Independent report

The government's response to the ACMD review of the evidence on the use and harms of etomidate (accessible)

Updated 20 January 2026

Sarah Jones MP
Minister of State for Policing and Crime
2 Marsham Street
London
SW1P 4DF

Professor David Wood
Chair, Advisory Council on the Misuse of Drugs (ACMD)
Professor Simon Thomas
Chair, ACMD New Psychoactive Substances Committee
C/o ACMD Secretariat
1st Floor, Peel Building
2 Marsham Street
London
SW1P 4DF

By e-mail only: ACMD@homeoffice.gov.uk

19 January 2026

Dear Professor Wood and Professor Thomas

The Government’s response to the Advisory Council on the Misuse of Drugs (ACMD) review of the evidence on the use and harms of etomidate and related compounds

I would like to thank the ACMD, particularly the Novel Psychoactive Substances (NPS) Committee, for your work on considering the harms of etomidate, and for your helpful report.  Etomidate is clearly a dangerous substance, and while its level of usage in the UK seems currently to be limited, it is absolutely right that we should remain vigilant, not least because its usage is likely to be underestimated due to a lack of routine testing.  I have sought views from colleagues in other government departments, other statutory bodies and my counterparts in the devolved governments where necessary, and I set out each recommendation and the Government’s response below:

Recommendation 1

The ACMD’s recommendation

“Whilst there is currently limited evidence of detection and/or use of etomidate and related compounds in the UK, due to the potential risk that the availability and use of these etomidate and related compounds will increase in the UK, the ACMD advises that control of etomidate and related compounds via the Misuse of Drugs Act 1971 is required. The harms are broadly equivalent to those of other sedatives such as benzodiazepines, zopiclone or pregabalin, so listing in Class C is recommended.

As etomidate is licensed for use in medical practice, it should be listed in Schedule 4 (Part 1) of the Misuse of Drugs Regulations 2001. As there are a range of simple variants of etomidate which could be or have already been encountered, a small generic control, similar to that used in Hong Kong legislation, should be drafted and consulted on to cover these compounds.

Since those compounds, apart from etomidate, have no legitimate medical or other use, those covered by the generic control should be listed in Schedule 1 of the Misuse of Drugs Regulations 2001. They should also be designated as controlled drugs to which section 7(4) of the 1971 Act applies.”

The Government’s response

I accept this recommendation and will implement it when parliamentary time allows.  Before commencing the parliamentary process I will consult with stakeholders on adopting the definition used in Hong Kong’s legislation.

Recommendation 2

The ACMD’s recommendation

“Due to limited testing of e-liquids seized at the border or by police, the true availability and use of etomidate and related drugs, which are widely reported in Asia and New Zealand to occur through vaping of e-liquids, is likely to be significantly underestimated at this time.

“The ACMD would recommend that law enforcement bodies and Trading Standards should be encouraged to submit samples of seized vaping products for analysis in order to allow monitoring of this new route for drug administration. This should be coupled with an increase in the availability and capability of UK-based analytical services to enable wider testing of e-liquids in order to be able to determine the true threat to the UK public from drugs such as etomidate which can be consumed through vaping of e-liquids containing them.

“Forensic science providers and others need to ensure that they have the ability and capacity to analyse e-liquids and other products designed for vaping, as well as the ability to detect etomidate and related compounds.”

The Government’s response

I accept the principle of this recommendation.  As the report notes, seizures can be made either at the border (by staff in Border Force, which is a part of the Home Office) or in-country (by the police or – less likely in this case – the National Crime Agency [NCA]).

My Home Office ministerial colleagues and I support the objectives of recommendation 2 insofar as it relates to seizures at the border.  Border Force prioritisation of activity depends on levels of threat and risk, in the context of necessarily finite resources. 

If the threat/risk from etomidate increases then we will consider whether funding could be made available to support specific border-focused activity, which could assist partner agencies to understand the scale of the problem entering via the UK border.

The National Police Chiefs’ Council, on behalf of police forces in England and Wales, fully supports the objectives of Recommendation 2, while noting that responsibility for vapes education and awareness, including ensuring that young people are informed about the risks associated with vapes, sits with trading standards, education, and health partners.  Policing will work collaboratively with partners, in line with the recommendations, to submit any contaminated vapes for testing and appropriate follow-up, while noting that funding is an inevitable constraint when it comes to putting in place the resources and processes required for testing and safe disposal.

The Police Service of Northern Ireland fully supports the objectives of Recommendation 2, while noting that the primary responsibility for vapes education and awareness, including ensuring that young people are informed about the risks associated with vapes, sits with trading standards, councils, education, and health partners.  They will continue to work collaboratively with partners through the Organised Crime Task Force, and, in line with the recommendations, submit any contaminated vapes for testing and appropriate follow–up, while noting that funding is an inevitable constraint when it comes to putting in place the resources and processes required for testing and safe disposal.

