This Week’s Focus: Benzodiazepines

The NDEWS Weekly Briefing this week highlights benzodiazepines, which are defined as depressants that produce sedation and hypnosis, relieve anxiety and muscle spasms, and reduce seizures. On March 18, 2026, the US Drug Enforcement Administration announced the emergency scheduling of bromazolam, a synthetic benzodiazepine analog that has been widely reported in the illicit drug supply.

This issue highlights a publication from last week, from NDEWS Co-Directors Linda Cottler and Joseph Palamar, focusing on the NDEWS Coordinating Center, and all of our surveillance efforts to detect emerging drug trends.

We then feature our special report on the latest findings on nonfatal benzodiazepine overdoses; this is coupled with our NDEWS Web Monitoring Team report of benzos from conversations on Reddit.

As always, we welcome your input.

Nationally, 114,706 nonfatal EMS encounters involving benzodiazepine overdoses were recorded from January 1, 2023 to February 28, 2026. Of these, 26,347 (23.0%) occurred in Western states, 17,187 (15.0%) in Midwestern states, 55,954 (48.8%) in Southern states, and 15,218 (13.2%) in Northeastern states. Counties with ≥ 10 encounters are presented below as encounters per 10,000 population; counties with fewer than 10 encounters have been suppressed. To view the entire Special Report from the weekly briefing, click here.

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Why are we reporting on this? Benzodiazepines and their research chemical analogs, such as bromazolam and fluoprazolam, are a frequent topic of discussion due to their reported addictive potential and the risks associated with withdrawal and polysubstance use. Reddit discussions include patterns of use such as utilizing these substances to terminate psychedelic experiences, manage stimulant comedowns, and as a substitute for alcohol. Commenters also discuss the availability of unregulated analogs and the potential for these products to contain unintended substances such as fentanyl and nitazenes."

What are Benzodiazepines? Benzodiazepines are a class of central nervous system depressants that act on GABA receptors to produce sedative, anxiolytic, and muscle-relaxant effects. This category includes common prescription medications like alprazolam (Xanax) and clonazepam (Klonopin), as well as a rapidly evolving market of research chemicals (RCs) or "novel benzodiazepines", such as bromazolam, flualprazolam, and etizolam, some of which are noted by discussants as being currently legal in certain regions in the world.

Public Health Impacts: Reddit discussants report significant adverse effects from long-term benzodiazepine use and abrupt cessation, including life-threatening seizures and protracted withdrawal syndromes characterized by extreme anxiety, insomnia, and cognitive impairment. Multiple commenters describe the "delusions of sobriety" associated with high doses, which often lead to dangerous disinhibition, blackouts, and accidental injury. There are frequent reports of severe respiratory depression when "downers" are combined with opioids or alcohol, a combination many discussants identify as potentially fatal.

How is it Being Discussed? Reddit commenters frequently compare the subjective effects of different analogs, often seeking equipotent doses to replace prescription medications. There is a strong focus on minimizing harm, with discussants sharing detailed guides on volumetric dosing and reagent testing to identify substances in pressed bars or "pressies" that mimic the appearance of pharmaceutical Xanax. Many threads center on the use of benzodiazepines as "landing gear" for stimulants like MDMA or methamphetamine, or as "trip killers" to abort challenging psychedelic experiences. Discussants also actively share tapering strategies, such as the Ashton Method, to manage physical dependence. The community frequently monitors the legal status of various analogs, noting that bans on popular chemicals like bromazolam often lead to the emergence of newer, less-studied compounds.

The United States Drug Enforcement Administration announced bromazolam as a Schedule I substance under the Controlled Substances Act on March 18, 2026. The emergency scheduling of bromazolam by the DEA was prompted by its increasing identification in illicit drug seizures tested by DEA laboratory systems. Read the full release here.

A recently published report by the Inter-American Observatory on Drugs examined the evolution of synthetic drugs in the Americas between 2019 and 2025, based on data from the Early Warning System of the Americas (SATA). It highlights the growing complexity of the synthetic drug market, including the spread of substances and mixtures such as synthetic opioids and “pink cocaine”, as well as the increasing risks associated with toxic combinations and patterns of use across the regions. Read the full report here.

A recently published case series in Clinical Toxicology by Farah et al. evaluated bromazolam in the urine of patients, highlighting its frequent co-occurrence with other substances. Among 2,838 confirmed urine tests conducted across four hospitals from October to December 2024, 35 samples from 32 patients were positive for bromazolam. Another finding was the co-positivity with fentanyl (94%), followed by cocaine (77%), and xylazine (69%). Read the full study here.