Japan is facing a fast-evolving drug crisis as young users turn to etomidate-laced vape liquids known as 'zombie cigarettes', a trend that has triggered arrests, heightened policing and renewed fears of fentanyl-style addiction.
Authorities in Okinawa have been intensifying their crackdown as the abuse of “zombie cigarettes” spreads among teenagers and people in their twenties. According to news agency Kyodo, at least 10 people had been arrested by the end of September for possessing etomidate, a sedative that impairs cerebellar function and coordination.
In May, Japan formally classified etomidate as a prohibited drug. Despite this, distribution continues.
In October, police arrested Yuto Agarie, the alleged leader of a trafficking syndicate, for storing nearly 64 grams of etomidate-based liquid at his home in Urasoe with intent to sell. Investigators suspect his group is the primary supplier in the prefecture.
The substance is commonly used overseas for surgical anaesthesia, but abuse can cause loss of consciousness, spasms and loss of control of limbs.
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How ‘zombie cigarettes’ are being sold
Etomidate-laced products are being marketed through encrypted messaging apps and social platforms, with vaping cartridges in both flavoured and unflavoured variants.
In a separate case, three Chinese nationals in the Tokyo region were arrested for allegedly smuggling 100 grams of etomidate from India via Singapore, then converting it into liquid and reselling it locally, the Narcotics Control Department said.
The UN Office on Drugs and Crime has also reported a rise in etomidate and its analogues across East and Southeast Asia.
A report in Japan Today warns that the country's drug market is shifting faster than policymakers expected, comparing the moment to a dangerous echo of the 1960s but potentially worse.
Fentanyl, which is described by the US Centers for Disease Control and Prevention as “up to 50 times stronger than heroin”, and etomidate-laced 'zombie cigarettes' were not even illegal in Japan until May, the report says, leaving enforcement steps behind evolving supply chains.
What the trafficking chain looks like
The alleged supply chain described by a syndicate source includes:
• Taiwanese mafia networks
• Links with mainland Chinese groups
• Cooperation with Japanese yakuza
• Vietnamese manufacturing hubs
• Mid-sea transfers to Japan-bound vessels
Drug shipments are allegedly passed at sea because “visibility is good” and traffickers can “toss the evidence overboard” if police appear.
The going price in Okinawa is 20,000 yen, though the report doesn’t specify per cigarette or packet.
How etomidate affects the body
Etomidate is a medical anaesthetic, prescribed in severe pain cases and used in high-risk surgeries abroad. Abuse via vaping may cause:
• sudden euphoria
• hallucinations
• convulsions
• delirium
• complete loss of motor control
• potential organ failure
Fentanyl and etomidate derivatives are part of a new category of drugs entering Japan through small cartridges, encrypted apps and cross-border courier chains, making them easy to transport and conceal.
Japanese authorities are bracing for a broader national spread. Investigators told Kyodo that the etomidate market “has started to emerge in the country as well", beyond Okinawa. The health ministry and police are expanding surveillance across messaging platforms and ports of entry.

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