CNA Explains: What to know about etomidate, the drug Singapore plans to make illegal

CNA

4 days ago

SINGAPORE: An anaesthetic agent that has been found in vapes will soon be listed by Singapore as a Class C drug under the Misuse of Drugs Act, Health Minister Ong Ye Kung said on Sunday (Jul 20).
The substance, called etomidate, was found during recent random testing in a third of the more than 100 vapes seized by the authorities. Vape products laced with etomidates are called K-pods.
The use of vapes, especially those that are laced with etomidate, is increasing, Mr Ong said.
E-vaporisers are banned and controlled under the Tobacco (Control of Advertisements and Sales) Act.
"But today, e-vaporisers are no longer just used for the delivery of nicotine, Mr Ong added. "They are being used to deliver a range of substances and what we are seeing is the delivery of etomidate. That is a serious problem."
The minister warned that consuming etomidate is "very damaging" and urged those consuming etomidate-laced vapes to give it up before the "law catches up" with them.
What is etomidate, exactly?
Etomidate is a short-acting agent administered intravenously to induce sedation for patients in surgery. It can also be used in certain medical processes such as intubation.
Adjunct Associate Professor Puah Ser Hon from Tan Tock Seng Hospital explained: "It has a very fast onset. It doesn't affect the blood pressure too much and it is quite a stable agent."
However, this is within the medical context, when etomidate is used in calculated doses and is monitored by doctors and nurses who are trained to use it, the senior consultant added.
Adj Assoc Prof Puah is the head of the hospital's department of respiratory and critical care medicine.
What are its effects?
Used outside a controlled medical environment, etomidate is "extremely dangerous".
Dr Lee Chuen Peng, a respiratory specialist from private clinic The Respiratory Practice, said that vaping in general can lead to a condition known as Evali, short for E-cigarette or vaping product use-associated lung injury.
For those who are asthmatic, a single exposure can cause them to have an asthma attack, which can be life-threatening.
Most commonly, however, etomidate is known for its suppression of adrenal glands, Dr Lee added.
"It can shut down your adrenal glands that are critical for producing certain stress hormones like cortisol. This suppression can last for a few days and leave your body unable to handle stress."
Assistant Professor Sewa Duu Wen, a senior consultant specialising in respiratory and critical care medicine at Singapore General Hospital, said that inhaling etomidate can reduce anxiety levels for a short period of time but the feeling passes quickly.
"They will need to use it several times to achieve the same level of sensation," he added, pointing to its addictive property.
When its effects start to wear off, users may deal with withdrawals such as increased anxiety and agitation. They may also get hallucinations and fall into a dissociative state.
"This disassociated state can be quite disturbing and can sometimes lead to certain actions that the user didn't intend to do, and that's where the potential of them causing self-harm may occur," Asst Prof Sewa said.
Dr Tan Sheng Neng, a senior consultant psychiatrist from The Safety Net, a private psychiatric practice, agreed that the fast-acting nature of etomidate can give users a "good feeling", leading users to rely on it as a coping mechanism.
What are the long-term dangers?
Prolonged use of etomidate can affect the adrenal gland's production of hormones released in response to stress.
"It becomes a vicious circle," Dr Tan said, adding that users may be more susceptible to depression or anxiety.
Adj Assoc Prof Puah, who also leads the National Healthcare Group's Respiratory Health Steering Committee Smoking Cessation Workgroup, said that it is still early to be certain about the effects of the long-term use of etomidate, but what they are seeing now is "already worrying".
Even without etomidate, vapes and nicotine can stunt brain growth and cause attention issues.
"You add etomidate to that, you add all sorts of illegal substances to these pods, you can imagine that the effects are double, triple, even 10 times," he added.
"Why do we want to wait till we have information and act when it's too late?"
Giving an example of another negative effect, Asst Prof Sewa said that the prolonged use of etomidate can suppress the vape user's ability to produce hormones essential in preventing low blood pressure or low sugar count.
"It can lead to an adrenal crisis, where the patient may go into seizures or even coma," he warned, adding that there have been reports of such cases in patients who have abused the drug for a long time and in large doses.
How can one overcome addiction to etomidate?
Dr Munidasa Winslow, a senior consultant psychiatrist at private clinic Promises Healthcare, said that people who use etomidate should know that they can get help and recover.
"Substance use is rarely just about the drug. It is often tied to deeper emotional or psychological roots," he said.
Users who find themselves wanting to seek help should start by talking to someone they trust. After that, they should speak to a qualified healthcare professional.
"Avoid the instinct to quit abruptly on your own," he advised.
Etomidate is a potent sedative and its misuse can have unpredictable and potentially dangerous effects.
Depending on how often it is used, stopping suddenly might lead to withdrawal symptoms and may increase the risk of relapse.
Dr Winslow also said that recovery must be approached with a plan, for example, through therapy or a support group.
"What is more important is understanding why it became a crutch in the first place, and how to replace that with healthier, more sustainable ways to cope."
What are other jurisdictions doing about it?
Across Asia, some governments have stepped up regulation on etomidate.
The authorities in China officially placed etomidate under control in October 2023, the Office of China National Narcotics Control Commission stated.
More recently, Hong Kong classified etomidate – known commonly as "space oil" there – under the Dangerous Drugs Ordinance in February. Under the ordinace, anyone found in possession or consumption of the substance is subject to a maximum penalty of seven years' jail and a fine of HK$1 million (S$163,400).
How does Singapore's move fit with its overall approach to vaping and drug use?
Assistant Professor Yvette van der Eijk from the National University of Singapore Saw Swee Hock School of Public Health said that classifying etomidate as an illegal drug will give the authorities greater leverage to curb its misuse in vaping devices.
In Singapore, all offenders caught for the purchase, use and possession of vapes, or e-vaporisers, are now referred to the Health Science Authority and subject to a fine of up to S$2,000 (about US$1,560).
Etomidate is a controlled substance under the Poisons Act. However, once it is listed under the Misuse of Drugs Act, people who consume it will be treated "no differently" from those who consume hard drugs and narcotics such as cannabis and cocaine, Mr Ong said.
This means that anyone caught using etomidate will be subject to supervision, have to undergo mandatory rehabilitation and may also be committed to a drug rehabilitation centre.
Repeat offenders will be prosecuted and may be jailed for at least a year.
Asst Prof van der Eijk said: "This move not only disrupts the supply and demand for K-pods, but also reinforces Singapore's zero-tolerance approach to emerging forms of substance abuse."
She also said that the move will raise awareness on the significant health risks associated with drug-containing vapes.