The role of Etizolam in Scottish drug- related deaths Dr. Andrew McAuley @arjmcauley
Senior Research Fellow Glasgow Caledonian University
Principal Scientist Health Protection Scotland
Trends in prescribing of Benzodiazepines in Scotland, 2006-2017
25,000,000
20,000,000
DIAZEPAM 15,000,000 TEMAZEPAM NITRAZEPAM LORAZEPAM 10,000,000 LOPRAZOLAM CHLORDIAZEPOXIDE Number of dispenseditems LORMETAZEPAM 5,000,000 OXAZEPAM
-
Source: NHS National Services Scotland Benzodiazepine-related deaths, Scotland, 2008-2018
1400
1200
1000
800
600
400
200
0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Benzo-involved DRDs Total DRDs
Source: National Records of Scotland (NRS) Benzodiazepine-related deaths, Scotland, 2008-2018
1400
1200
1000
800
600
400
200
0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Benzo-involved DRDs Total DRDs
Source: National Records of Scotland (NRS) Benzodiazepine-related deaths by substance, Scotland, 2008-2018
600
500
400 Etizolam Diazepam Alprazolam n 300 Diclazepam Phenazepam Delorazepam 200 Temazepam
100
0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Source: National Records of Scotland (NRS) Benzodiazepine-related deaths by substance, Scotland, 2008-2018
600 Etizolam only drug present = 4/1187 (0.3%)
500 Etizolam only drug involved = 7/1187 (0.6%)
400 Etizolam Diazepam Alprazolam n 300 Diclazepam Phenazepam Delorazepam 200 Temazepam
100
0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Source: National Records of Scotland (NRS) Why ‘street benzo’s matter...
• Increases polydrug toxicity Increased risk of overdose
• When compared traditional Benzo’s... – Much stronger Increased risk of overdose – Different half-life
• False advertising “Consumption roulette” Consumption roulette
“The ACMD is concerned with Police Scotland’s report that a number of benzodiazepines are being sold as ‘street valium’. When analysed, tablets with the appearance of diazepam tablets were found to contain diclazepam, diazepam, a mixture of etizolam and the synthetic opiate U-47,700 or U-47,700 on its own.”
ACMD letter to Home Office recommending control of Etizolam and other designer benzodiazepines, 2 Dec 2016 Consumption roulette
Future trends?
6 5 5 4 3 2 2 1 1 1 Benzodiazepine 0 0 0 0 0 notifications to EWS 2005 2008 2011 2014 2017
Source: Michael Evans Brown, EMCDDA, personal communication, 2019 Summary
• High demand for benzodiazepines among PWUD in Scotland, alongside other drugs
• Shift from diversion of prescribed benzos to street based illicit benzos has increased the risk environment
• Policy and practice responses require flexibility and innovation
Thank you for listening [email protected] @arjmcauley