Etizolam is an illicit drug that is chemically and pharmacologically very similar to benzodiazepines, which are commonly prescribed anti-anxiety medications. Although etizolam has not been approved by the Food and Drug Administration (FDA) for use in the United States, it is not a scheduled drug, meaning that the Drug Enforcement Administration (DEA) has not officially recognized that it has a high potential for abuse. Despite a lack of federal regulation, etizolam abuse is associated with numerous adverse effects, prompting several states to include etizolam on their controlled substances lists.

How is Etizolam Abused?

Etizolam has a high oral bioavailability (approximately 93%), meaning that oral ingestion allows most of the drug to reach the systemic circulation. Thus, the most common route of etizolam administration is via swallowing pills, although powder may be dissolved in alcohol and ingested as a liquid or dropped in measured doses onto blotter paper for future oral consumption (etizolam blotter). Pills can also be dissolved sublingually (under the tongue) or transbuccally (against the cheek). Other routes of administration (smoking, snorting and injecting) are uncommon.

How Long Does it Take to Get Addicted to Etizolam?

The most significant factors that predict whether someone will develop dependence or addiction is the amount and frequency of use. High doses of etizolam taken daily could cause someone to suffer from profoundly uncomfortable, even dangerous withdrawal symptoms within a matter of weeks.

Etizolam Addiction Symptoms

Symptoms of addiction are subjective reports that cannot easily be measured by an observer (for example, headache or depression); signs of addiction are objective and can be measured by an observer (for example, respiration rate or wakefulness).

Etizolam is associated with physical and psychological symptoms of addiction. Physical symptoms of etizolam addiction and withdrawal include insomnia, headache, muscle weakness, nausea, appetite changes, and libido changes. Some people will succumb to risky drug-seeking behavior if they do not have more etizolam on hand. A hallmark psychological symptom of etizolam addiction is an inability to stop using the drug despite wanting to quit. Psychological symptoms of withdrawal frequently include anxiety, panic attacks, intense cravings, and depression.

Physical Signs

Etizolam abuse is often associated with drowsiness, slurred speech, memory loss, confusion and loss of coordination. Some people who regularly use etizolam, especially women, develop abnormal twitching or closing of the eyes (“blepharospasm”) that worsens with continued use. Extremely high doses of etizolam may cause signs of a dangerous overdose, including unconsciousness, respiratory depression, and arrhythmia. Physical signs of etizolam withdrawal include trembling, vomiting, and a rapid heart rate.

Behavioral Signs

Etizolam addiction is associated with characteristic behavioral signs including secrecy and evasive behavior, attempts to isolate from friends and family, failure to meet expectations at school or work, unusual irresponsibility, preoccupation and a general lack of ability to concentrate. Behavioral signs of etizolam withdrawal include intense anxiety, preoccupation with acquiring the drug or quelling withdrawal symptoms and depression.

Side Effects of Etizolam Addiction

While signs and symptoms are objective and subjective measures of addiction and withdrawal, respectively, side effects include short- and long-term consequences of substance use disorders. Etizolam side effects often include physical, psychological and social ramifications.

  • Short-term Effects

    Loss of interest in hobbies, failure to meet expectations, general irresponsibility and preoccupation with the drug. In states where etizolam is a scheduled substance, someone who uses etizolam risks arrest and subsequent legal ramifications.

  • Long-term Effects

    Little is known about long-term adverse health effects resulting from etizolam addiction. However, long-term effects of etizolam abuse are likely similar to those of long-term benzodiazepine use and include substantial changes to brain chemistry and function, rebound insomnia, and the potential for cognitive decline even after cessation of regular use.

  • Side Effects of Polysubstance Abuse

    Combining drugs can cause respiratory depression, coma, and death. Non-lethal side effects of polysubstance abuse involving etizolam include periods of memory loss, profound lethargy, muscle weakness, loss of coordination and unconsciousness.

What Causes Etizolam Addiction?

Etizolam effects are a consequence of altered brain chemistry. Therapeutic doses modestly enhance the efficacy of the inhibitory neurotransmitter GABA. Large doses of etizolam have farther-reaching effects, including indirectly increasing dopamine levels. Dopamine regulates addiction via the “reward pathway,” so when drugs that increase dopamine are taken, the reward circuit is activated and the outcome is a sense of pleasure or euphoria. Drugs hijack this process to an extreme degree by inappropriately activating the reward pathway and reinforcing an inaccurate but incredibly real perception that a drug is “needed” for survival.

