A bitter pill to swallow: The rising use of street valium in Scotland

Paul McNamara is a GP and honorary clinical lecturer at the University of Glasgow

Yoosuf Ibrahim is a 4th year medical student at the University of Glasgow

 

‘It’s been nearly a year since he died and I still can’t believe it doctor.’ All I could do was listen to the mother in front of me who cried heavy, angry, tormented tears. Her grief was palpable and etched on her face which had aged significantly since our last consultation.

I knew this mother and her family well. Her son was 27 when he died. He was funny, kind, caring, and full of bravado with his whole life in front of him. But he was also deeply troubled and ravaged by childhood trauma. His father died after years of alcohol abuse and addiction when he was 7, and the cracks of trauma started to take their toll on his mental health. Unbeknown at the time, he was self-medicating by taking valium which he was buying on line and from street dealers. Then he tragically died; alone, in the middle of the night, from an accidental street valium overdose. Her boy was gone.

Once again I was witnessing the consequences of addiction, social deprivation, and poverty. 
Street valium (diazepam) also known as blues, vallies, benzos, and scoobies is a benzodiazepine-type tablet which causes central nervous system depression and gives a sense of calm and relaxed sensation.¹ However, the valium tablet you get on the streets may only have a small amount of diazepam (if any) and is mixed with other substances and stronger benzodiazepines such as etizolam. This significantly increases the risk of overdose and death among drug users, especially in people who already use prescribed opioids and painkillers such as methadone and gabapentin.² An Australian study from 2022 showed that there is a substantial increase in the risk of accidental overdose if patients are prescribed an opioid with a benzodiazepine and a gabapentinoid drug.² As GPs, when prescribing opioids and/or benzodiazepines to patients, it is important to consider whether or not these patients have traits of street ‘Benzo’ users. More often than not these are patients struggling with mental health issues, insomnia, and chronic pain all of which are motivators for the use of street valium.

According to the 2020 European Drug Report released by the European Monitoring Centre for Drugs and Drug Addiction, Scotland had the highest drug-related mortality with a 295 deaths per million adult population.³ The report also showed a constant exponential rise in the drug-related mortality rates in Scotland since 2012 which was also when the use of Etizolam was first recorded.⁴ It noted that criminal groups in Scotland are involved in large-scale illegal manufacturing and distribution of fake benzodiazepine tablets.³ Some of the additional substances in these tablets include newly introduced psychoactive substances such as Etizolam, flualprazolam, and alprazolam.³

In 2019, Glasgow City Council released a warning due to a sharp rise in fatal and non-fatal overdoses plausibly related to the use of street valium, with a 43% increase in deaths from overdoses in 2018 compared to the same duration in 2017.⁵ In 2023, there were 1,197 suspected drug deaths in Scotland which was a 10% increase from 2022.⁶ Taking this into account, last year, a new state-of-the-art forensic centre, Moorepark Laboratory was established by the Scottish Police Authority Forensic Services to perform toxicology studies of deaths that occur due to drug-related deaths. Another service of note for GPs is the Welsh Emerging Drugs & Identification of Novel Substances Project (WEDINOS), a drug testing site located in Wales that offer anonymous testing of unidentified or new psychoactive substances submitted by individuals and many other authorities. After analyzing the drugs, complete chemical profiles, and information to reduce harm with the use of these drugs are shared on their website and their quarterly bulletin ‘PHILTRE’.⁷

It is imperative for GPs to highlight the increased risk of overdose associated with street valium use, given its unpredictable composition, to individuals struggling with drug dependency. Additionally, efforts should be made on disseminating knowledge about the safe usage of these drugs. Noteworthy resources such as We Are with You UK and Substance Misuse Resources UK offer valuable information aimed at educating drug users. Such resources are extremely useful in reducing the potential harms associated with drug misuse and promoting healthier behaviors within communities.

*Authors’ note: The above scenario is fictional interaction based on our experiences, but sadly, stories like this are becoming more prevalent in Scotland’s town and inner cities.

References

1. User S. Substance Misuse Resources [Internet]. Substance Misuse Resources. [cited 2024 Apr 24]. Available from: https://www.substancemisuseresources.co.uk/harm-reduction-information/street-benzos-harm-reduction-information [accessed 17/7/24]
2. Bharat C, Gisev N, Barbieri S, Dobbins T, Larney S, Farrell M, et al. The effect of opioid analgesics, benzodiazepines, gabapentinoids, and opioid agonist treatment on mortality risk among opioid-dependent people. International Journal of Population Data Science. 2022 Aug 25;7(3).
3. European Drug Report 2020: Trends and Developments | www.emcdda.europa.eu [Internet]. www.emcdda.europa.eu. 2020. Available from: https://www.emcdda.europa.eu/publications/edr/trends-developments/2020_en [accessed 17/7/24]
4. Lowther E, Brocklehurst S. Scotland’s drug death crisis in six charts. BBC News [Internet]. 2020 Dec 15; Available from: https://www.bbc.co.uk/news/uk-scotland-48853004  [accessed 17/7/24]
5. 1619. Drugs Deaths Warning Over Lethal Street Valium [Internet]. www.glasgow.gov.uk. 2019. Available from: https://www.glasgow.gov.uk/article/23805/Drugs-Deaths-Warning-Over-Lethal-Street-Valium
6. Main points [Internet]. www.gov.scot. Available from: https://www.gov.scot/publications/suspected-drug-deaths-scotland-october-december-2023/pages/3/ [accessed 17/7/24]
7. WEDINOS – Welsh Emerging Drugs & Identification of Novel Substances Project [Internet]. www.wedinos.org. Available from: https://www.wedinos.org/ [accessed 17/7/24]

Featured photo by Warren Wong on Unsplash