Department of Health, Taipei City Government

In recent years, a new illicit substance known as “zombie cartridges” has emerged on the market. The active ingredient in these products is etomidate, a compound originally developed as a medical anesthetic. In clinical settings, etomidate is administered intravenously by licensed physicians in carefully controlled doses for surgical procedures and sedation therapy. However, when illicit actors began incorporating it into e-cigarette liquid for sale, the substance became a highly dangerous drug of abuse. When inhaled through an e-cigarette device, etomidate acts rapidly on the central nervous system, triggering abnormal physical and cognitive responses in users. Since 2023, these cartridges have grown increasingly prevalent among certain adolescent and young adult populations. Many users mistakenly assume that the e-cigarette format is comparatively “safe,” but in reality, the liquid may contain anesthetic agents or other unidentified chemical substances, posing serious health risks and heightening public safety concerns.

Pharmacist Kang Hsiu-chia of the Pharmacy Department at Taipei City Hospital, Heping Fuyou Branch, noted that short-term effects associated with the use of such cartridges may include: 

1. Confusion and disorientation: Users may experience impaired thinking, diminished judgment, and difficulty communicating clearly or controlling their behavior.
2. Dizziness and loss of balance: Inhalation may cause lightheadedness and unsteady gait, increasing the risk of falls and accidents.
3. Muscle twitching or tremors: Some users exhibit involuntary body shaking or abnormal movements. (A phenomenon commonly referred to as the “zombie state.”)
4. Respiratory depression: When used with alcohol or other sedative substances, the drug may cause breathing to slow significantly or cease altogether, posing a life-threatening risk.

Prolonged abuse may also give rise to chronic health complications:

1. Endocrine system disruption: Long-term use interferes with hormonal regulation. Severe suppression of adrenal cortisol synthesis may result in physical weakness, hypoglycemia, and other metabolic disorders.
2. Neurological and cognitive impairment: Sustained use may damage brain function, leading to memory loss, emotional instability, and difficulty concentrating.
3. Addiction and psychological dependence: Some users develop a gradual dependence on the substance, increasing the likelihood of repeated use.
     

Beyond the health risks, possession or use of controlled narcotics of this nature may carry legal consequences ranging from administrative fines to criminal liability. Should drug-impaired driving result in a traffic accident or otherwise endanger public safety, offenders may face aggravated charges under provisions governing endangerment of public safety and drug-impaired driving causing death. Multiple incidents of deliberate vehicular assault targeting pedestrians and law enforcement officers have already been recorded, resulting in the deaths of innocent bystanders and the loss of frontline police officers in the line of duty. In February 2026, an accident occurred in Tainan City, followed by another in Yilan City in March of the same year; in both cases, officers recovered zombie cartridges from the vehicles of the at-fault drivers.

In 2024, the Executive Yuan undertook a significant revision of the drug classification framework, and etomidate was formally reclassified as a Schedule II controlled substance effective late November of that year. In sum, anesthetic cartridges are not an ordinary recreational product — they are a high-risk narcotic. Pharmacist Kang Hsiu-chia emphasized that raising public awareness of emerging drugs, resisting the temptation to experiment, and seeking professional assistance when substance-related concerns arise are all essential to safeguarding individual health and maintaining public safety.

※ Comparison Table: Medical Use vs. Drug Abuse