The NCA, as above, is unlikely in practice to be seizing vaping products, but if it does then it will endeavour to submit them for analysis.

My officials have spoken with relevant representatives of trading standards services.  They note that the supply of a controlled drug, even if it is inside another product, is a matter for the police.  Upon receipt of any intelligence about which products to look for, trading standards officers can submit intelligence if they find anything suspicious during enforcement activity, although in practice there will usually be police officers present in the course of such operations.

The Office for Health Improvement and Disparities (OHID), a part of the Department for Health and Social Care (DHSC), collects, analyses and reports on data from different sources at national level, including forensic testing of seized drugs, post mortem toxicology, drug checking services and the Sentinel drug testing system, run by OHID and the UK Health Security Agency, of biological samples from people starting opioid substitution therapy.  OHID will ensure each source is monitored closely for signs of increasing levels of detections of these drugs and will respond appropriately if levels increase, including by notifying the ACMD NPS monitoring committee to inform drug screening, with special attention to samples of vape liquid.

Recommendation 3

The ACMD’s recommendation

“Emerging evidence from Asia and Oceania indicates increasing use of etomidate and related analogues in vaping products, with limited current visibility in UK data. Given the rapid global spread of NPS, including those delivered via e-liquids, the ACMD recommends strengthening international collaboration and data sharing with key partners.

“The ACMD recommends that there should be enhanced engagement with international drug monitoring systems (e.g. UNODC, EUDA), regional early warning networks, and forensic laboratories will support earlier detection and improved risk assessment of substances such as etomidate analogues entering the UK.

“There needs to be monitoring of the impact of any national and/or international control of etomidate and related compounds on the emergence of other drugs to replace those that have been controlled.”

The Government’s response

I accept this recommendation. The Government is already taking steps to strengthen international collaboration on drugs.  It was agreed at a UK-EU Summit in May 2025 that the UK and the European Union Drugs Agency (EUDA) could establish a working arrangement to enable information exchange on drug threats, and discussions on this are progressing.  OHID exchanges data with other countries through the Early Warning Advisory (EWA) on NPS run by the United Nations Office on Drugs and Crime (UNODC), which collects and reports on data on detections of NPS worldwide.  Our engagement with the EWA is likely to be enhanced in future as we strengthen our national surveillance capabilities.  Another source of information on emerging drug trends is the United States National Drug Early Warning System, which OHID follows through its weekly reports and by regularly attending webinars.

Recommendation 4

The ACMD’s recommendation

“Currently there is no information for potential users of etomidate and related compounds, as well as healthcare professionals, on the acute health risks associated with the non-medical use of these compounds. In addition, due to the risk of inadvertent overdose this potentially puts individuals at risk of acquisitive crime due to their sedative effects.

“The ACMD recommends that information on acute health risks of etomidate and related compounds, and on the risks of exposure to psychoactive materials in vaping products should be made available to the public and healthcare professionals.”

The Government’s response

I accept this recommendation on behalf of the UK government and the three devolved governments.  I consider that providing information to potential users is particularly important in this case, in view of the wide usage of vaping products.  All four nations of the UK will work to ensure that appropriate information is made available to the public and healthcare professionals:

• In England, OHID is developing a page to be included on the Government’s ‘Talk to Frank’ website with information about etomidate and its risks, including its potential use in vaping products.  OHID will update FRANK’s page on the risks of adulterated vapes to include etomidate as a potential adulterant.  FRANK will reinforce messaging around this form of use if it becomes more frequent in the UK.  This will complement the existing information on that website about so-called ‘THC vapes’ adulterated with other substances.  OHID also launched a campaign in October on, among other topics, the risks of THC vapes contaminated with other substances.  Those other substances are mostly known to be synthetic cannabinoids, but OHID makes it clear that other dangerous substances can be added to vaping products.

• The Welsh Government will work with its national helpline DAN 24/7 and partner agencies to ensure the appropriate information is made available to the public and healthcare professionals.

• The Scottish Government will work with partners, including those responsible for delivering the Know The Score website, to ensure appropriate information is made available to the public and healthcare providers.

• The Department of Health in Northern Ireland will work with the Public Health Agency to make appropriate information available to all key stakeholders.

Officials from all four governments will co-ordinate their activities to ensure that these are complementary and not duplicative.

The National Poisons Information Service (NPIS) thanks the ACMD for its report on etomidate and concurs that healthcare staff in the UK need information on management of exposures to this substance.  The NPIS is currently in the process of producing a page on TOXBASE on etomidate exposures.  The NPIS will continue to monitor exposures to etomidate and make further changes as they become necessary.

As always, I am grateful for the work of the ACMD in supporting the Government’s aims to protect the public from the harmful consequences of drug misuse and diversion, as part of the wider mission to keep our streets safe.  Home Office officials will continue to work closely across government to implement the recommendations agreed in this letter and I look forward to seeing the delivery of these measures in due course.

Yours sincerely,

Sarah Jones MP
Minister for Policing and Crime