EDUCATION
THE
Improving our understanding
of benzodiazepines would save many
lives, says Kevin Flemen
Non-medical use of
benzodiazepines
creates big
challenges
for treatment
services. There
need to be significant changes in
how we respond if we are to reduce
dependency and fatalities related
to this family of drugs.
The extent of non-prescribed
benzo use is poorly understood.
The Crime Survey for England and
Wales (CSEW) reports a drop in use,
but anecdotal information from
drug services, including young
people’s services, suggests the
opposite is true.
The CSEW data is highly
suspect in relation to benzos, and
this may be because it misses
key using populations. Questions
to identify benzo use need to be
carefully framed too – would young
people taking ‘Xans’ automatically
know that this is alprazolam, a
benzodiazepine? If not, standard
screening questions such as ‘have
you used benzodiazepines in the
past six months?’ are liable to
under-count actual use.
Further, not all our benzotype
drugs will show up on urine
screens, possibly because the
stronger ones produce effect
at very low doses – producing
lower levels of metabolites
below the detection threshold.
And some of the drugs, such as
etizolam, are thienodiazepines not
benzodiazepines, so won’t produce
metabolites that show up on a
standard screen.
YOUNG PEOPLE
Young people’s benzo use appears
to have increased. Some of this is
recreational, influenced by popular
culture, including a new generation
of rappers whose image and lyrics
have popularised Xanax. For others,
use may be self-medicating for
trauma, anxiety or other negative
mental health conditions.
The trap here is the slow access
that too many young people
encounter when seeking help from
child and adolescent mental health
services (CAMHS). Long waiting lists
or failure to meet the threshold to
access services mean young people
may be waiting months for access
to CAMHS, if they can access the
service at all.
In the meantime, some will find
benzos and start to self-medicate.
When and if the young person
does access mental health services
there is a good chance – in classic
‘dual diagnosis ping pong’ – that
they will be told they have a
primary presenting drug problem
and therefore should be referred
to a drug service. In turn, when
they present to the drug service
they may well find a paucity of
treatment options to assist with
their benzo dependency.
THE BENZO BACKLASH
The increase in the use of Xanax
may have started among young
people, but the wider pattern of
non-prescribed benzo use has been
an ongoing issue and has morphed
over time. Initial benzo dependency
was largely driven by massive
over-prescribing and long-term
prescribing, something that has been
addressed but remains an issue.
The path to hell is, however,
paved with good intentions.
The ongoing guidance to GPs to
carefully consider the need for
benzo prescribing and review
existing patients has certainly
Initial benzo
dependency was
largely driven
by massive overand
long-term
prescribing,
something
that has been
addressed but
remains an issue.
reduced the extent of benzos
being prescribed in the UK. But
without measures to address the
underlying reasons why people feel
they need tranquillisers, people
ended up seeking these drugs first
from online pharmacies, then via
the NPS market off the dark web
and, ultimately, off the streets.
This has allowed people to build
up tolerance to novel benzos at
6 • DRINK AND DRUGS NEWS • JUNE 2020
WWW.DRINKANDDRUGSNEWS.COM