Etizolam and ‘Dosage’ (Including Lethal Dose)
Unapproved for medical use in the United State by the US Food and Drug Administration (FDA), etizolam is considered a “research chemical” that may be abused recreationally to get “high.” Used primarily as an anti-anxiety and insomnia medication in other countries, like Japan, Italy, and India, etizolam works similarly to the way that benzodiazepine drugs do. Similar in action to Valium (diazepam), etizolam is 6-10 times more potent, with sedative-hypnotic, sedative, muscle relaxant, central nervous system depressant, anxiolytic, and anticonvulsant effects, the Drug Enforcement Administration(DEA) publishes.
A benzodiazepine analogue, etizolam is a thienodiazepine derivative, which is just slightly different in molecular structure than traditional benzodiazepines. Called “etizzy” or “etiz” on the street, the drug can be ordered in tablet or powder form online from other countries and shipped into the United States. It may be a growing drug of concern, CBS Local Chicago reports. Etizolam may be abused for its mellow and euphoria-inducing “high,” or as a date rape drug for its amnesia-producing effects and its ability to greatly lower a person’s inhibitions.
In countries where etizolam is approved for medical use, it is marketed in 0.25 mg, 0.5 mg, and 1.0 mg doses. The Scottish Drugs Forum (SDF) publishes that it may also be manufactured in 2 mg tablet formulations as well, with the following dosage recommendations: 0.25-0.5 mg twice a day for anxiety disorders, 0.5 mg twice a day for panic disorder, and 1-2 mg per day for insomnia, with a daily maximum of 3 mg per day. The World Health Organization(WHO) publishes that etizolam is comparable to Xanax (alprazolam) and recommended to be taken by mouth twice a day in 0.5 mg doses.
Any use of etizolam in the United States is considered abuse, as the drug currently has no medically accepted uses. Etizolam may be abused by swallowing the tablet; chewing it; inserting it into the rectum; snorting, smoking, or injecting the powder; or by dissolving spiked blotter paper in the mouth. While it is difficult to quantify etizolam abuse within the United States, the DEA publishes that drug seizures involving etizolam have been increasing in recent years, with 140 drug reports from 2012 through June 2014 in 21 states.
Etizolam Side Effects and Hazards of Abuse
Common side effects of etizolam use include drowsiness, muscle weakness, headache, slurred speech, impaired cognitive abilities, and loss of motor control. Skin lesions and blepharospasm, which is when the eyelids close tightly involuntarily, may also be side effects of etizolam use or abuse.
Etizolam intoxication may be similar to intoxication with alcohol or traditional benzodiazepines. Accidents due to falling down; short-term memory loss or lapses; impaired judgment, causing a person to engage in potentially dangerous or hazardous behaviors; and decreased inhibitions, leading to possible unwanted sexual contact, are all possible side effects of etizolam abuse. The higher the dose, the more significant the potential risk factors and negative consequences may be.
Etizolam can be particularly dangerous as it is not regulated or controlled within the United States. An individual may never be entirely sure what they are buying and subsequently ingesting. Suspicious packages from out of the country may be a sign of possible etizolam abuse.
Overdose may cause shallow breathing, slowed and weak pulse, a cold feeling and blue pallor to the skin, nausea, vomiting, extreme mental confusion or delirium, and loss of consciousness or coma. In the United States in 2014, almost 50,000 people died from a drug overdose – the highest fatality rate ever recorded, the Centers for Disease Control and Prevention (CDC) publishes.
While fatal etizolam overdoses are rare, taking too much of the drug at one time or mixing it with another substance, particularly another central nervous system depressant, like alcohol, benzodiazepines, or opioid drugs, can have disastrous consequences.
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Etizolam Dependence and Withdrawal
With less of a sedative effect than traditional benzodiazepines, according to the European Journal of Pharmacology, etizolam may produce less drug tolerance and dependence with chronic use. That being said, it can cause drug dependence, especially with chronic use at high doses; therefore, withdrawal symptoms may occur upon discontinuation of the drug.
Etizolam, and benzos in general, slow down some of the nerve firings and activity of the central nervous system, increasing levels of dopamine and gamma-aminobutyric acid (GABA) in the brain. Dopamine is the chemical messenger that causes feel-good feelings while GABA is a sort of natural tranquilizer quelling the “fight-or-flight” and stress reaction. Large doses of etizolam may cause a person to become tolerant to the drug’s effects and make them want to take higher and higher doses each time.
Etizolam, like benzodiazepine drugs, is not meant to be taken for longer than a few months at a time and is considered a short-term solution for the temporary relief of anxiety or panic disorder symptoms. Regular and prolonged use, as well as increasing dosage frequently, can cause the brain to get used to the drug being active in the body. As a result, the body may stop producing and transmitting its neurotransmitters in a normal fashion. This can cause dopamine and GABA levels to be dangerously low when etizolam is not active in the bloodstream, and withdrawal symptoms may result as the brain struggles to regulate itself.
