According to the DEA (Drug Enforcement Agency), etizolam is a thienodiazepine drug that is chemically similar to the benzodiazepines. Etizolam is a prescription medication in Europe and Japan; however, it is currently not offered for medicinal uses in the United States, and it is not a controlled substance under the statues of the DEA. The DEA lists its trade names as Etilaam, Etizest, Depas, Etizola, Pasaden, and Sedekopan.
It is most often used in tablet or powder form; however, some sources may also illicitly distribute it on blotted paper. The DEA reports that the drug is often marketed online and may be available in local shops, often with a label that it is a drug used for “research purposes.”
Uses and Mechanism of Action
Etizolam has three major medicinal uses in countries where it is legally available:
- To control anxiety: This is typically associated with individuals who have some form of dysfunctional anxiety, such as an anxiety disorder, and not for everyday variations in nervousness.
- To treat insomnia: Etizolam can be used to initiate sleep.
- For seizure control: Similar to the benzodiazepines, etizolam’s mechanism of action may be useful in the control of seizures for some individuals.
The mechanism of action of etizolam is similar to the benzodiazepines. Its primary mechanism is to increase the availability of the inhibitory neurotransmitter gamma aminobutyric acid (most often abbreviated as GABA). This neurotransmitter is the major inhibitory neurotransmitter in the central nervous system. Its function is to modulate the actions of the neurons in the central nervous system by reducing or inhibiting their rate of firing. This offers much more variation and control in the central nervous system. For individuals where neuronal firing has somehow become excessive or uncontrolled, such as individuals with seizures or anxiety, the drug can help to modulate the situation and reduce the symptoms.
Effects of Taking Etizolam
According to the DEA and numerous research studies, the effects of taking etizolam include:
- Sedation: The sedative effects of the drug are dose-dependent, and at higher doses, it may produce extreme lethargy.
- Euphoria: Relaxation and sedation contribute to feelings of wellbeing or euphoria.
- Respiratory and cardiac suppression: Decreased rates of breathing, heart rate, blood pressure, etc., are associated with the use of social system depressant drugs.
- Cognitive effects: The effects on cognition that occur with etizolam are also dose-dependent and can include suppression of anxiety, a loss of inhibitions, issues with rational thinking and judgment, amnesia, flat emotions, and decreased speed of thought
- Paradoxical effects: Paradoxical effects consist of the expression of symptoms that would be contrary to what would be expected given the drug’s mechanism of action. These effects most often occur in individuals who abuse the drug, individuals with pre-existing mental health disorders, extremely young children, and individuals who take extremely high doses of the drug. These effects can include increases in anxiety, insomnia, seizures, and psychotic-type behaviors. In some instances, individuals may become suicidal. It should be noted that even in high-risk groups, paradoxical effects are rare.
- Physical dependence: Although some sources report that the development of physical dependence is more likely to occur in individuals who use benzodiazepines compared to the use of etizolam, it is well documented that individuals who use the drug may develop physical dependence on it.
Physical Dependence to Etizolam
Tolerance to etizolam is well documented in individuals who regularly use the drug for medicinal reasons or recreational purposes. Individuals who have been using the drug for a significant length of time and abruptly discontinue its use will develop a withdrawal syndrome similar to the withdrawal syndrome that occurs with benzodiazepines. The withdrawal syndrome associated with discontinuation may include issues with nausea, vomiting, cramps, muscle spasms, pain, insomnia, increases in anxiety and depression, confusion, delirium, and potential seizures.
In rare cases, the development of neuroleptic malignant syndrome may occur, which consists of extreme rigidity of the muscles, extreme temperature increase, delirium, and instability in the autonomic nervous system. Neuroleptic malignant syndrome may also have potentially fatal consequences. Because of the potential dangers associated with the withdrawal syndrome, individuals who are using the drug for any reason and wish to discontinue its use should consult with a physician before doing so.
Individuals who abuse the drug in combination with other central nervous system depressant drugs, such as alcohol, narcotic pain medications, or benzodiazepines, run the risk of enhancing the effects of the drug and exacerbating the potential serious side effects of use, including significant damage to the brain and other organs as a result of respiratory suppression and a decrease in oxygen or a lack of oxygen that can have potentially fatal ramifications. Of course, mixing etizolam with other drugs or overdosing on etizolam can also have potentially fatal consequences.
