- Rapid emergence of etomidate-containing e-cigarettes, aerosolised easily for inhalation; misuse driven by fast-onset dissociation, transient euphoria, and illusion of safety.
- Repeated exposure causes 11-β hydroxylase suppression, producing hyperaldosteronism with hypertension, hypokalaemia, virilisation, apparent biochemical hypoadrenalism, and electrolyte disturbances.
- Urgent regulatory action, expanded toxicological screening and targeted education are required; LC-MS/MS improves detection but discreet vaping hinders control.
Am J Drug Alcohol Abuse. 2026 Oct 8:1-3. doi: 10.1080/00952990.2026.2739864. Online ahead of print.
ABSTRACT
Background: The emergence of etomidate-containing e-cigarettes represents a significant and rapidly evolving public health challenge, marking a transition of this clinical anesthetic into illegal use of an anesthetic agent. Originally utilized as a short-acting intravenous anesthetic for intubation induction, etomidate’s high lipophilicity allows it to be easily aerosolized for inhalation via vaping devices. Misuse is primarily driven by its rapid-onset effects, including relaxation, dissociation, and transient euphoria, as well as a pervasive “illusion of safety” among users who perceive hospital-grade medications as less harmful than traditional illegal drugs.Method: A PubMed search was conducted to identify literature on etomidate vaping and e-cigarette use published between 2024 and May 2026. The retrieved publications were critically reviewed and evaluated across four core scientific dimensions: geographic distribution, clinical manifestations, publication types, and analytical detection methods.Results: The clinical implications of repeated exposure are severe, notably involving the suppression of 11-β hydroxylase, which leads to clinical hyperaldosteronism (hypertension and hypokalemia), virilization but apparent biochemical hypoadrenalism, and electrolyte imbalances. While analytical advances like Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) and novel zirconium-based extraction materials have improved detection capabilities in biological samples and e-liquids, the discreet nature of vaping continues to lower barriers to misuse.Conclusions: Addressing this trend necessitates urgent regulatory intervention, expanded toxicological screening, and targeted education to dismantle misconceptions regarding the safety of etomidate inhalation.
PMID:42848713 | DOI:10.1080/00952990.2026.2739864
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