Although etizolam is related to benzodiazepine drugs such as Xanax, Klonopin, and Valium, it is technically in a different drug class called thienodiazepines. Etizolam is much more potent than any of its benzodiazepine relatives—usually around 10 times more potent than diazepam or Valium—but produces many of the same effects.

Three countries—Italy, India, and Japan—have etizolam available as a prescription sedative, but most other countries have not passed legislation on the drug yet. That said, etizolam is considered a drug of abuse in the United States, but it is not technically illegal because it is not scheduled under the Controlled Substances Act (CSA).

Signs and Symptoms of Etizolam Intoxication and Abuse

When etizolam is prescribed in the countries that have made it legal, it is prescribed for some of the same conditions that benzodiazepines are prescribed for, like anxiety disorders, panic attacks, and insomnia. Etizolam was initially introduced in Japan in 1983 as a treatment for these neurological conditions, and it is usually prescribed in 0.25 mg, 0.5 mg, or 1 mg tablets.

When etizolam is found outside these countries, it is a drug of abuse, and it is most often found in the pure powdered form. This form of the drug is sold over the internet and sometimes in local convenience stores or “head shops” where it is labeled a research chemical. Unlike other new psychoactive substances (NPS), etizolam has been used in other countries in medical settings, and it is related to common drugs, so its side effects are better understood and predicted than many other NPS.

There Are Short-Term Side Effects of Both Benzodiazepines and Etizolam. The Most Common Ones Are:

  • Loss of motor coordination
  • Lethargy, fatigue, and drowsiness
  • Dizziness
  • Confusion
  • Depression
  • Changes to vision, like blurred vision
  • Vertigo
  • Physical shaking or tremors
  • Respiratory depression or shallow breathing
  • Low blood pressure
  • Slow heartbeat
  • Nausea, abdominal cramps, constipation, or vomiting
  • Appetite loss
  • Diarrhea

In Higher Doses, these Drugs May Cause Intense Symptoms, Such As:

  • Slowed reflexes
  • Mood swings
  • Erratic behavior
  • Euphoria
  • Blackouts or memory loss

Long-term harm can be caused by consistent, high-dose benzodiazepine abuse, which means that abusing etizolam likely also leads to serious physical and mental harm.

People Who Abuse Etizolam May Experience:

  • Impaired cognition, memory, and judgment
  • Disorientation
  • Confusion
  • Slurred speech
  • Muscle weakness
  • Changes in mobility or gait

Someone who has taken a lot of benzodiazepines or a larger dose of etizolam may appear drunk without consuming alcohol. Benzodiazepines, etizolam, and alcohol all work on the same area of the brain, so the effects across these three types of drugs will be very similar.

Some reports suggest there are few, if any, comedown effects from taking etizolam. However, like benzodiazepines, as the drug wears off, you are likely to experience depression, rebound anxiety, rebound insomnia, and trouble staying awake from fatigue. You also may feel sick or have trouble falling asleep. Feeling bad after abusing a drug that makes you feel good puts you at risk of returning immediately to that drug and taking more of it to feel normal.

Tolerance to benzodiazepines can develop quickly with regular consumption. Doctors are likely to prescribe a benzodiazepine in the smallest possible dose for as-needed use or regular use for two weeks or less. This is because the body rapidly develops a tolerance to these drugs, so you will feel like you need more of them to feel the original effects. This increases the risk that you could develop a dependence on them, meaning you may crave more to feel normal, not just high.

Potency: Xanax vs. Etizolam

To understand how truly dangerous etizolam is, comparing the drug to Xanax, another widely prescribed and abused benzodiazepine, may be helpful.