Symptoms of Abuse
Abuse of etizolam is similar to the abuse of benzodiazepines regarding the types of symptoms that one may display. Some of the symptoms that are associated with abuse of etizolam include:
- Physical symptoms:Decreased response times, impaired coordination, the appearance of extreme lethargy or sedation, slurred speech, stuttering, altered visual perception, shuffling gait, and/or the appearance of being intoxicated without the smell of alcohol
- Cognitive symptoms: Decreased rate of speech, confusion, trouble paying attention, memory issues, and, in some cases, agitation and aggression
- Psychological/emotional symptoms: Loss of inhibitions, mood swings, extreme emotional reactivity, and, in some cases, the expression of depression or even anxiety
- Other behaviors: Using the drug in spite of its use causing the individual negative consequences, using the drug in situations where it is dangerous to do so (e.g., before driving), or giving up activities or not meeting obligations as a result of use of the drug, and/or using the drug in combination with other dangerous drugs of abuse, such as alcohol, other prescription drugs, cannabis products, etc.
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Treatment for Abuse
Individuals in the United States who abuse etizolam will have most likely gotten the drug from an illicit source. The presentation of abuse in individuals who use this drug is very similar to benzodiazepine abuse, and treatment is similar.
It is important that individuals who are entering recovery for any formal substance use disorder engage in the practice of being honest about their substance abuse. Individuals who abuse etizolam should be frank about the drug they were abusing, how they abused it, and if they abused it in combination with other drugs. Benzodiazepines are commonly abused drugs; however, they are not commonly the major drug of abuse as they are most often abused in combination with other drugs. One would expect in the United States that this pattern of abuse also holds true for individuals who abuse etizolam. It is extremely important that treatment for one’s substance use disorder be directed toward the needs of the individual, and those who suffer from polysubstance abuse should be frank regarding their drug use with their treatment providers.
- Withdrawal management: Following a thorough assessment of the individual’s physical, psychological, cognitive, and social functioning, the person would be enrolled in a physician-assisted withdrawal management program (medical detox). This program will typically involve the administration of a benzodiazepine or, in some cases, the use of etizolam on a tapering schedule. The treating physician will establish an initial dosage of the drug that would control any symptoms of withdrawal and then slowly taper down the dosage over time to allow the individual to be weaned off the drug. This approach would eliminate any withdrawal symptoms and also avoid any potential complications associated with withdrawal, such as the development of seizures.
- Therapy: The person would be expected to complete formal substance use disorder therapy. This therapy typically is of a Cognitive Behavioral Therapy paradigm that addresses the specific motivations that drove the individual’s substance abuse, helps them develop a plan for relapse prevention, helps them to develop a plan of stress management, and prepares them for long-term recovery. The therapy can be delivered in group therapy, on an individual basis, or as a combination of group and individual therapy sessions.
- Family support and social support: The support of one’s family members and friends is crucial to assisting an individual in recovery. Family members and close friends are encouraged to become directly involved in the individual’s recovery. Family members can attend family therapy sessions or assist the individual personally at home. Individuals in recovery can also benefit from attendance at social support groups, such as 12-Step groups. These groups are ongoing and provide an excellent source of support, the opportunity to develop new healthy relationships with other individuals in recovery, and the chance to engage in a long-term and ongoing program of treatment/support.
- Treatment for co-occurring conditions: Individuals in recovery should have any co-occurring mental health conditions treated along with their substance use disorder and should also be treated for any significant medical conditions. This includes the use of medicines and therapy where appropriate. In many cases, providing other interventions, such as occupational therapy, case management services, placement services, and even complementary therapies like music therapy or animal-assisted therapies, can improve the quality of one’s program.
- A significant time investment: Research indicates that there is a strong relationship between successful outcomes in substance use disorder treatment and the length of time spent in treatment, such that individuals who engage themselves in treatment for longer periods of time have overall better outcomes. In most cases, this means remaining in treatment for years after being abstinent. Most often, ongoing treatment consists of social support group participation and periodic updates with one’s therapist. Simply completing a withdrawal management program or a 30-day inpatient program is often not sufficient to ensure long-term recovery.
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