markets. However, this picture has become much more complex more recently – and with serious consequences. As with other pharmaceuticals that are commonly used in this way, for example gabapentin and pregabalin, there is significant diversion from legitimate supply. There is certainly supply from NHS prescription where patients sell or are dispossessed of benzodiazepines prescribed to them.
‘However, there are also significant levels of importation of pharmaceutical benzodiazepines which are not licensed in the UK, but are prescribed legitimately abroad. These include Phenazepam and Etizolam. At one stage these were available in so-called ‘legal highs’ shops although since May this year, the law prevents such supply of any psychoactive substances.
‘Another substantial issue exists with illegally manufactured benzodiazepines – some of which contain no benzodiazepines - and most of which are mixed or diluted benzodiazepines sometimes mixed with other substances.
‘All of these are sold on the street as valium (diazepam) or ‘blues’. To discourage diversion, some health boards only allow the prescription and dispensing of yellow (5mg) diazepam. The perception is that these have less of a street value because they are half the dose and less recognisable as ‘blues’. It seems unlikely that an experienced and perhaps desperate user would not use them despite this.
‘It is not unusual for users to self- administer way over the advised safe therapeutic dose. Street prices can be relatively low and tolerances very high. Profits are made from the sheer volume of sales.
‘In terms of harms, experienced users most often suffer acute problems with new types of benzodiazepine or when mixing substances. Benzodiazepine rate of onset and half lives vary significantly. Phenazepam, for example, has a very slow onset compared with diazepam, so users often re-dose during this period which results in overdosing as the full effect comes on.
‘However, once the variant factors are identified by users, they develop their own harm reduction messages and seem to share them. The evidence for this is that when new benzodiazepines have become
Blues, Vallies, Scoobies, Benzos, Diazepam
whatever you call them, we have a problem!
There have been a number of recent cases where people using ‘street valium’ have had a very bad experience. A number of these people required life saving interventions and hospital treatment.
Many tablets sold on the street look the same as those given out from pharmacies. However; testing has shown that:
Some do not contain diazepam at the stated dose. Some have been shown to contain no diazepam at all. Some contain more powerful and dangerous drugs.
If you use benzodiazepines very regularly, then it may be unsafe to stop suddenly, and you should get advice from your local addiction services or your GP.
Please don’t take tablets that you are unsure of.
available on the market, this is usually flagged up by a series of incidents, such as overdosing, blackouts and sustained periods of memory loss - sometimes with confusion as a result of using unfamiliar forms of benzo – and often in combination with other drugs including alcohol. After a period of time these presentations and issues subside.
‘The market is far more complex than it was only a few years ago and there is no reason to believe it will become less complex.’ •
‘DRUG-RELATED DEATHS IN SCOTLAND IN 2015’ STATISTICS:
* 706 drug-related deaths were registered in Scotland in 2015, 93 (15 per cent) more than in 2014
* This was the largest number ever recorded, and 370 (110 per cent) higher than in 2005
* Males accounted for 69 per cent of the drug-related deaths in 2015
* In 2015, there were 249 drug-related deaths of people aged 35-44 (35 per cent of all drug-related deaths), 183 in the 45-54 age-group (26 per cent), and 163 drug-related deaths of 25-34 year olds (23 per cent)
* The NHS Board areas which accounted for most of the 706 drug-related deaths in 2015 were: Greater Glasgow & Clyde - 221 (31 per cent); Lothian - 100 (14 per cent); Lanarkshire - 73 (10 per cent); Grampian - 69 (10 per cent); and Tayside - 63 (9 per cent)
SCOTTISH PHARMACIST - 9
GP0047_B69_01
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