New Uncontrolled Benzodiazepine, Phenazepam, Emerging drug of Abuse

| September 1, 2012 | 0 Comments

Adegboyega Oyemade, MD
Board Certified Addiction Psychiatrist, Southern Illinois Healthcare Foundation
Behavioral Health Clinic, Belleville, Illinois

Phenazepam is a long-acting benzodiazepine that was developed in the former Soviet Union in the 1970s. It is not a scheduled drug here in the United States or in most of Western Europe. Phenazepam has become a drug of concern due to the number of hospitalizations and fatalities following overdoses.[1–3] The drug is potent at one-tenth of the recommended dose for diazepam.[3] The lack of data on this drug highlight the need for healthcare professionals to be aware of its existence.[1]

In Russia, the indications for phenazepam are epilepsy, anxiety, and sleep disorders.[1] Its increase in use for nonmedicinal purposes has been reported in Western Europe in the last couple of years, and its use has spread to the United States, with recorded deaths resulting from its use in Georgia and Louisiana.[1,4,5] Some of phenazepam’s concerning side effects include loss of coordination, drowsiness, and amnesia.[5] I believe the latter side effect to be particularly concerning due to its potential for use as a date rape drug.

Fatalities have been reported when the drug is taken with other prescription opioid analgesic drugs.[4] Phenazepam has been referred to as benzo-relaxation by its users.[4]

As mentioned previously, phenazepam is not a controlled substance in the United States and in parts of Europe and can be obtained over the internet, where it has been sold either as a tablet or as crystalline powder.[2] In the United States, it has been sold as an air freshener known as “Zannie.” Reports indicate that spraying Zannie into the mouth is the main route of administration, and when used with antidepressants, sleep medications, pain medications, or alcohol, it can prove fatal.[5] The product Zannie was tested at the Louisiana Poison Center, which revealed that the product contains 100-percent phenazepam.[5] As a result, legislators in Louisiana have filed a bill to make the product illegal in the state.

The detection of phenazepam in the blood stream has been demonstrated using gas chromatography (GC), gas chromatography/mass spectrometry(GC/MS), and liquid chromatography/mass spectrometry (LC/MS), but there are no data regarding the sensitivity of available immunoassays.[3]

The need for healthcare personnel to be aware of phenazepam, its symptoms of use, and its risk of death by overdose alone or by use with other substances cannot be overstated, particularly in emergency room settings.

References:
1. Corkery JM, Schifano F, Ghodse AH. Phenazepam abuse in the UK: an emerging problem causing serious adverse health problems, including death. Hum Psychopharmarmacol. 2012;27(3):254–261.
2. Bailey K, Richards-Waugh L, Clay D, et al. Fatality involving the ingestion of phenazepam and poppy seed tea. J Anal Toxicol. 2010;34(8):527–532.
3. Kyle PB, Brown AP, Stevenson JL. Reactivity of commercial benzodiazepine immunoassays to phenazepam. J Anal Toxicol. 2012;36(3):207–209.
4. The Atlanta Journal-Constitution. Exotic drug leaves Cherokee teen dead, 3 friends hospitalized. http://www.ajc.com/news/news/local/exotic-drug-leaves-cherokee-teen-dead-3-friends-ho/nQkNR/. Accessed on 03/22/2012
5. America Now. KSLA News 12 Investigates: “Zannie” in the ArkLaTex. http://www.americanownews.com/story/17040198/ksla-news-12-investigates-zannie-in-the-arklatex. Accessed on 04/07/2012

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Category: Letters to the Editor, Past Articles, Psychiatry, Substance Use Disorders

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