ACMD review of the evidence on the use and harms of etomidate

Whilst there is currently limited evidence of detection and/or use of etomidate and related compounds in the UK, due to the potential risk that the availability and use of these etomidate and related compounds will increase in the UK, the ACMD advises that control of etomidate and related compounds via the Misuse of Drugs Act 1971 is required. The harms are broadly equivalent to those of other sedatives such as benzodiazepines, zopiclone or pregabalin, so listing in Class C is recommended. As etomidate is licensed for use in medical practice, it should be listed in Schedule 4 (Part 1) of the Misuse of Drugs Regulations 2001. As there are a range of simple variants of etomidate which could be or have already been encountered, a small generic control, similar to that used in Hong Kong legislation, should be drafted and consulted on to cover these compounds. Since those compounds, apart from etomidate, have no legitimate medical or other use, those covered by the generic control should be listed in Schedule 1 of the Misuse of Drugs Regulations 2001. They should also be designated as controlled drugs to which section 7(4) of the 1971 Act applies.

Due to limited testing of e-liquids seized at the border or by police, the true availability and use of etomidate and related drugs, which are widely reported in Asia and New Zealand to occur through vaping of e-liquids, is likely to be significantly underestimated at this time. The ACMD would recommend that law enforcement bodies and Trading Standards should be encouraged to submit samples of seized vaping products for analysis in order to allow monitoring of this new route for drug administration. This should be coupled with an increase in the availability and capability of UK-based analytical services to enable wider testing of e-liquids in order to be able to determine the true threat to the UK public from drugs such as etomidate which can be consumed through vaping of e-liquids containing them. Forensic science providers and others need to ensure that they have the ability and capacity to analyse e-liquids and other products designed for vaping, as well as the ability to detect etomidate and related compounds.

Emerging evidence from Asia and Oceania indicates increasing use of etomidate and related analogues in vaping products, with limited current visibility in UK data. Given the rapid global spread of NPS, including those delivered via e-liquids, the ACMD recommends strengthening international collaboration and data sharing with key partners. The ACMD recommends that there should be enhanced engagement with international drug monitoring systems (e.g. UNODC, EUDA), regional early warning networks, and forensic laboratories will support earlier detection and improved risk assessment of substances such as etomidate analogues entering the UK. There needs to be monitoring of the impact of any national and/or international control of etomidate and related compounds on the emergence of other drugs to replace those that have been controlled.

Currently there is no information for potential users of etomidate and related compounds, as well as healthcare professionals, on the acute health risks associated with the non-medical use of these compounds. In addition, due to the risk of inadvertent overdose this potentially puts individuals at risk of acquisitive crime due to their sedative effects. The ACMD recommends that information on acute health risks of etomidate and related compounds, and on the risks of exposure to psychoactive materials in vaping products should be made available to the public and healthcare professionals.