The Emergence of Novel Benzodiazepines in Australia, Evidence, Alerts, Clinical Management and Harm Reduction-A Narrative Review.

issuesIn Australia, detections of novel benzodiazepines (NBZ) and related overdoses have increased markedly over the last five years. This review summarises Australian peer-reviewed literature and NBZ-related drug alerts, outlines the pharmacology of commonly detected NBZs and discusses approaches to harm reduction, managing toxicity, dependence and withdrawal. APPROACH: Australian peer-reviewed articles published between January 2020 and June 2025 were identified via Embase, PubMed, Scopus and PsycINFO. Drug alerts from this period were retrieved from an Australian online repository. Data were extracted, coded and synthesised. Global literature on the pharmacology associated with commonly detected NBZs in Australia, was retrieved via Google Scholar as were sources on benzodiazepine-related harm reduction and clinical management and narratively summarised. KEY

findingsBetween 2020 and 2025, NBZs were frequently detected from data from emergency department, forensic, drug checking and coronial sources. The most common were etizolam, clonazolam, clobromazolam, bromazolam, flualprazolam and flubromazolam. Twenty-three NBZ-related alerts were issued over this period, with nearly half of these (n = 11) issued between January and June of 2025. Health responses are hindered by limited pharmacological data, detection challenges and little research on the experiences of consumers. IMPLICATIONS: To inform interventions spanning harm reduction and clinical management, future research must develop understandings of the pharmacology of NBZs and the experiences of people who source NBZs from unregulated markets.

conclusionNBZs were consistently detected across Australian coronial, toxicological, forensic and drug checking data sources from 2020 to 2025. Their emergence represents a public health concern, worthy of ongoing attention and response.