Etizolam (Thienodiazepine): What It Is, Uses, Side Effects, & Abuse Potential

Although not approved for use in the US, illicit use of etizolam is rising. This article outlines etizolam, including its potential for abuse and addiction.

Etizolam is an illicit drug in the United States that is increasingly gaining in popularity. It is often abused because it can cause a sense of pleasurable relaxation, even euphoria. Etizolam is associated with a high risk for developing dependence or addiction, and rapid cessation causes withdrawal symptoms. In addition, etizolam abuse has been linked to an alarming number of deaths.

What Is Etizolam?

Etizolam is an illicit drug that belongs to a class of drug called “thienodiazepines”, which are chemically similar to benzodiazepines. Both drugs are central nervous system (CNS) depressants, meaning that they reduce excitability in the brain. When taken in small amounts, etizolam and benzodiazepines work to reduce anxiety and panic, and can help with insomnia and muscle relaxation. When used recreationally (often in the form of etizolam liquid or etizolam tablets), high doses are taken that lead to altered brain chemistry and signaling, potentially resulting in the development of dependence or addiction. Furthermore, when etizolam is taken with other CNS depressants, including alcohol, the outcome can be lethal.

What Does Etizolam Look Like?

Etizolam can be obtained in pill form or as a white powder. Pills are usually blue but may be white or pink. Recreational etizolam may be consumed on blotter paper.

Etizolam Street Names

Etizolam goes by several street names, some of which refer to brand names of etizolam. The following list includes common brand and street names:

Etilaam
Etizest
Etizola
Sedekopan
Pasaden
Etizex
Depas
Etiz
Eitizzy
Street vallies

Etizolam Drug Classification

Etizolam has not been approved for use by prescribers in the United States. In other words, the FDA has not approved etizolam for any medical purpose and does not provide etizolam prescribing information. The DEA has also not classified etizolam as a drug that has medical value or abuse potential (it is an “unscheduled” drug), so its sale and use are not federally regulated. However, as a result of the increasing numbers of people who are abusing etizolam, several states have added it to their own lists of controlled substances.

Check with your state to determine whether etizolam is legal to purchase or use. If you live in a state that does not regulate etizolam and you choose to use it, do so with extreme caution and be cognizant of adverse effects and abuse potential associated with regular etizolam use.

Is Etizolam Legal in the United States?

Etizolam legal status in the US is somewhat confusing for many because, although not approved by the FDA as a prescription drug, it remains unclassified (in other words, it is not “scheduled” by the Drug Enforcement Agency (DEA). This means that the DEA has not defined the potential for abuse associated with etizolam, nor has it identified medicinal value, so etizolam is not listed under the Controlled Substances Act. The result is that etizolam can be purchased legally as a “research chemical.”

However, there are several states that have taken action to prevent etizolam abuse, including Alabama, Arizona, Arkansas, Florida, Georgia, Louisiana, Indiana, Mississippi, North Carolina, Ohio, Texas, and Virginia. These states have included etizolam on their controlled substances lists, although penalties for possession or use may vary. It is important to note that this list may be incomplete; check with your state to determine etizolam’s legal status.

What Is Etizolam Used For?

In countries where etizolam is a prescription medication (Japan, India, and Italy), etizolam uses commonly includes the treatment of generalized anxiety disorder and panic disorder. It has also been used to treat insomnia and, unlike benzodiazepines, may be useful for people who have generalized anxiety disorders with depressive symptoms. Etizolam may have other valid medical uses, including use to minimize bleeding after neurosurgery and to reduce bronchoconstriction in emphysema and asthma.

Recreationally, high doses of etizolam are taken for the resulting feelings of relaxed euphoria. Like benzodiazepines, etizolam gives users the feeling that “everything [is] going to be OK.” Users often report that they feel like they are floating. Unfortunately, these feelings lead first-time users to continue to use etizolam, and regular use leads to tolerance, dependence, and addiction.

Administration & Dosage

In countries where etizolam is a prescription drug, etizolam dosage is generally between 0.5 mg and 2 mg per day and is administered orally. Although studies to clarify pharmacology and pharmacokinetics in humans remain underway, some reports indicate that etizolam is up to 10 times more potent than diazepam (a benzodiazepine). However, data on the toxicology of etizolam compared to diazepam are conflicting. Rarely, people who abuse etizolam may take it in other ways, including inhalation, rectal suppository, or via injection.

