This Week’s Focus: Bromazolam

Our focus for this week’s NDEWS Weekly Briefing is on bromazolam, a potent triazolobenzodiazepine that continues to be monitored across forensic, clinical, and public health settings. First identified in the illicit supply in 2016, bromazolam has since become the most frequently detected novel benzodiazepine in the United States, often appearing in counterfeit pills or polydrug mixtures involving fentanyl, xylazine, and synthetic cathinones. In Q2 2025 alone, 198 bromazolam detections were reported by the Center for Forensic Science Research & Education (CFSRE), extending its year-long lead in national toxicology and drug material identifications. This week’s briefing highlights recent literature examining bromazolam in nonfatal overdoses, postmortem casework, and clinical presentations, alongside original NDEWS content from biospatial.io overdose surveillance and Reddit web monitoring.

As an update from last week’s briefing, NDEWS is sharing new information regarding a recent mass overdose event in Baltimore. Through outreach from the NDEWS Coordinating Center, city officials confirmed that the incident—which resulted in 35 overdoses and 27 EMS transports on July 10—was linked to fentanyl and benzodiazepine combinations, not the rumored “New Jack City” formulation or freon-laced products. A second cluster occurred on July 18, in the same neighborhood. Baltimore’s harm reduction response included rapid outreach, naloxone and test strip distribution, and connections to treatment. City officials are now refining a Mass Overdose Incident protocol, which will be shared with NDEWS partners when available.

NDEWS Special Report: Biospatial survelliance: EMS encounters for bromazolam-related overdoses (nonfatal or fatal) in the US January 1, 2022 - June 30, 2025

NDEWS evaluated biospatial data from January 2022 to June 2025 using the keywords “bromazolam” ( or “bromozolam”, “bromazolan”, “brom”, “bromo”, “bromaz”), “bro+fentanyl”, “bro+heroin” or “bro+stim” and found ten counties that had the highest numbers of encounters overall for the US. All but one county presented suppressed data (under 10 encounters) related to bromazolam EMS encounters. Out of 157 encounters for bromazolam-related overdoses during this time period, only Halifax County, NC produced non suppressed data (rate per 10k population=7.07). NDEWS will continue to monitor the situation for overdoses to this drug.

To view the entire Special Report from our Weekly Briefing, click here.

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Why are we reporting on this? Bromazolam has emerged as the most frequently detected novel benzodiazepine in the United States, with the Center for Forensic Science Research & Education (CFSRE) reporting 198 detections in Q2 2025 alone. In the past several months, Reddit discussion of bromazolam has seen an increase, although removing the term "bromazolam" from the search and using only aliases so that the timeline can be extended reveals that discussion is still well below where it was at the beginning of the year.

What is Bromazolam? Bromazolam is a designer benzodiazepine. It is a triazolobenzodiazepine structurally similar to alprazolam but with reportedly higher potency and longer duration. It is commonly sold as a research chemical in powder form, pressed pills, or liquid solutions.

Public Health Impacts: Reddit discussants frequently report experiencing "delusions of sobriety"—a dangerous phenomenon where users believe they are unimpaired despite significant intoxication. Multiple Reddit users report job loss, psychiatric holds, and relationship problems due to this effect. Withdrawal concerns are prominent, with commenters expressing fear about seizure risk even after relatively short periods of use (as little as three weeks).

How is it being discussed? Bromazolam's potency is frequently compared to pharmaceutical benzodiazepines across Reddit. Reddit users report that 1–2 mg of bromazolam produces effects similar to 1–2 mg of alprazolam, though with longer duration and more pronounced sedation. The "delusions of sobriety" phenomenon is a recurring theme. Some commenters even describe complete blackouts lasting multiple days while believing they were functioning normally, often resulting in job termination or psychiatric intervention.

Reddit analysis reveals that accessibility through research chemical vendors makes bromazolam attractive to those unable to obtain prescribed benzodiazepines. Some commenters express concern about receiving bromazolam in pressed pills marketed as alprazolam, reflecting the broader issue of counterfeit pharmaceuticals containing novel benzodiazepines.

Withdrawal management dominates many discussions. Reddit users with only a few weeks of bromazolam use express concern about discontinuation safety. Some discussants report attempting to use bromazolam for short periods to manage withdrawal from other substances, only to develop dependence on bromazolam itself.

Commenters report combining bromazolam with stimulants like methamphetamine, cannabis, gabapentin, and other benzodiazepines. These combinations are described as increasing both desired effects and risks.

Drug Terms: Bromazolam, bromaz, brom

Previous Reports:
- December 13, 2024
- March 29, 2024

Click here to read more about NDEWS Online Monitoring.

