Working with Dr Rachel Britton ( formerly clinical director at WithYou , now clinical lead at Via ) and other senior clinicians — WithYou adapted its benzodiazepine guidance . The new guidance allows a slightly higher starting dose of diazepam for clients who would struggle with unpleasant and potentially risky withdrawal symptoms under the regular regime . |
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prescribe him the dose that he would have needed to stabilise , Nick instead turned to his illicit supply . He shared his story with Release in the hope of raising awareness about the need for more flexibility when detoxing from street benzos .
FINDING A WAY TO BETTER SUPPORT PEOPLE LIKE NICK — WITHYOU ’ S APPROACH
According to the ‘ Orange Book ’, diazepam can , under certain circumstances , be part of a benzo detox programme , while not specifying for how long the drug can be prescribed .
Separate from Nick ' s experience , WithYou noticed an increase in the number of clients using street benzos such as flualprazolam and flubromazolam , thinking they were taking regular benzos – this meant clients were often in the dark about increased potency and risk . In addition , WithYou noticed an increase in people with severe dependence to what was believed to be diazepam but turned out to be street benzos after testing . Having made these observations , the clinical team decided to review WithYou ’ s approach .
Firstly , the clients were encouraged to test their samples using the WEDINOS external testing facility and harm reduction project . In some instances , flubromazolam was identified and it was possible to screen for it as part of the treatment programme .
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NEW GUIDANCE Following this — working with Dr Rachel Britton ( formerly clinical |
director at WithYou , now clinical lead at Via ) and other senior clinicians — WithYou adapted its benzodiazepine guidance . The new guidance allows a slightly higher starting dose of diazepam for clients who would struggle with unpleasant and potentially risky withdrawal symptoms under the regular regime ( and therefore be more inclined to top up with benzos obtained illicitly ).
In addition , the level of support for those replacing high-strength benzodiazepines with the reduction regime was increased , including more frequent check-ins . Once stabilised , the gradual reduction could proceed regularly . The revised approach meant that clients suffered less unpleasant withdrawal symptoms and were less likely to turn to an illicit supply to cope with these during their initial detoxing journey .
IDENTIFYING RISK This is one example of how to better cater to the clinical needs of people like Nick . However , it ’ s important to remember that not all people who use street benzos will require this approach , many can withdraw safely themselves , supported by treatment services or primary care . The challenge from a clinical perspective is to identify those more at risk and be prepared to be flexible , within a safe , clinical framework .
A REVISED APPROACH TO SUPPORTING PEOPLE DEPENDENT ON STREET BENZOS — RELEASE
Having initially shared Nick ’ s story to raise awareness about the need to adapt clinical
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treatment offered to people detoxing from street benzos , it ’ s important to remember that there are several underaddressed dangers for people who use illicit benzodiazepines . Firstly , the increased presence of novel benzos in the illicit benzo supply . For instance , in Scotland , where benzodiazepines were implicated in more than half of 2022 ’ s drug-related deaths , Public Health Scotland notes an ‘ increase in harms related to the use of new benzodiazepines such as bromazolam ’.
In October alone , WEDINOS received more than 20 samples from around the UK containing new benzodiazepines largely from samples believed to be either diazepam or alprazolam when purchased . The consumers of these benzodiazepines often lack access to a steady supply at a known and controlled dose , with these substances also often significantly stronger than legally prescribed ones .
Additionally , there have been many recent instances of drugs purported to be benzodiazepines turning out to contain nitazenes . Nitazenes are potent and highrisk synthetic opiates , posing great danger to people who use them . This is especially true for people who use benzodiazepines and don ’ t regularly use opiates .
REVISED APPROACH Given the risks above , including the likelihood of new , unregulated substances emerging around the country , we need a revised approach to supporting people dependent on benzodiazepines across the sector .
This approach must include
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In October alone , WEDINOS received more than 20 samples from around the UK containing new benzodiazepines largely from samples believed to be either diazepam or alprazolam when purchased .
promoting drug testing to all people who use drugs , as well as greater access to naloxone . Additionally , we must improve screening tests to have an understanding of what benzodiazepines – and potentially other substances such as nitazenes – the person has used in order to respond appropriately .
As drug supplies evolve , the sector must stay current to be relevant to people who are using drugs and are at risk of drug-related harms . Updating how we collectively work with people who use benzodiazepines is paramount to the greater mission of keeping people who use drugs alive .
* not his real name
Dr Kate Blazey is medical director at WithYou . Shayla Schlossenberg is drugs service coordinator at Release
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