Much more importantly, etizolam overdose can be fatal. Etizolam is a central nervous system (CNS) depressant that is often taken with other CNS depressants, including alcohol or opioids. When CNS depressants are combined, the odds of overdose increase dramatically.

Overdoses are associated with unconsciousness, respiratory depression, extremely slow heart rate, and arrhythmia, coma, and death. There is currently no empirically validated treatment for etizolam overdose, although the drug, flumazenil, competitively binds to the same place that etizolam and benzodiazepines bind (namely, GABA receptors in the brain) and can help to reverse the effects of etizolam overdose.

Etizolam Side Effects

Etizolam works by enhancing signaling of a chemical in the brain called GABA, which is an inhibitory neurotransmitter, meaning that it reduces brain activity. Etizolam is thus quite effective at reducing anxiety and preventing panic attacks. However, too much inhibitory neurotransmission leads to such low levels of brain activity that normal physiological functions, including breathing, are inhibited.

When taken therapeutically (that is, at doses and frequencies that would be prescribed to treat anxiety or panic disorders), the most commonly reported side effects of etizolam are drowsiness, sleepiness and muscle weakness. Serious adverse side effects of etizolam are often associated with abuse and include loss of coordination, slurred speech, confusion, and unconsciousness. Regular abuse has been significantly linked to something called blepharospasm, especially in women. Blepharospasm is a medical term that refers to abnormal eyelid spasms that progress in intensity and frequency as time goes on.

When etizolam is combined with other drugs that slow brain function (CNS depressants), the result can be dangerous, even lethal. When etizolam is taken with alcohol, opioids, or benzodiazepines, the net effect can be synergistic, meaning that the drug combination has a greater overall effect than any of the drugs would have had if they were taken independently. The outcomes of polysubstance abuse including etizolam is often severe respiratory depression and dangerously slow heart rate. Many deaths that are associated with benzodiazepine or etizolam overdoses involve other drugs and are caused when people fall unconscious and their breathing and heart rate become so slow that they enter into a comatose state, eventually leading to death.

How Long Will Etizolam Stay in Your System?

The etizolam half-life is 3.4 hours, but this has been shown to vary quite a bit depending on the amount taken and the metabolism of the person who is using it. Larger doses of etizolam are associated with longer half-lives, with one report finding that the etizolam half-life can be as long as 15 hours.

Consequently, etizolam detection time can range from approximately a day and a half to more than 6 days. In addition, etizolam metabolism produces at least one byproduct which can be measured for approximately three and a half days. It should be noted that these tests all sampled blood. Currently, the most popular drug testing companies do not provide specific etizolam drug tests. However, drug testing protocols are being evaluated and preliminary results show that testing for etizolam is easy to do and the results are reliable.

There are over-the-counter “dipstick” type tests that can evaluate whether benzodiazepines are present in urine or other fluids. Because etizolam has a chemical structure that is similar to benzodiazepines, it is possible that a dipstick type test will deliver a positive result if someone has used etizolam recently. However, these tests are not approved for use as employment or court-ordered drug testing.

Is Etizolam Addictive?

Because etizolam is a relatively new drug that has not been well-studied, there have been few clinical trials that evaluated the potential for dependence and addiction. However, mounting preliminary data indicates that etizolam has a high risk of dependence and has a relatively high potential for abuse. In addition, anecdotal reports and case studies released from hospital emergency departments indicate that etizolam is addictive and can have dangerous, even lethal consequences. Currently, a number of European and Asian countries are the major source of data on adverse effects associated with etizolam abuse. On the domestic front, however, the American College of Emergency Physicians published a 2015 editorial seeking to highlight the increasing risk of etizolam abuse and overdose in the US.

Further underscoring that etizolam is associated with addiction is the finding that rapid cessation leads to withdrawal symptoms that are similar to those seen in cases of benzodiazepine withdrawal, including irritability, anxiety, difficulty concentrating, anhedonia, heart palpitations, insomnia and panic attacks. Extreme cases of benzodiazepine withdrawal can cause hallucinations, delusions and even seizures; it is likely that etizolam will be empirically found to have similar symptoms.