Etizolam Abuse Facts and Statistics

Most of the statistics surrounding etizolam abuse come from European and Asian countries, which have dealt with etizolam abuse for much longer than the United States. Scotland had the highest rate of drug deaths per capita in Europe in 2018, driven in part by a staggering 83% increase in etizolam-related deaths. Although long-term trends and statistics that clarify etizolam abuse in the United States are not as robust as they are in other parts of the world, case studies and regional reports emphasize that etizolam is an “emerging drug of concern” in the United States.

Etizolam Abuse and Treatment Trends in Florida

Like the rest of the country, Florida has witnessed the emergence of etizolam abuse in recent years. Data from 2017 and 2018 include early findings of etizolam abuse in Florida, and in 2018 the Florida Senate took steps to add etizolam to Florida’s controlled substance list.

Etizolam Overdose Risks

As with benzodiazepines, etizolam overdose risk in the absence of other drugs is likely to be more uncomfortable than dangerous, but the risk of etizolam-related overdoses goes up significantly when other CNS depressants (alcohol, opioids, benzodiazepines) are present.

Overdose signs and symptoms associated with CNS depressants often overlap, so it can be difficult for medical professionals to determine exactly what caused an overdose. Naloxone is a standard treatment in opioid overdoses, but if etizolam is present a patient may be essentially unresponsive to naloxone treatment. Flumazenil can help in cases of benzodiazepine overdose but is associated with its own risks. Flumazenil can cause potentially lethal seizures in people experiencing benzodiazepine overdoses, likely because of the rapid reversal of inhibition of brain activity associated results in a hyperexcitable brain state that manifests as seizure activity.

Etizolam Addiction Treatment

Treatment for etizolam use disorders follows a similar trajectory as to other substance use disorders, particularly benzodiazepines. As with benzodiazepines, abrupt cessation (cold turkey) is not recommended for people struggling with etizolam use disorder; tapering provides a safe and effective way to wean the body off of etizolam dependence. Treatment steps include:

  • Detox

    Because etizolam and benzodiazepines can be associated with profoundly uncomfortable acute withdrawal symptoms, medically supervised detox is often the most effective way to manage detox. In extreme cases, pharmacological interventions can mitigate withdrawal symptoms.

  • Residential

    Because of the relative ease of access to etizolam in many states and the substantial and often prolonged withdrawal symptoms that are a consequence of regular, heavy etizolam use, residential rehab can offer a safe, secure environment that maximizes success in the early days of recovery.

  • Outpatient

    Some people find that outpatient programs offer the support and care they need to overcome etizolam use disorder without a prior residential program, but for people with severe dependence or addiction, outpatient treatment often follows a residential stay.

  • Dual Diagnosis

    Substance use disorders often develop while people try to deal with underlying mental health issues or mask emotions associated with past trauma. Because etizolam is an anxiolytic (a drug that reduces anxiety), people who abuse it are likely to struggle with anxiety disorders. By addressing the emotional driver of substance use, people often find that they are far more able to deal with stress, depression or anxiety in healthy, productive ways and do not need to rely on etizolam or other substances to help them cope.

Key Points: Understanding Etizolam Abuse

Keep the following key points in mind regarding etizolam:

  • Etizolam use disorder, like all substance use disorders, is a consequence of real and significant changes in brain chemistry and function and is not indicative of a lack of willpower or insufficient moral fortitude
  • Etizolam is a benzodiazepine derivative, meaning that is is chemically and pharmacologically similar to benzodiazepines but has a slightly different mechanism of action
  • Although etizolam can be smoked or snorted, the most common route of administration is oral via pills, tablets or blotter paper
  • Etizolam use is characterized by physical and psychological signs and symptoms, including drowsiness, lethargy, muscle relaxation/weakness, impaired coordination, slurred speech, and confusion; heavy use can cause unconsciousness and respiratory depression.
  • Etizolam overdose in the absence of other drugs is extremely rare
  • When taken with other depressants (alcohol, opioids or benzodiazepines), the risk of etizolam overdose increases drastically