Driving Under the Influence of Flualprazolam: 10 Case Reports

Mercurio, Nicholas; Triebold, Craig; Coleman, Dan

doi:10.1093/jat/bkab105

Cited by 7 publications

(1 citation statement)

References 7 publications

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“…Flualprazolam is an analogue of alprazolam with a fluorene moiety, which was first reported to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) by Swedish police in January 2018 ( 37 ). A more recent report from California about traffic accidents related to driving under the influence of flualprazolam between 2018 and 2020 ( 38 ) shows that motorists with relatively low flualprazolam blood concentrations, averaging 12 ng/mL and ranging between 5.5 and 26 ng/mL, exhibited CNS depression consistent with benzodiazepine usage and were weaving between lanes. This account warns that flualprazolam can considerably impair driving ability even at concentrations below 10 ng/mL, which is much lower than anticipated for other benzodiazepines.…”

Section: Toxicology and Public Health Risksmentioning

confidence: 99%

Recent findings and advancements in the detection of designer benzodiazepines: a brief review

Wu,

2023

Archives of Industrial Hygiene and Toxicology

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This review article takes a closer look at a new class of psychoactive substances called designer benzodiazepines (DBZs) and the challenges of their detection. These are adinazolam, clonazolam, deschloroetizolam, diclazepam, etizolam, flualprazolam, flubromazepam, flubromazolam, phenazepam, and pyrazolam. They are central nervous system depressants and sedatives that can cause psychomotor impairment and increase the overdose risk when combined with other sedatives. DBZs undergo phase I and II metabolism similar to traditional benzodiazepines, but their specific metabolic pathways and the influence of genetic polymorphisms are yet to be clarified. Advances in liquid chromatography-tandem mass spectrometry (LC-MS/MS) have enhanced the method's sensitivity for DBZs and their metabolites in biological samples and coupled with improved blood sampling methods require less blood for drug monitoring. Further research should focus on elucidating their pharmacokinetic properties and metabolism in humans, especially in view of genetic polymorphisms and drug interactions that could inform clinical treatment choices. Even though we have witnessed important advances in DBZ detection and measurement, further refinements are needed to expand the scope of detectable DBZs and their metabolites. All this should help toxicological research to better identify and characterise the risks of chronic and polydrug abuse and facilitate clinical, forensic, and regulatory responses to this growing issue.

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Section: Toxicology and Public Health Risksmentioning

confidence: 99%

Recent findings and advancements in the detection of designer benzodiazepines: a brief review

Wu,

2023

Archives of Industrial Hygiene and Toxicology

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A Two-Year Evaluation of Flualprazolam Concentrations in Orange County Drivers: Effects on Driving and Field Sobriety Test Performance

Manaloto

Meneses

Mata

2022

Journal of Analytical Toxicology

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Starting in early 2017 flualprazolam was detected in toxicology and seized drug cases across the United States of America. Due to the addition of fluorine to alprazolam, flualprazolam’s chemistry was enough to bypass targeted toxicology confirmations and it has become increasingly available for purchase both on the dark web and in counterfeit pills. Flualprazolam was added to the exact mass screening regiment of the Orange County forensic laboratory in December of 2018. Through data mining of previously analyzed cases, data were evaluated beginning from August of 2018. Flualprazolam was subsequently added to the laboratory’s validated quantitative liquid chromatography dual mass spectrometry method in the summer of 2020 and all driving cases from August of 2018 to June of 2020 were re-analyzed to obtain concentrations. The police and drug recognition evaluation (if available) reports were collected and reviewed for all cases where flualprazolam was detected. Of the 203 cases containing quantifiable drug, the average flualprazolam concentration (median, range) was 22.8 ng/mL (15.4 ng/mL, 4.0 to 133.3 ng/mL). Only two cases had flualprazolam detected with no other drugs. The most common other drugs detected were THC (62%), ethanol (20%) and cocaine and/or methamphetamine (32%). The most common reason for the police investigation was an accident/collision (50%) and the most common time of officer contact was evening (1800 to 2359). The field sobriety test (FST) results were evaluated and showed a higher frequency of impaired performance in cases of flualprazolam in combination with other drugs. No conclusion could be made regarding the effect of flualprazolam alone on FST performance.

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Driving Impairment Cases Involving Flualprazolam

Youso¹,

Osawa²,

Divine³

et al. 2022

Journal of Analytical Toxicology

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Flualprazolam is a novel psychoactive substance in the benzodiazepine class that is increasing in prevalence in the United States. This study describes 19 cases of drivers stopped for impaired driving where flualprazolam was detected. This represents ~9% of the total cases submitted to the Sedgwick County Regional Forensic Science Center (SCRFSC) toxicology laboratory between July 2019 and May 2020. Blood concentrations of flualprazolam ranged from 4.0-69 ng/mL, with mean and median concentrations of 20.9 ng/mL and 15 ng/mL, respectively. The increased prevalence in which laboratories are detecting flualprazolam along with the low concentrations necessary for pharmacological effects, illustrates the importance of laboratories to remain vigilant in testing for novel psychoactive substances.

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Driving Under the Influence of Flualprazolam: 10 Case Reports

Cited by 7 publications

References 7 publications

Recent findings and advancements in the detection of designer benzodiazepines: a brief review

Recent findings and advancements in the detection of designer benzodiazepines: a brief review

A Two-Year Evaluation of Flualprazolam Concentrations in Orange County Drivers: Effects on Driving and Field Sobriety Test Performance

Driving Impairment Cases Involving Flualprazolam

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