Bromazolam Positive Toxicology Cases: Analytical Findings and Observed Impairment

Novel psychoactive substance (NPS) benzodiazepines, such as bromazolam, present significant public health and safety risks due to their high potency, unpredictable effects, and frequent presence in forensic casework, often in combination with opioids. Their impact on driving impairment remains poorly understood, creating challenges for law enforcement and forensic toxicology. This study examines bromazolam associated driving investigated cases submitted to the Tennessee Bureau of Investigation (TBI), analyzing 289 forensic cases, with 41 cases providing comprehensive toxicology and law enforcement data, including 31 Standardized Field Sobriety Tests (SFSTs) and 5 Drug Recognition Expert (DRE) evaluations. For the cases included in this report, bromazolam was only detected once in isolation. All other samples included substances such as THC, methamphetamine, and/or fentanyl. The most common purpose for a traffic stop was failure to maintain lane position and motor vehicle crashes. SFST results documented multiple impairment related findings particularly during the walk-and-turn test; however, because most cases involved other potentially impairing substances, these findings cannot be attributed specifically to bromazolam. Limitations in forensic testing underscore the need for improved detection capabilities and law enforcement training. This study emphasizes the importance of monitoring and modification of forensic toxicology methodologies to effectively detect novel substances, while further research is needed to refine SFST and DRE protocols for more accurate impairment assessment and enhance road safety.