The proliferation of novel psychoactive substances (NPSs) continues to challenge toxicology laboratories. In particular, the United Nations Office on Drugs and Crime considers designer benzodiazepines to be a current primary threat among all NPSs. Herein, we report detection of a new emerging designer benzodiazepine, clobromazolam, using high-resolution mass spectrometry and untargeted data acquisition in combination with a “suspect screening” method built from the crowd-sourced HighResNPS.com database. Our laboratory first detected clobromazolam in emergency department presenting intoxications included within the Emerging Drugs Network of Australia—Victoria project in the state of Victoria, Australia, from April 2022 to March 2023. Clobromazolam was the most frequent designer benzodiazepine detected in this cohort (100/993 cases, 10%). No patients reported intentional administration of clobromazolam, although over half reported exposure to alprazolam, which was detected in only 7% of cases. Polydrug use was prevalent (98%), with phenazepam (45%), methylamphetamine (71%) and other benzodiazepines (60%) most frequently co-detected. This is the first case series published in the literature concerning clobromazolam in clinical patients. The identification of clobromazolam in patients presenting to emergency departments in Victoria demonstrates how high-resolution mass spectrometry coupled with the HighResNPS.com database can be a valuable tool to assist toxicology laboratories in keeping abreast of emerging psychoactive drug use.

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使用数据独立的高分辨率质谱和 HighResNPS.com 数据库鉴定澳大利亚急诊科中毒中的氯溴唑仑

新型精神活性物质（NPS）的扩散继续给毒理学实验室带来挑战。特别是，联合国毒品和犯罪问题办公室认为苯二氮卓类药物是目前所有新精神活性物质中的主要威胁。在此，我们报告了使用高分辨率质谱法和非目标数据采集，结合基于众包 HighResNPS.com 数据库构建的“嫌疑人筛选”方法，检测到了一种新兴的苯二氮卓类药物氯溴唑仑。我们的实验室首次在急诊室检测到氯溴唑仑，该药物出现中毒症状，属于澳大利亚维多利亚州新兴药物网络维多利亚项目，时间为 2022 年 4 月至 2023 年 3 月。氯溴唑仑是该队列中检测到的最常见的设计苯二氮卓类药物（100/ 993 例，10%）。没有患者报告故意服用氯溴唑仑，但超过一半的患者报告暴露于阿普唑仑（仅在 7% 的病例中检测到）。多种药物的使用很普遍（98%），其中最常同时检测到非那西泮（45%）、甲基苯丙胺（71%）和其他苯二氮卓类药物（60%）。这是文献中发表的第一个关于临床患者使用氯溴唑仑的病例系列。在维多利亚州急诊科就诊的患者中对氯溴唑仑的鉴定表明，高分辨率质谱法与 HighResNPS.com 数据库相结合如何成为帮助毒理学实验室及时了解新兴精神活性药物使用情况的宝贵工具。