A case report published by the Indian Journal of Pharmacology reported on an individual taking 2.5 mg of etizolam a day for over a month who experienced classic benzodiazepine withdrawal symptoms when the dosage was reduced or stopped.
These symptoms include:
- Heart palpitations
- High blood pressure
- Lowered mood
- Drug cravings
Significant depression, self-harming behaviors, and seizures may be further symptoms of etizolam withdrawal, especially if someone has been taking high doses for a long period of time and is severely physically and psychologically dependent on the drug.
According to the DEA, etizolam usually takes effect within a half-hour to two hours, and it has a half-life of 3.4 hours. Etizolam’s effects generally peak in 3-5 hours and last 6-8 hours on average. Higher doses may stay in the body for longer. When etizolam wears off, withdrawal symptoms can start. The withdrawal symptoms may begin in as little as eight hours, peaking within 3-5 days, and lasting about 10 days on average. Since etizolam is similar to benzodiazepine drugs, which are never recommended to be stopped “cold turkey,” medical detox is the safest method to remove etizolam from the body.
Detox generally lasts 5-7 days and may include the use of medications and supportive care in a specialized and medically supervised facility. Etizolam may be slowly tapered off in a safe manner to avoid any rebound side effects from overactivity of the central nervous system after it has been suppressed by the drug for so long. Longer-acting benzodiazepine drugs may be substituted for etizolam during detox and then slowly weaned off. By using a tapering schedule, the dangerous and more difficult withdrawal symptoms can be managed and controlled. Medications that are specific to certain symptoms of withdrawal can be helpful.
Supportive methods and encouragement provided by mental health professionals can be beneficial in medical detox as well. Beyond detox, therapeutic methods are helpful in determining the root causes of self-destructive and substance-abusing behaviors and working to modify them into more positive ones. Therapy, support groups, relapse prevention programs, counseling, education, and life skills training are all integral parts of a complete substance abuse treatment program that can aid in addiction recovery.
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Lethal Dose of Etizolam
Being similar in mechanism to other benzodiazepines, etizolam can be fatal when abused. In general, deaths involving etizolam on its own are not as common; most fatalities occur when the drug is mixed with other substances, particularly other central nervous system depressants.
Etizolam is considered to have a lethal dose level of about two to five times less than diazepam, according to a study involving rats published by WHO. The FDA does not recommend taking more than 10 mg of diazepam at a time, with average doses often falling between 2 and 2.5 mg at a time. More than that can constitute a lethal dose.
The Journal of Cardiology Cases reports that etizolam can cause a toxic and fatal arrhythmia, especially when it is used in combination with other medications. Taking more than the recommended medical dose or taking etizolam with other drugs can amplify the toxicity of the drug and raise the odds for a lethal dose. There is no hard-and-fast rule when it comes to a specific amount that will constitute a lethal dose either; each person is different.
There are many factors that can contribute to this risk of overdose, including:
- Metabolism: Some people will absorb and process the drug faster than others, breaking it down more rapidly and therefore increasing the lethal dose.
- Body size: Typically, the bigger the person, the more apt they are to be able to absorb the drug, making it easier to process out higher doses more safely.
- Gender: Differences in body type between males and females can impact how a drug is metabolized, absorbed, and processed out of the body, the journal US Pharmacist Therefore, a drug may impact a woman more significantly and at lower doses than it does a man, for instance.
- Co-occurring medical or mental health disorders: Someone who struggles with a mental health or medical illness may face additional complications when taking a drug like etizolam, therefore making the lethal dose potentially lower.
- Genetics and other biological factors: Each person will be able to handle certain drugs at specific levels at different rates, and much of this is inherent to their individual genetic and biological makeup.
- Age: As individuals get older, metabolism slows down. Elderly individuals can then be more impacted by lower doses of drugs, making them potentially lethal in lesser amounts.
It is important to remember that etizolam has no accepted medical use within the United States and therefore no amount is considered to be safe.
While etizolam has yet to be classified as a controlled substance federally, WHO reports it has been declared as such in Arizona, Alabama, Florida, Arkansas, Indiana, Georgia, Mississippi, and Virginia.
Since etizolam is illegal to buy and sell in America, it is likely obtained on the black market. As a result, it can be difficult to know exactly what is in the product. Other chemicals or toxins may be used to “cut” the drug, or there may be a variety of additives in the unregulated substance. Any mixture of etizolam with other drugs exacerbates the possible negative side effects, and a lethal dose may involve a smaller amount of the drug.
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