A recent study published in Drug and Alcohol Dependence by NDEWS Community-Based Health Expert Dr. Alyssa Falise et al., and co-authored by NDEWS SAG member Dr. Alex Krotulski, analyzed data from April 2023 to May 2024 on 341 emergency department patients with suspected opioid and/or stimulant-related non-fatal overdoses. Bromazolam was detected in 8.2% of cases (n=28). Bromazolam-positive patients had higher fentanyl levels and more frequent xylazine (64%) and quinine (57%) co-detection. None reported intentional bromazolam use; most reported using fentanyl or heroin, often in powder form (70%) via snorting (55%). Read the full study here.

The Center for Forensic Science Research & Education (CFSRE), prepared by NDEWS SAG members Drs. Krotuslski and Logan et al., publishes quarterly trend reports using advanced GC-MS and LC-QTOF-MS techniques to detect over 1,200 substances, with a focus on novel psychoactive substances (NPS). In Q2 2025, bromazolam was the most frequently identified novel benzodiazepine, accounting for 198 total detections—164 in drug materials and 34 in toxicology cases. Bromazolam has led quarterly NPS benzodiazepine detections for over a year and is often found alongside fentanyl and other depressants. Read the full report here.

 A recently published study in Academic Emergency Medicine by Huges et al. and co-authored by NDEWS SAG member Dr. Alex Krotulski, analyzed 1,427 emergency department patients with confirmed opioid overdoses from September 2020 to December 2023. Using LC-QTOF-MS, benzodiazepines were detected in 29% of cases, including 8.5% with novel benzodiazepines such as bromazolam (46.3% of novel cases). Novel benzodiazepine co-exposure was linked to younger age (median: 34), higher rates of naloxone nonresponse (28.3%), and increased odds of mechanical ventilation (aOR: 2.14; 95% CI: 1.07–4.05), independent of fentanyl presence. Read the full study here.

A recently published original research article in Frontiers in Toxicology by Gerona et al. analyzed serum samples from 1,000 roadway crash victims using LC-QTOF/MS against a comprehensive database of 1,314 drugs, including 1,008 new psychoactive substances (NPS), and quantitative analysis was performed using isotope dilution. Seventeen cases (1.7%) were positive for eight distinct NPS, with bromazolam, para-fluorofentanyl, and mitragynine most common. All but one involved co-use with fentanyl, methamphetamine, or delta-9-THC. Read the full article here.

A recent advisory issued by the New York City (NYC) Department of Health and Mental Hygiene reports that medetomidine and bromazolam have been found in samples of drugs circulating in NYC. Serum and urine specimens obtained during hospitalization of five people in November 2024 were analyzed by a third-party laboratory and, in addition to fentanyl, medetomidine and bromazolam were detected in all specimens. Read the full advisory here.

This toolkit was created for healthcare providers and other professionals. It contains resources to reduce SUD-related stigma, information about social services and the legal system, and evidence-based guidance on the management of opioid use disorder (OUD).

- Watch the Webinar
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A recent report by WABC discusses bromazolam during a tour of the Drug Enforcement Agency’s (DEA) Northeast Regional Laboratory with New York DEA Special Agent in Charge Frank Tarentino. The report mentions that bromazolam can be disguised as counterfeit Xanax pills that are often broken down into powder form and mixed with fentanyl, carfentanil, and xylazine. The most recent seizure of bromazolam occurred in February 2025 out of Long Island City where 3.4 million counterfeit pills were confiscated. Read the full article here.

 A recent report by Hawaii News Now has brought attention to five bromazolam-related overdose deaths so far in 2025. The most recent death occured in early June from a mixture of bromazolam and fentanyl. The report noted that bromazolam-related incidents have increased since 2021 as one death occurred in 2021, two deaths in 2022 and 2023 and no deaths in 2024. Hawaii HIDTA director Gary Yabuta and Honolulu Emergency Services Department director Dr. James Ireland provided insight related to a spike in overdoses. Read the full article here.

The NDEWS Weekly Briefing curates emerging data and findings from across the Early Warning Network, which includes three core components: our Scientific Advisory Group (SAG), comprised of national experts and federal partners; our Sentinel Site Directors (SSDs), who lead local surveillance in key geographic regions; and our Community-Based Health Experts, who provide on-the-ground insights from populations most impacted by drug trends. Together, these contributors generate timely, multidisciplinary and impactful information, ranging from peer-reviewed research findings to local surveillance data. These contributions inform public health and research communities.

More about The NDEWS Early Warning Network
- Issue 230: Early Warning in Action — Insights from the NDEWS Early Warning Network
- Issue 234: Early Warning in Action — Insights from the NDEWS Early Warning Network

📅 Date: Tuesday, July 29, 2025

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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:

     • NDEWS Hotspot Alerts using substance-related EMS data
     • NDEWS Rapid Street Reporting (RSR) survey data reports
     • NDEWS Web Monitoring Team Reddit Alerts
     • NDEWS Sentinel Site Reports
     • Previous issues of the NDEWS Weekly Briefings

The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.