Etomidate and related compounds
etomidate · metomidate · propoxate · isopropoxate
What does current UK evidence show?
The ACMD review, corrected in February 2026, identified a small number of UK detections, including tablets, powders and a vape residue; its UK stakeholder evidence was gathered in 2025. Some samples also contained potent opioids or other sedatives. UNODC has reported a larger international vaping concern, particularly in parts of East and Southeast Asia. Neither selected sample submissions nor overseas incidents establish widespread UK use. Limited routine testing can miss exposure, but that uncertainty must not be converted into an unsupported estimate of hidden prevalence.
Overview
Identity, legal classification, form and pharmacological context
- Drug category
- Depressants · Medicines · Synthetic drugs
- Common names
- etomidate, metomidate, propoxate, isopropoxate
- Typical forms
- Licensed etomidate is supplied as an injection for clinical anaesthesia. Unregulated detections internationally include liquids in vaping products; UK reports have also involved tablets and powders. International terms such as “space oil” and “kpods” are product labels, not proof of contents or established UK market categories.
- Routes
- Intravenous administration is a supervised medical use. Vaping is prominent in international non-medical reports. A detected powder or tablet does not by itself establish how a person used it.
- UK legal classification
- Compound-specificAs checked on 12 October 2026, the identified UK measure proposing Class C etomidate control remains a draft, laid on 14 September. Its proposed commencement is 28 days after making; approval alone is not commencement. Etomidate is already a prescription-only medicine. The ACMD distinguishes its medicines exemption under the Psychoactive Substances Act from related psychoactive compounds likely covered by that Act. Check each analogue and any enacted amendment; do not apply a blanket Class C label.Check government source ↗
- Concise pharmacology
- Etomidate enhances inhibitory GABA-A signalling and can rapidly produce unconsciousness. It also inhibits an enzyme involved in adrenal steroid production. Related compounds may differ in potency and endocrine effects; a family resemblance does not establish equivalent safety.
Main harms
Concise clinical and polydrug picture
Marked sedation, involuntary movements and respiratory depression or apnoea can occur. Reduced consciousness can expose someone to injury. The licensed medicine requires staff and equipment able to manage airway and breathing emergencies.
Clinical reports of repeated exposure through e-cigarette liquids describe disrupted steroid hormone production. One Hong Kong case linked analytically identified etomidate and analogues to menstrual and androgen-related symptoms. This demonstrates a possible harm, not its frequency. Evidence is insufficient to describe a standard long-term risk profile for every analogue.
The ACMD identified case reports of dependence and withdrawal after regular non-medical use, with anxiety, irritability, sleep disturbance, craving and, in a severe case, hallucinations. The evidence base is small. Suspected dependence requires clinical assessment; an established UK withdrawal protocol cannot be assumed.
Alcohol, opioids and other sedatives can enhance etomidate's hypnotic effects and breathing risk. Mixed samples require attention to all detected drugs. A short period of apparent recovery does not identify the mixture or exclude subsequent complications.
Unregulated liquids have uncertain composition and concentration. The safety experience of controlled intravenous anaesthesia does not establish the safety of inhalation, repeated recreational exposure or analogue-containing mixtures.
Current intelligence status
Assessment, confidence and direction
The ACMD review, corrected in February 2026, identified a small number of UK detections, including tablets, powders and a vape residue; its UK stakeholder evidence was gathered in 2025. Some samples also contained potent opioids or other sedatives. UNODC has reported a larger international vaping concern, particularly in parts of East and Southeast Asia. Neither selected sample submissions nor overseas incidents establish widespread UK use. Limited routine testing can miss exposure, but that uncertainty must not be converted into an unsupported estimate of hidden prevalence.
Reason: The limited rating concerns current UK market size and direction. Etomidate's clinical sedative and endocrine effects are established, but evidence on non-medical vaping and individual analogues is much less complete.
Principal source limits: Sparse UK detections and incomplete routine testing do not establish national prevalence. Control recommendations are not enacted law. International detections, including selected UK samples, are not population estimates or evidence that UK nicotine vapes are generally contaminated.
Geography and reference periods are given in each linked source card below. The rating is an editorial evidence judgement, not a probability, clinical risk score or TD priority.Available UK evidence is too limited or unrepresentative for a stronger trend judgement.
Operational implications
Evidence-supported prompts for professional response
Early-warning teams should record suspected exposure, the intended purchase, product type and co-detected substances separately, and seek analytical confirmation where available. Laboratories need suitable screening methods; an untested sample is not evidence of absence. Clinicians should consider both acute sedation and endocrine disturbance where exposure is credible. Commissioners can support proportionate surveillance and links between emergency care, toxicology and drug-checking services. Public communications should identify the place and date of an alert and avoid implying that all UK nicotine vapes contain etomidate. These are surveillance and service implications inferred from the cited evidence.
Record substance, sold identity, route, frequency and combinations; review overdose and withdrawal needs.
Use symptom-led assessment and escalate reduced consciousness, seizures, overheating, chest pain or severe agitation.
Send unexpected products or incidents through agreed testing and alert routes; distinguish confirmed results from preliminary reports.
Related intelligence
Continue into connected platform evidence
Sources & limitations
Direct evidence links, reference periods and status
Review of the evidence on the use and harms of etomidate and related compounds
Published21 Oct 2025; corrected 06 Feb 2026Reference periodEvidence reviewed in 2025; UK stakeholder request April 2025
Sparse UK detections and incomplete routine testing do not establish national prevalence. Control recommendations are not enacted law.Increasing detections of etomidate and analogues on illicit drug markets
PublishedMar 2025Reference periodInternational early-warning evidence to early 2025
International detections, including selected UK samples, are not population estimates or evidence that UK nicotine vapes are generally contaminated.Etomidate emulsion for injection: Summary of Product Characteristics
PublishedUpdated 28 Feb 2025Reference periodSections 4.4–4.9 and 5.1
Evidence from supervised intravenous anaesthesia cannot quantify the risk of unregulated vaping products.Acquired 11β-hydroxylase deficiency by inhaled etomidate and its analogues
Published20 Nov 2024; correction Jan 2025Reference periodHong Kong clinical case report
A case with analytically identified etomidate and analogues demonstrates possible endocrine harm; it cannot estimate frequency or UK prevalence.Draft Misuse of Drugs Act 1971 (Amendment) Order 2026
PublishedLaid 14 Sep 2026Reference periodDraft as checked 12 Oct 2026; no commencement established
Proposes etomidate Class C. The draft would commence on the 28th day after making; laying or parliamentary approval is not commencement. It does not establish a blanket class for every etomidate analogue.Misuse of Drugs Act 1971 (Amendment) Order 2026: parliamentary record
PublishedLaid 14 Sep 2026Reference periodParliamentary progress checked 12 Oct 2026
Track making and commencement separately from the date laid.