{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T13:33:23Z","timestamp":1781530403821,"version":"3.54.1"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T00:00:00Z","timestamp":1632700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,13]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Although not used clinically in North America, etizolam has been identified in forensic samples as an illicit \u2018designer\u2019 benzodiazepine. As a central nervous system depressant, analysis for etizolam has probative value in both death investigations and forensic cases where incapacitation or human psychomotor performance is relevant. This report examines toxicological findings and demographic data in a series of authentic forensic cases analyzed between November 2019 and December 2020 in which etizolam was quantified by liquid chromatography-tandem mass spectrometry analysis. Blood concentrations were determined in 191 individuals aged 1\u201375\u2009years. In living individuals (i.e., impaired driving and sexual assaults), etizolam concentrations ranged from &amp;lt;5 to 767\u2009ng\/mL which overlapped with the range of &amp;lt;5 to 260\u2009ng\/mL reported in death investigations. In all but one case, other drugs were detected in combination with etizolam. Fentanyl was the most common co-occurring drug and was present in 164 cases (86%). Additional case details are provided for cases of forensic interest: two deaths involving children &amp;lt;3\u00a0years of age, two deaths involving body packing and an individual arrested for drug-impaired driving with, to our knowledge, the highest reported etizolam concentration to date.<\/jats:p>","DOI":"10.1093\/jat\/bkab106","type":"journal-article","created":{"date-parts":[[2021,9,18]],"date-time":"2021-09-18T11:07:59Z","timestamp":1631963279000},"page":"719-725","source":"Crossref","is-referenced-by-count":16,"title":["Etizolam Blood Concentrations in 191 Forensic Cases in Ontario, Canada (2019\u20132020)"],"prefix":"10.1093","volume":"46","author":[{"given":"Christena","family":"Watts","sequence":"first","affiliation":[{"name":"Toxicology Section, Centre of Forensic Sciences , 25 Morton Shulman Ave, Toronto, ON M3M 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3059-2751","authenticated-orcid":false,"given":"Teri L","family":"Martin","sequence":"additional","affiliation":[{"name":"Laboratory Services Section, Centre of Forensic Sciences , 25 Morton Shulman Ave., Toronto, ON M3M 0B1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,9,28]]},"reference":[{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1185\/03007999009111650","article-title":"Etizolam in the treatment of a generalized anxiety disorder: a double blind study versus placebo","volume":"12","author":"Casacchia","year":"1990","journal-title":"Current Medical Research and Opinion"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1185\/03007998909112670","article-title":"Etizolam in the treatment of generalized anxiety disorder associated with depressive symptom","volume":"9","author":"Pariante","year":"1989","journal-title":"Current Medical Research and Opinion"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1185\/03007999009111500","article-title":"Etizolam versus placebo in the treatment of panic disorder with agoraphobia: a double-blind study","volume":"12","author":"Salvodi","year":"1990","journal-title":"Current Medical Research and Opinion"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.forsciint.2019.05.018","article-title":"Is etizolam a safe medication? Effects on psychomotor performance at therapeutic dosages of a newly abused psychoactive substance","volume":"301","author":"Busard\u00f2","year":"2019","journal-title":"Forensic Science International"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"2851","DOI":"10.1016\/j.clinthera.2009.12.010","article-title":"Effects of treatment with etizolam 0.5 mg BID on cognitive performance: a 3-week, multicenter, randomized, double-blind, placebo-controlled, two-treatment, three-period, noninferiority crossover study in patients with anxiety disorder","volume":"31","author":"De Candia","year":"2009","journal-title":"Clinical Therapeutics"},{"key":"2023031315055797000_","first-page":"1","article-title":"High-dose dependence and cognitive side effects to medical prescription of etizolam","volume":"11","author":"Tamburin","year":"2020","journal-title":"Frontiers in Psychiatry, Brief Research Report"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/BF00280074","article-title":"Single and multiple dose pharmacokinetics of etizolam in healthy subjects","volume":"40","author":"Fracasso","year":"1991","journal-title":"European Journal of Clinical Pharmacology"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/pcn.13216","article-title":"Etizolam levels in maternal serum, cord blood, and breast milk during pregnancy and lactation: a case report","volume":"75","author":"Saito","year":"2021","journal-title":"Psychiatry and Clinical Neurosciences"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.forsciint.2008.08.012","article-title":"Case report: etizolam and its major metabolites in two unnatural death cases","volume":"182","author":"Nakamae","year":"2008","journal-title":"Forensic Science International"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.forsciint.2016.02.017","article-title":"A fatal intoxication related to MDPV and pentedrone combined with antipsychotic and antidepressant substances in Cyprus","volume":"265","author":"Liveri","year":"2016","journal-title":"Forensic Science International"},{"key":"2023031315055797000_","doi-asserted-by":"publisher","DOI":"10.1177\/0025802420973814","article-title":"Femoral blood concentrations of the designer benzodiazepine etizolam in post-mortem cases","author":"Hikin","year":"2021","journal-title":"Medicine, Science, and the Law"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.forsciint.2016.09.006","article-title":"Blood concentrations of new designer benzodiazepines in forensic cases","volume":"268","author":"H\u00f8iseth","year":"2016","journal-title":"Forensic Science International"},{"key":"2023031315055797000_","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bkaa146","article-title":"A case series of etizolam in opioid related deaths","author":"Gevorkyan","year":"2021","journal-title":"Journal of Analytical Toxicology"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1093\/jat\/bkaa043","article-title":"Blood concentrations of designer benzodiazepines: relation to impairment and findings in forensic cases","volume":"44","author":"Heide","year":"2020","journal-title":"Journal of Analytical Toxicology"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1093\/jat\/bkaa050","article-title":"Driving impairment cases involving etizolam and flubromazolam","volume":"45","author":"Rohrig","year":"2021","journal-title":"Journal of Analytical Toxicology"},{"key":"2023031315055797000_","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1093\/jat\/23.6.479","article-title":"Quantitation of alprazolam and \u03b1-hydroxyalprazolam in human plasma using liquid chromatography electrospray ionization MS-MS","volume":"23","author":"Crouch","year":"1999","journal-title":"Journal of Analytical Toxicology"},{"key":"2023031315055797000_","article-title":"What\u2019s in Toronto\u2019s Drug Supply? 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