This Week’s Focus: Benzodiazepines

This week’s briefing focuses on benzodiazepines, also known as "benzos", a class of depressant drugs prescribed to relieve anxiety, muscle spasms, and seizures, and to induce sleep. Benzodiazepines can cause drowsiness, confusion, impaired coordination, and memory problems, especially when misused.

Our NDEWS Special Report shows the top 10 counties from each of the four regions across the US where the highest rates of emergency medical service encounters occurred for nonfatal benzodiazepine-related overdoses.

Also, the NDEWS Web Monitoring Team published its first report on norflurazepam, a benzodiazepine analog, that serves as an active metabolite of several pharmaceutical benzodiazepines including flurazepam, midazolam, and quazepam.

The NDEWS Web Monitoring Team will also take part in the upcoming Our Community, Our Health - NDEWS Town Hall on Thursday, December 11, at 2 p.m. ET. Information regarding how to join the webinar is listed below.

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Out of 67,886 EMS encounters for nonfatal benzodiazepine-related overdoses from January 1, 2024 to November 30, 2025, 15,878 (23.4%) occurred in Western states, 10,346 (15.2%) in Midwestern states, 32,730 (48.2%) in Southern states and 8,932 (13.2%) in Northeastern states.

To view the entire Special Report from the weekly briefing, click here.

Click here to learn more about NDEWS Hotspot Alerts

Why are we reporting on this? Norflurazepam discussions appear frequently across multiple drug-related subreddits, with Reddit commenters seeking information about dosing, comparisons to other benzodiazepines, and use for various purposes including anxiety management, sleep, and tapering from other substances. The extremely long reported half-life presents unique public health concerns.

What is Norflurazepam? Norflurazepam (also known as N-desalkylflurazepam) is a benzodiazepine analog that serves as an active metabolite of several pharmaceutical benzodiazepines including flurazepam, midazolam, and quazepam. According to pharmacological data, it has an elimination half-life of 47–150 hours. Reddit users report that it is sold as pellets (commonly 5mg and 10mg) and powder form through research chemical vendors.

Public Health Impacts: Reddit commenters report difficulty predicting effects of norflurazepam due to its extended duration, with some describing unexpected sedation persisting for days after their last dose. Discussions reveal concerning patterns of polydrug use, with users combining norflurazepam with opioids, stimulants, dissociatives, and other benzodiazepines. Multiple discussants express concern about respiratory depression when combining with other central nervous system depressants. Several posts describe rapid dependency development and challenges with tapering, with Reddit commenters describing difficulty controlling consumption and subsequent withdrawal concerns. Inconsistent pellet dosing is mentioned as a concern, with discussants noting that tablets may be unevenly pressed.

How is it Being Discussed? Reddit commenters frequently compare norflurazepam to diazepam (Valium), with many describing similar effects but with longer duration. Discussants report using it for anxiety relief, sleep induction, muscle relaxation, and as a "trip killer" for psychedelic experiences. Commenters commonly ask about dose equivalencies, with discussions suggesting varying estimates of potency relative to diazepam, though individual responses differ considerably. Norflurazepam is frequently discussed as a tool for managing stimulant comedowns from substances such as synthetic cathinones and amphetamines. The substance is discussed alongside other research chemical benzodiazepines such as bromazolam, pyrazolam, and flubromazepam. Some users note that norflurazepam was originally developed for medical use but was shelved in favor of shorter-acting alternatives.

Drug Terms: Norflurazepam, N-Desalkylflurazepam, Norflu

A recently published narrative review in Substance Use and Rehabilitation by Liu et al. discusses concomitant use of benzodiazepines among individuals with opioid use disorder. The authors point out the prolonged use of benzodiazepines frequently resulted in the rapid development of tolerance and dependence, and benzodiazepine misuse was linked to depression. Recommended interventions include routine screening, patient education, gradual tapering, psychological therapies (CBT, DBT), and non-addictive alternatives such as Traditional Chinese Medicine and acupuncture. Read the narrative review here.

A recently published study in Substance Use & Addiction Journal by Mixson et al. investigated benzodiazepine and opioid co-use in rural areas. The study focused on 1,107 participants who were interviewed as part of the Rural Opioid Initiative. 10% reported benzodiazepine + opioid co-use, while 90% reported stimulant + opioid co-use. The study found that benzodiazepine and opioid co-use was associated with heavy episodic drinking and gabapentin use, and also a lower prevalence of criminal legal system involvement. Additionally, the individuals reporting co-use have distinct behavioral patterns.  Read the study here.

A recently published review in the Frontiers of Toxicology by Thalib et al. discussed the increasing misuse of benzodiazepines in drug-facilitated crimes. The review focused on benzodiazepines being used in drug-facilitated crimes in which victims are left vulnerable due to the drug's ability to reduce awareness and erase memory. Additionally, the review also pointed out that benzodiazepines are difficult to detect due to their metabolization rate. The review outlines strategies to improve prevention, detection, and judicial outcomes. Read the report here.

A recently published article by King's College London discussed research on the differences in strength among illicit diazepam tablets over a 25-year period. The study analyzed 100 tablets that were confiscated between 1998 and 2023. The analysis revealed a large variability in strength as some samples contained no detectable diazepam and others contained up to 26.25mg per tablet. The variability observed in street samples highlights the need for ongoing market monitoring and surveillance of emerging drug trends. Read the full article here.

Are you committed to advancing the science of substance use and public health? The University of Florida’s NIDA-funded T32 Training Program offers predoctoral and postdoctoral scholars an exceptional opportunity to launch impactful research careers focused on NDEWS!

What We Offer:
- Interdisciplinary training at the intersection of addiction science, epidemiology, and surveillance
- Mentorship from leading UF faculty in epidemiology, public health, psychology, medicine, and more
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- Career development support, including grant writing, publishing, and professional networking
- A collaborative, inclusive research community committed to reducing the burden of substance use

Eligibility:
- US citizens or permanent residents
- Interested in a PhD in Epidemiology, or early-stage postdoctoral fellows
- Demonstrated interest in substance use, addiction, or public health research

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📅 Dates: Thursday, December 11, 2025

🕑 Time: 2 pm - 3 pm ET

📍 Location: Online

🔗 Zoom

📅 Dates: Thursday, December 18, 2025

🕑 Time: 12:30 pm - 1:30 pm ET

📍 Location: Online

📅 Date: Saturday, June 13, 2026

🕑 Time: 1 pm - 5 pm PT

📍 Location: Oregon Convention Center & Hyatt Regency Portland

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.

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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.