactive substances flualprazolam or flubromazolam, instead of the benzodiazepine alprazolam contained in pharmaceutical Xanax®. Drug testing agencies in Austria, Switzerland, the United Kingdom and New Zealand have issued alerts in 2020 and 2021 to warn potential users. Moreover, EMCDDA has expressed concern about the growing use of new benzodiazepines in falsified tablets of commonly prescribed benzodiazepine medicines, and the involvement of criminal groups in producing such tablets. In some cases, the fake tablets are packaged in blister packs resembling legitimate products, which makes it more difficult for consumers to spot the fake medicine (EMCCDA, 2021). In Europe, serious adverse events, such as severe poisonings, involving fake medicines with new benzodiazepines have been reported (EMCCDA, 2021).
The substances flualprazolam and flubromazolam are triazolo-benzodiazepines, similar to alprazolam, with high potency and capacity to produce a state of dependence and central nervous system depression. Flualprazolam was placed under international control at the 63rd regular session in 2020 and flubromazolam at the 64th regular session in 2021 of the Commission on Narcotic Drugs upon recommendation by the World Health Organization. Both substances were scheduled in Schedule IV of the Convention on Psychotropic Substances of 1971.
Flubromazolam was reported to the UNODC Early Warning Advisory on NPS for the first time in 2015 in 13 countries and flualprazolam in 2017 in 2 countries. Flubromazolam was reported in total by 24 countries from 2015-2021 and flualprazolam by 26 countries from 2017-2021 (both substances were reported from countries in Europe, North America and Asia).
Figure: Number of countries identifying flubromazolam and flualprazolam, 2015-2021*
Source: UNODC Early Warning Advisory on NPS.
Note: *Data for the years 2020 and 2021 are preliminary and subject to change.
The NPS flualprazolam and flubromazolam are not known to have any therapeutic use. Flualprazolam is likely to cause disinhibition and sedation that would impair driving, and, when combined with substances such as opioids, would contribute to increased overdose through benzodiazepine potentiated opioid-induced respiratory depression (World Health Organization 2019). For flubromazolam, impaired driving, non-fatal intoxications requiring hospital admission, and fatal intoxications are documented. In these cases, central nervous system depression and severe sedation were clinical features of presentation. Flubromazolam has the potential to increase unintentional opioid overdoses and its long half-life may increase the risk of accumulation and interactions when combined with other drugs (World Health Organization 2020).
The harmfulness of both substances is further reflected in toxicology data from post-mortem, clinical and other casework in the UNODC Early Warning Toxicology Portal. Flualprazolam was involved in 778 toxicology cases in seven countries, the majority of which (529) were reported in 2020. Flubromazolam was involved in 406 toxicology cases reported between 2016 and 2021, with the majority being reported in 2020 (264) and 2019 (106).
For more information, please see:
Ntoupa, PS.A., Papoutsis, I.I., Dona, A.A. et al. A fluorine turns a medicinal benzodiazepine into NPS: the case of flualprazolam. Forensic Toxicology 39, 368–376 (2021).
Checkit!, Gefaelschte XANAX, alert (2020).
Saferparty, Vorsicht: Falschdeklarierte Xanax-Tablette, alert (November 2020).
Welsh Emerging Drugs and Identification of Novel Substances Project (Wedinos), Collecting, Testing, Informing - February 2021 (February 2021).
High Alert, Flualprazolam found in fake ‘Xanax’ tablet, alert (2020).
EMCDDA, New benzodiazepines in Europe – a review (Luxembourg, Publications Office of the European Union 2021).
***The Spanish translation of this news item is made possible thanks to a collaboration with OAS/CICAD, a partner of the UNODC EWA.***