  • Both drugs are prescribed, in different countries, to treat generalized anxiety and panic disorder; etizolam is also used to treat insomnia and acute panic disorder, but Xanax is not approved for this use. There are no known off-label uses for etizolam, but Xanax has been prescribed off-label to treat insomnia, agitation, premenstrual dysphoric disorder, agitation, and chemotherapy-induced vomiting.
  • Both etizolam and Xanax are prescribed in similar dose sizes. Etizolam is 93 percent bioavailable after it is taken, and Xanax is about 90 percent bioavailable. This means that, at the same size dose, there will be more etizolam in the body compared to Xanax.
  • Both chemicals act on the GABA receptors in the brain. Xanax appears to have more action on dopamine while etizolam acts on acetylcholine, a different neurotransmitter that is more active in the hippocampus and prefrontal cortex. Still, both drugs have a significant effect on how much dopamine is secreted and absorbed by the brain, so they both affect the brain’s reward center.
  • They have slightly different half-lives. Etizolam lasts between seven and 15 hours while Xanax lasts from nine to 16 hours, with 12 hours being considered the average half-life. The main effects for both, however, last about five hours.
  • Etizolam binds to the brain faster than Xanax. Etizolam’s onset of action is between 15 and 25 minutes after it is ingested while Xanax takes between 20 and 40 minutes to become active. This is a small difference, but someone abusing these sedatives is likely looking for something that binds as fast as possible to the brain.

Abuse of Benzodiazepines and Etizolam

Benzodiazepines are known to be an addiction risk in the U.S. Etizolam has been shown in studies involving monkeys to have reinforcing effects, meaning it is associated with drug addiction. In the countries that made it legal, it has been associated with some reports of addictive behaviors, dependence, and overdose.

Etizolam is only now making its way to the United States and the United Kingdom as a drug of abuse. According to law enforcement in the U.S., the number of reports of etizolam being seized in the country rose from just three in 2012 to 92 reports in 2013. Then, in just the first six months of 2014, there were 45 reports. Before 2012, law enforcement had no reports of etizolam anywhere in the U.S. However, the use of the drug is spreading across the country, worrying officials everywhere.

In fact, in February 2018, the Ohio State Board of Pharmacy voted to classify etizolam as a Schedule I substance. While it is not scheduled at the federal level, any reports of the drug in Ohio will be considered a serious drug crime since there is no recognized medical use for the substance in the U.S., and it is only available as a substance of abuse.

Other states that have banned etizolam include Alabama, Arkansas, Florida, Louisiana, and Mississippi. Georgia and Texas have both made the drug Schedule IV so it can be tracked, and it has been nonspecifically scheduled in Arizona and Indiana.

Benzodiazepines have been used as a date rape drug—the most infamous of which is Rohypnol—in the U.S. Mixing any benzodiazepine with alcohol unbeknownst to the person drinking the beverage can lead to them passing out or blacking out, making them extremely vulnerable to crime. Although there are not yet specific reports of etizolam being abused in this way in the U.S., the potency of the substance and ease of finding it online may lead someone to abuse etizolam mixed with alcohol as a date rape drug.

The World Health Organization (WHO) does not list any specific differences between the effectiveness of Xanax versus etizolam and considers etizolam to have a “low-to-moderate” addiction risk. At the same time, Xanax is one of the most abused drugs in the U.S., even among benzodiazepines. Some studies in the late 1980s found there was greater somatization among people who took etizolam compared to Xanax, but this was not considered to be significant.

Etizolam is largely dangerous in the U.S. because it is always an illicit drug here. It could be mixed with other substances such as the stimulant cocaine, opioid fentanyl, or other illicit benzodiazepines. There is no way to appropriately dose it because there is no medical supervision for the drug. It is more potent than several benzodiazepines, so taking too much will lead to an overdose. As a result, you are more likely to abuse the drug and become addicted to it.

A Better Future

There are no known treatments for etizolam addiction, but treatment programs specializing in benzodiazepine addiction can help. A medically supervised detox, followed by evidence-based behavioral therapy, creates the core foundation to overcome addiction to any drug, especially potent and illicit substances like etizolam.

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