Etizolam is a prescription medication in Italy, Japan, and India that is marketed under various names, including Etilaam, Depas, Etizest, Etizola, Pasaden, and Sedekopan. In these countries, it is used to treat anxiety and panic disorders much like the benzodiazepine drugs that it is chemically similar to. Currently, Etizolam is not marketed or controlled in the United States, although it has emerged as a drug of abuse.

As a benzodiazepine analogue, etizolam is just slightly molecularly different from other benzodiazepines such as diazepam (Valium) or alprazolam (Xanax). Instead of a benzene ring like other benzodiazepines, etizolam has a thiophene ring. Benzodiazepine drugs interact with the naturally occurring and stress-relieving neurotransmitter GABA (gamma-Aminobutyric acid) to quell the fight-or-flight reaction and calm the body and brain. As a central nervous system depressant, etizolam lowers body temperature, slows respiration, reduces heart rate, and lowers blood pressure. With no accepted medical use in the United States, any use of etizolam is considered abuse. Prescription forms of etizolam are marketed in 0.25 mg, 0.5 mg, and 1.0 mg tablets in the countries where it is distributed legally, and it may be found online labeled as a “research chemical” in tablet form, powder form, or spiked onto blotter paper.

The National Survey on Drug Use and Health (NSDUH) publishes that 2.5 million people in the United States misused a prescription sedative or tranquilizer medication in the month before the 2016 survey. Benzodiazepine drugs are widely abused for the relaxing and euphoric high they can produce when taken recreationally. Etizolam can lessen anxiety and may, therefore, be abused when a person uses it to self-medicate for conditions such high stress levels.

Abuse of benzodiazepines, including benzo analogs like etizolam, can lead to a toxic overdose, drug tolerance and dependence, and high rates of addiction.

Problematic Use and Hazards

Since there is no medical use for etizolam in the U.S., any use is considered problematic. Etizolam is most commonly swallowed or placed under the tongue and absorbed sublingually when abused, but it also may be snorted, smoked, or placed in the rectum. It may be used to lessen the crash from stimulants or other drugs. Etizolam may also be abused with other drugs or alcohol, which can make the side effects worse and odds for a dangerous overdose higher.

The journal Annals of Emergency Medicine publishes that etizolam abuse has been rising since 2011 in the United States. In 2014, there were 41 cases of exposure reported to the American Association of Poison Control Centers (AAPCC).

Signs that May Indicate Etizolam Abuse Include:

  • High rate of secrecy and large amounts of time spent online
  • Suspicious packages coming from out of the country
  • Changes in moods and behaviors
  • Weight fluctuations and irregular eating habits
  • Sleeping and waking at strange times
  • Decreased interest in things that used to be important
  • Changes in physical appearance and a lack of attention to personal hygiene
  • Lowered output and production at work and/or school
  • Social isolation and changes in peer circles

The Drug Enforcement Administration (DEA) warns that the pharmacological effects of etizolam are six to 10 times more powerful than diazepam and that etizolam is 10 times more potent than diazepam in relation to hypnotic effects. Etizolam can have a greater effect at lower doses than other traditional benzodiazepines. This can potentially increase the risk for a serious and life-threatening overdose.

The National Institute on Drug Abuse (NIDA) publishes that more than 10,500 Americans died from a benzodiazepine overdose in 2016. An etizolam overdose can cause extreme suppression of the central nervous system, making it hard for a person to breathe and slowing down the heart rate and blood pressure to dangerous levels, which can lead to coma or death. Drowsiness, sedation, headache, nausea and vomiting, dry mouth, fainting, lack of coordination, slurred speech, vision disturbances, tremors, muscle weakness, depression, and mental confusion are all possible side effects of etizolam abuse.

Like other benzodiazepines, etizolam can impair thinking, making a person more susceptible to risky behaviors, injuries, or accidents. An etizolam high can look very much like alcohol intoxication. It can cause lowered inhibitions, increased sociability, and the diminished ability to make good decisions.

Tolerance, Dependence, and Addiction

Just like with benzodiazepines, regular use of etizolam builds up a tolerance. With the repeated interaction of etizolam on brain chemistry, the body can get used to it and learn how to “level out” at regular dosage amounts. A person will then have to increase the amount of etizolam they are taking for it to take effect.

Etizolam has been heralded as having a lower tolerance and dependence potential than other benzodiazepines. However, the Indian Journal of Pharmacology warns that its quick onset and short duration of action may actually make it just as easy to develop a tolerance to and dependence on it as other benzodiazepines. Drug dependence is indicated by difficult withdrawal symptoms and cravings when etizolam wears off and stops working in the body.

