{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:00:00Z","timestamp":1792699200625,"version":"4.5.0"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Postmortem toxicology is an ever-changing landscape presenting challenges for toxicologists and medical examiners. Trends can vary for certain benzodiazepines. While diazepam use tends to remain constant, alprazolam and clonazepam ebb and flow depending on prescription trends and street popularity. Novel benzodiazepines like etizolam vary in casework depending on legal restrictions and black market availability. In May 2022, the first case of the designer benzodiazepine, bromazolam, was detected in Jefferson County Coroner\/Medical Examiner\u2019s Office casework. Between then and December 2023, an additional nine cases have been observed. Bromazolam is the brominated analog of the low-dose benzodiazepine, alprazolam, and is likely similar in potency. As bromazolam is a potent benzodiazepine, low concentrations of this novel drug are likely to contribute to central nervous system depression in opioid overdose cases. We present 10 cases in which bromazolam was detected in postmortem samples at the University of Alabama at Birmingham toxicology laboratory. The decedents ranged in age from 20 to 41\u2009years. Most of the decedents were White (n\u2009=\u20098; 80%) and male (n\u2009=\u20097; 70%). Bromazolam concentrations ranged from 21 to 3220\u2009ng\/mL (mean 401\u2009ng\/mL). All but one case were polydrug, and all deaths were related to drug toxicity. Fentanyl was detected in 8 of the 10 decedents, with concentrations ranging from &amp;lt;2.5 to 97\u2009ng\/mL (mean 30\u2009ng\/mL). Additional drugs detected were methamphetamine, ethanol, oxycodone, methadone, cocaine, amphetamine, morphine, and diphenhydramine. While all manners of death were ruled as accidental, bromazolam was included in the cause of death statements in 9 of the 10 cases. Capturing important emerging drug trends in the death certificate is critical to help inform public health and medical colleagues for preventive measures and treatment in the continued drug epidemic.<\/jats:p>","DOI":"10.1093\/jat\/bkae067","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T20:44:14Z","timestamp":1722545054000},"page":"566-572","source":"Crossref","is-referenced-by-count":7,"title":["The emergence of bromazolam in Jefferson County, AL: a case series"],"prefix":"10.1093","volume":"48","author":[{"given":"Kesley D","family":"Green","sequence":"first","affiliation":[{"name":"Department of Pathology, University of Alabama at Birmingham , Birmingham, AL 35249,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M","family":"Bianco","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Alabama at Birmingham , Birmingham, AL 35249,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandi C","family":"McCleskey","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Alabama at Birmingham , Birmingham, AL 35249,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8054-024X","authenticated-orcid":false,"given":"Karen S","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Alabama at Birmingham , Birmingham, AL 35249,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"2024110407431578200_R1","article-title":"Alprazolam \u2013 Drug Usage Statistics, United States, 2013\u20132021","volume-title":"ClinCalc DrugStats Database, Version 2024.01. ClinCalc","author":"Kane"},{"key":"2024110407431578200_R2","article-title":"Clonazepam \u2013 Drug Usage Statistics, United States, 2013\u20132021","volume-title":"ClinCalc DrugStats Database, Version 2024.01. ClinCalc","author":"Kane"},{"key":"2024110407431578200_R3","article-title":"Diazepam \u2013 Drug Usage Statistics, United States, 2013\u20132021","volume-title":"ClinCalc DrugStats Database, Version 2024.01. ClinCalc","author":"Kane"},{"key":"2024110407431578200_R4","article-title":"Trend Reports","author":"The Center for Forensic Science Research & Education"},{"key":"2024110407431578200_R5","article-title":"NPS Benzodiazepines in the United States","author":"Novel Psychoactive Substances (NPS)"},{"key":"2024110407431578200_R6","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1093\/jat\/bkad005","article-title":"Bromazolam blood concentrations in postmortem cases\u2014a British Columbia perspective","volume":"47","author":"M\u00e9rette","year":"2023","journal-title":"J Anal Toxicol"},{"key":"2024110407431578200_R7","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2023.111891","article-title":"Post mortem blood bromazolam concentrations and co-findings in 96 coronial cases within England and Wales","volume":"354","author":"Hikin","year":"2024","journal-title":"Forensic Sci Int"},{"key":"2024110407431578200_R8","article-title":"Bromazolam Prevalence Surging across the United States Driven in Part by Increasing Detections alongside Fentanyl","author":"The Center for Forensic Science Research & Education"},{"key":"2024110407431578200_R9","article-title":"(2023) WHO Expert Committee on Drug Dependence: Forty-Fifth Report","author":"World Health Organization"},{"key":"2024110407431578200_R10","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1177\/0897190013515001","article-title":"Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics","volume":"27","author":"Jann","year":"2014","journal-title":"J Pharm Pract"},{"key":"2024110407431578200_R11","volume-title":"Introduction to Drug Classes, Depressants","author":"Drug Enforcement Administration","year":"2020","edition":"2020"},{"key":"2024110407431578200_R12","article-title":"QuickFacts Jefferson County, Alabama","author":"United States Census Bureau"},{"key":"2024110407431578200_R13","article-title":"Jefferson County Coroner and Medical Examiner\u2019s Office Report","author":"Statistical Data","year":"2023"},{"key":"2024110407431578200_R14","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1093\/jat\/bkad036","article-title":"Increasing prevalence of designer benzodiazepines in impaired driving: a 5-year analysis from 2017 to 2021","volume":"47","author":"Papsun","year":"2023","journal-title":"J Anal Toxicol"}],"container-title":["Journal of Analytical Toxicology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jat\/advance-article-pdf\/doi\/10.1093\/jat\/bkae067\/58892338\/bkae067.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/48\/8\/566\/60385627\/bkae067.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/48\/8\/566\/60385627\/bkae067.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T07:43:25Z","timestamp":1730706205000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jat\/article\/48\/8\/566\/7725379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,1]]},"published-print":{"date-parts":[[2024,10,28]]}},"URL":"https:\/\/doi.org\/10.1093\/jat\/bkae067","relation":{},"ISSN":["0146-4760","1945-2403"],"issn-type":[{"value":"0146-4760","type":"print"},{"value":"1945-2403","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,10]]},"published":{"date-parts":[[2024,8,1]]}}}