{
  "abstract": "Aims and Objectives There is an emerging trend of novel benzodiazepines being mis-sold as diazepam, particularly in street tablets. The Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) service analyses illicit drugs to support harm reduction. There is currently limited understanding of the pharmacokinetics and toxicity of novel benzodiazepines. The aim of this study was to estimate the relative oral potencies of three benzodiazepines (etizolam, flubromazolam, and flualprazolam) compared to diazepam, and to correlate these findings to drug quantification data from WEDINOS from 2022. Given the rising prevalence of designer benzodiazepines and their overdose risk, this approach provides new insight into the potential clinical risks associated with counterfeit benzodiazepine exposure.Method and Design Potency values for etizolam, flubromazolam, and flualprazolam were derived from the lowest reported effective oral doses in the literature, using diazepam 10mg as the baseline. Approximate relative oral potencies were: flubromazolam (~25–67×), flualprazolam (>20×), etizolam (~5–10×), and diazepam (1×). Quantitative data from 416 WEDINOS benzodiazepine samples from 2022 were converted into diazepam-equivalent doses by multiplying each sample dose by the estimated oral potency value. Median and interquartile range (IQR) values were calculated to describe data distribution.Abstract 4008 Figure 1Distribution of diazepam-equivalent doses in WEDINOS benzodiazepine samples (2022)Results and Conclusion Among 416 WEDINOS benzodiazepine samples from 2022, median doses (mg) and interquartile ranges [IQR] varied widely: diazepam (10.2 [1.7]), flubromazolam (6.1 [8.3]), etizolam (5.5 [3.2]), and flualprazolam (4.8 [4.4]). Flubromazolam exhibited the greatest variability, with multiple high-end values. The distribution of diazepam-equivalent doses ( figure 1) demonstrated marked inconsistency among designer benzodiazepines. As these substances are associated with a higher risk of polydrug fatality, ongoing surveillance and improved understanding of potency equivalence are essential for informing emergency care management and harm reduction strategies.",
  "authors": [
    {
      "affiliations": [
        "King’s College London"
      ],
      "name": "Harman Gill"
    },
    {
      "affiliations": [
        "Cardiff University"
      ],
      "name": "Emily Williams"
    },
    {
      "affiliations": [
        "Cardiff and Vale University Health Board"
      ],
      "name": "Joanne Rogers"
    },
    {
      "affiliations": [
        "Public Health Wales"
      ],
      "name": "Dean Acreman"
    },
    {
      "affiliations": [
        "Cardiff University"
      ],
      "name": "James Coulson"
    }
  ],
  "title": "4008 Relative oral potency of counterfeit diazepam-labelled benzodiazepines: an analysis of WEDINOS 2022 data",
  "uid": "aef94308-61c5-5a1b-ba90-21ed92c8a288"
}