Etizolam typically starts working within about 30 to 60 minutes after it is ingested orally. The effects peak in three to four hours, and the drug typically wears off in about six to eight hours. When it wears off, withdrawal symptoms can include tremors, insomnia, irregular blood pressure and heart rate, sweating, nausea, vomiting, rebound anxiety, depression, muscle weakness, and dizziness. Significant withdrawal symptoms can also occur, and a person may suffer from agitation, hallucinations, psychosis, confusion, fever, and seizures, which can be especially hazardous.

Drug tolerance and dependence can make it so that a person struggles to stop taking etizolam. It can seem easier to keep taking it to avoid the crash or comedown from the drug. Instead, keeping a steady dose of etizolam in the system may seem like the easier option. This can cause difficulties with controlling dosages or stopping the drug altogether.

Thoughts of the drug may become overpowering, as someone struggling with etizolam addiction may be able to think of little else. As a result, relationships suffer, work output declines, interest in recreational or social activities wanes, and one’s emotional and physical well-being take a hit.

NIDA explains that addiction makes physical changes to the brain that influence how a person feels pleasure, learns, forms memories, thinks, makes decisions, controls impulses, and deals with stress. Addiction is an all-encompassing brain disease infiltrating most, if not all, aspects of a person’s life. According to the NSDUH, more than 20 million Americans battled addiction in 2016.

Withdrawal and Detox

Etizolam and benzodiazepine drugs are considered to be habit-forming. Their associated level of drug dependence can form rather quickly, which means the drugs should not be stopped suddenly or “cold turkey.” Benzodiazepine drugs are generally weaned out of the body slowly through a controlled tapering schedule. Since etizolam can have significant withdrawal symptoms, its dosage should be lowered safely to avoid the brain’s rebound effect, as it attempts to reestablish balance with brain chemistry after the drug wears off.

Etizolam dependence and addiction are optimally managed through a medical detox program, which can replace the short-acting drug with a benzodiazepine with a longer mechanism of action. In this way, the medication can be taken less often, and the dosage can be slowly lowered over time, allowing the brain to regulate bit by bit until physical stability is reached. Additional medications for drug cravings and withdrawal symptoms can be useful during medical detox as well. Etizolam withdrawal can start as soon as the drug processes out of the body, within six to eight hours. Side effects will generally peak within two to three days and start to taper off in a week or so. Some of the symptoms, such as anxiety, residual cravings, depression, mental cloudiness, and insomnia can last a few weeks or months after etizolam use stops.

The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that with continued abstinence, withdrawal symptoms will subside over time.

Several Factors Can Influence the Withdrawal Timeline and Severity. Some of these Factors Include:

  • Concurrent abuse of alcohol or other drugs with etizolam
  • Level of drug dependence, as the more and longer a person has been using etizolam, the more significant dependence will be
  • Biological and genetic factors, including metabolism and family history of addiction
  • Presence of co-occurring mental health or medical disorders
  • Environmental aspects like unstable or stressful surroundings

Medical detox typically lasts about a week. It provides a safe and stable environment with continual medical support and supervision.

Options for Abuse and Addiction Treatment

Medical detox is often a highly beneficial and important component of a complete addiction treatment plan. It can help a person to become physically stable and ready to address the psychological aspects of drug abuse and addiction.

Behavioral therapies in individual and group counseling sessions are some of the most widely accepted methods for treating drug addiction. These sessions and workshops help people to address the root cause of the drug abuse and learn new stress management and coping strategies for recovery. Relapse prevention skills are also learned. Support groups and 12-step programs can help with this.

Educational programs, life skills trainings, holistic and complementary methods like mindfulness meditation, nutrition planning, art therapy, yoga, spa treatments, massage therapy, and chiropractic care can all be parts of a complete addiction treatment program.

When a person also struggles with a medical or mental health disorder at the same time, integrated treatment for co-occurring disorders is needed. Every program is tailored specifically to the individual and their family. SAMHSA’s Behavioral Health Treatment Services Locator can help individuals to identify programs by location and type.

Both inpatient and outpatient addiction treatment programs exist to help people manage substance abuse and addiction. Inpatient, or residential, treatment programs offer the highest level of support and structure while outpatient programs provide more flexibility with scheduling.

Each person is different in terms of what they need. A trained professional can help families to decide on the best program and level of care. Treatment should be flexible, and the level of care may change as a person moves through a program. Alumni programs and aftercare support can be very helpful in minimizing relapse, providing ongoing support, and helping individuals and families to live healthy and fulfilled lives in recovery.

A well-rounded addiction treatment program will take into account the medical, emotional, physical, behavioral, social, and spiritual needs of each individual. The right program can provide clients with a comprehensive approach for a long-term recovery.

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