Max had been selfmedicating his anxiety with illicit alprazolam for some time . Struggling to manage this by himself , he reached out to his GP for support . His doctor explained that they would not be able to prescribe any benzos , and instead referred Max to his local drug service . Already receiving OST from the service , Max requested additional support for his alprazolam use . However , they too explained that they were unable to prescribe benzos , and tried to refer Max back to his GP – acting in contradiction to section 4.10.1 of the ‘ Orange Book ’ guidance .

With no way to obtain a safe supply of medication , Max ran out of his illicit supply and found he was unable to acquire more . He soon began

experiencing withdrawals – at first hallucinations and delusions , followed by his first seizure .

An ambulance was called and he experienced numerous seizures while in A & E that went untreated – he was instead administered the antipsychotic drug haloperidol , which exacerbated his symptoms . This was compounded when he did not receive any methadone for more than 24 hours , putting him unnecessarily into further withdrawal from opiates . ‘ It was like I was an animal ,’ he later said . ‘ They looked at me like I was subhuman .’

The hospital did not have any alprazolam in stock , so said they would order some in . To try to mitigate some of Max ’ s symptoms , a nurse prescribed cyclizine and chlordiazepoxide . A day later she returned to find Max alone in a room on the mental health ward , experiencing further seizures , delusions , vomiting and bowel incontinence . The medications had never actually been administered . ‘ This is not patient care ,’ the nurse remarked .

On the morning of his third day in hospital , Max was seen by an alcohol liaison nurse . They informed Max that , despite what he had been told previously , they would be unable to prescribe any benzos to manage the withdrawals . Instead , he was advised – in spite of his

continuing poor health and delusions – to discharge himself , go home and self-taper .

Unfortunately , many services are far too reluctant to prescribe benzos for dependency . Release has heard multiple stories like Max ’ s of people seeking treatment and being bounced back and forth between their drug service and their GP . No one wants to take responsibility for prescribing to dependent benzo users , and as a result they can end up experiencing dangerous and unnecessary withdrawals .

The Office for Health Improvement and Disparities ( OHID ) has issued clear guidance that benzo dependency sits under the remit of the local drug service . Despite this , many people are still refused by their service , instead having to rely on an inconsistent and increasingly toxic illicit market . Where services are willing to prescribe , they will often only do so on a strict and inflexible reduction regime , offering none of the longer-term holistic thinking that is more common with OST . Without support from his local drug service , GP or hospital , Max has been left to manage his benzo dependency by himself , slowly reducing

Benzo dependency sits under the remit of the local drug service . Despite this , many people are still refused .

his daily dose at home . He even reached out to the commissioner for the region to make them aware of the gap in provision and to try to find a resolution , but received no reply .

As Dr Kate Blazey made clear in our earlier piece ( https :// www . drinkanddrugsnews . com / streetbenzos-clinical-managementthats-fit-for-purpose /), it ' s time the sector changes its approach to benzodiazepine use . Until medical professionals recognize the heightened risks of telling these patients to self-taper using an unstable and contaminated illicit supply , people like Max will continue to suffer and potentially die , and a growing number of new and unknowing synthetic opioid users will remain locked out of treatment .

Shayla Schlossenberg is drugs service coordinator at Release

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8 • DRINK AND DRUGS NEWS • JUNE 2024

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