18 | New Scientist | 5 October 2019
SCOTLAND is in the middle of
a drug crisis. The number of
drug-related deaths in the country
soared by 27 per cent over the
course of 2018. Today, it has the
highest drug-related death rate
in the European Union.
Though smaller in scale, the
problem has been compared to
the US opioid crisis. There, huge
numbers of people became
addicted to prescription opioid
painkillers and graduated to illegal
opioids. It seems a similar sort of
pattern is unfolding in Scotland,
but with a different sort of drug.
Opioid drugs like heroin and
morphine are implicated in the
largest number of Scotland’s
drug-related deaths. But a less
well known class of drugs called
benzodiazepines is the second
biggest cause. These tranquilisers,
often used to treat anxiety
disorders, are implicated in
67 per cent of such deaths.
And here’s the real trouble:
we are beginning to learn how to
tackle the opioid epidemic, but the
same solutions probably won’t
work with benzodiazepines.
When they were first prescribed
in the 1960s, benzodiazepines
(often called benzos) were seen as
a safe alternative to barbiturates,
a class of sedatives that had
been responsible for several
high-profile fatal overdoses,
such as that of Marilyn Monroe.
One example is the drug
diazepam, sometimes sold as
Valium. It can bring on sleepiness,
relax muscles and the mind, and
can help treat anxiety disorders.
“They were introduced as wonder
drugs with no downsides,” says
Keith Humphreys at Stanford
University in California. “Doctors
were giving them out like candy.”
But they did have a downside. It
became apparent during the 1970s
that people taking the drugs came
to depend on them. Benzos wereimplicated in drowsiness-induced
car accidents and falls. It was also
easy to overdose. “In the 1970s,
diazepam was one of the most
common reasons for hospital
admissions,” says Humphreys.
Then, in the 1990s, benzos
started to become a drug of choice
for people in Scotland who took
heroin. They eased the withdrawal
effects when people were coming
off a high or struggling to
maintain their supply, says
Andrew McAuley at Glasgow
Caledonian University. The drugs
were available on prescription,
but they were then being sold
on to heroin users illegally.
As doctors in Scotland became
aware of this onward sale they
cut back on prescriptions. But
this made things worse as many
of those who had been taking
prescribed benzos then turned to
illegal alternatives that tend to be
much stronger. One of the most
commonly taken in Scotland is
etizolam. Possession of this drug
is illegal in the UK, though it is
often made to look like diazepam.Deaths resulting from
overdoses of illegal benzos have
shot up in Scotland in the past
few years (see graph, below right).
Etizolam was first implicated in a
single such death in Scotland in- In 2017, it was involved in 299
deaths. By 2018, the figure was 548.
Not only is etizolam stronger
than benzos like diazepam, its
effects wear off more quickly,
so people tend to take it more
frequently. The low cost of illegal
benzos makes that easy to do.
“They can be purchased for as little
as 15p per tablet,” says McAuley.
“When we talk to drug users about
how they consume these drugs,
they don’t talk about taking one
or two, they talk about taking
them in handfuls.”
At the end of 2018, a group of
men were found to be producing
etizolam pills in a garage in
Paisley, Scotland. A £20,
pill-pressing machine (pictured
below) enabled them to produce
250,000 tablets per hour.
Benzos are far less of a problem
in the rest of the UK, but they are an
issue in the US, where some people
warn that they are becoming the
country’s next prescription drug
crisis. An estimated 12.6 per cent
of adults are taking the drugs, both
legally and illegally. Research has
shown that the number of people
in the US visiting outpatient
doctors for health matters related
to benzos increased from 919 in
2003 to 1672 in 2015.
There are stark parallels with
the opioid crisis, says Humphreys.
“In both cases, the drugs were
produced perfectly legally, given
out by physicians and then a large,
addicted base looks for illegal
sources,” he says. “It’s following a
similar trajectory, but in terms of
Diazepam is prescribed
to help treat anxiety
disordersAddictionMAXIMILIANC
LARK
E/GET
TY
IMAGESNews Insight
The trouble with benzos
A hidden drugs crisis is contributing to soaring overdose rates
in Scotland. Can we fix it, asks Jessica Hamzelou250,
Number of etizolam pills produced
by one pill press per hour15p
Approximate cost of an illegal
etizolam tablet in ScotlandPROVIDED^ BY^ CRO
WNOFFICEThis illegal pill press was
used to create etizolam
tablets in a garage in
Paisley, Scotland