Bromazolam Blood Concentrations in Postmortem Cases-A British Columbia Perspective

Area of Science:

• Forensic Toxicology
• Pharmacology
• Organic Chemistry

Background:

• Designer benzodiazepines are emerging synthetic psychoactive substances.
• Bromazolam, a novel benzodiazepine, has recently been identified in illicit drug supplies.
• Understanding the toxicological profile of new psychoactive substances is crucial for public health.

Purpose of the Study:

• To report the first quantitative concentrations of bromazolam in postmortem blood samples in Canada.
• To investigate the co-occurrence of bromazolam with other substances in fatal cases.
• To assess the potential role of bromazolam in postmortem findings.

Main Methods:

• Postmortem blood samples from 2021 were screened using liquid chromatography-high-resolution mass spectrometry (LC-HRMS).
• A novel psychoactive substances data processing method was employed for retrospective analysis.
• Bromazolam concentrations were quantitatively confirmed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) with standard addition.

Main Results:

• Bromazolam was detected in 41 postmortem cases in British Columbia during 2021.
• The mean concentration was 11.4 ± 53.7 ng/mL (median: 1.6 ng/mL), with concentrations ranging from 0.5 to 319.3 ng/mL.
• Bromazolam was consistently found with other opioids (fentanyl, carfentanil), stimulants (methamphetamine), and/or other benzodiazepines (etizolam, flualprazolam).

Conclusions:

• This study provides the first documented postmortem blood concentrations of bromazolam in Canada.
• The frequent co-occurrence with opioids, particularly fentanyl, suggests bromazolam may potentiate opioid effects.
• Further research is needed to fully elucidate the toxicological significance and clinical effects of bromazolam.