What is “Demon?”

What is the “Demon” drug? When did it first appear? 

In the spring of 2024, there was an outbreak of severe poisonings on the east coast, primarily in the Delaware area. What we know is that several people presented to the emergency department in critical condition after using a white powder in a bag labeled “Demon.” 

When investigators sent the powder for testing, they found that it contained several substances, including fentanyl, xylazine, bromazolam, quinine, and caffeine. Fentanyl is a potent opioid pain medicine often found as a contaminant in heroin, but which is also sold as both a prescription and a street drug on its own. Xylazine is a potent sedative that has been used in veterinary medicine, which is increasingly found in the illegal drug supply, usually in combination with fentanyl. It is commonly referred to as “tranq.” Bromazolam is an illicit benzodiazepine, similar to prescription medications such as Valium and Xanax. It is also a strong sedative. Caffeine acts as a stimulant but can also cause seizures and abnormal heart rhythms. Quinine has been used as a filler or to “cut” drug, but it can cause toxic effects, such as abnormal heart rhythms.

What are the effects of “Demon”?

Because there are no specific standards regarding illicit drugs, there may be variation in in the composition of each batch and patients may develop different symptoms. Based on initial experience, patients who took “Demon” had a variety of severe adverse effects. Some patients experienced severe sedation and slow breathing that did not respond to naloxone (Narcan), and they needed to be placed on a ventilator. Others had multiple seizures that did not respond to antiseizure medications. There has been at least 1 death reported with “Demon” use. 

What should I do if I suspect a case of “Demon” exposure?

The safest thing to do is to get the person immediate medical attention. Call 911 for help. If the person has a seizure, place them in a safety position on their side. If the person is not breathing, you can administer Narcan (naloxone) if it is available. It is important to know that because there are multiple sedative medications in “Demon,” naloxone may not reverse the effects. If the person does not have a pulse, start CPR until help arrives. 

Maryann Amirshahi, PharmD, MD, MPH, PhD
Medical Toxicologist 

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