Real or fake? Sourcing and marketing of non‐prescribed benzodiazepines amongst two samples of people who regularly use illicit drugs in Australia

Abstract

IntroductionThere is concern around non‐prescribed benzodiazepine use, particularly with increasing detections of counterfeit products containing high‐risk novel compounds. The aims of this study were to investigate how and which non‐prescribed benzodiazepines are being sourced; forms, appearance and packaging; and awareness of risks associated with non‐prescribed benzodiazepines.MethodsData were collected from a sample of Australians who inject drugs or use ecstasy and/or other illicit stimulants on a monthly or more frequent basis, and who reported past 6‐month use of non‐prescribed benzodiazepines (n = 235 and n = 250, respectively). Data were collected on source, diversion from a known/trusted prescription, product name and aesthetic characteristics for the last non‐prescribed benzodiazepine obtained.ResultsAmongst participants who injected drugs, 71% reported that their last non‐prescribed benzodiazepines were diverted from a known/trusted prescription, compared to 59% of participants who used ecstasy/other stimulants. Sourcing via cryptomarkets was rare. Across both samples, the majority reported last obtaining substances sold/marketed as diazepam or alprazolam. Participants sourcing via non‐diverted means were twice as likely to obtain alprazolam. Known sourcing of novel compounds was rare. Amongst participants who used ecstasy/other stimulants, 36% reported confidence in the content/dose of non‐prescribed benzodiazepines even when the source is unknown.Discussion and ConclusionsMost participants obtained substances sold as classic/registered benzodiazepines, mostly via diverted prescriptions, with a substantial minority potentially unaware of counterfeits circulating. While diverted use undeniably presents risks, tightening of prescriptions in Australia could inadvertently lead to greater supply of novel benzodiazepines as seen internationally, reinforcing prioritisation of demand and harm reduction strategies.

The use of prodrugs as drugs of abuse

“…Most of the stimulant prodrugs detected in the illegal drug markets reported so far have been for MDMA (3,4-metilenedioximethamphetamine) (Xu et al, 2020). There are, however, drugs approved for therapeutic purposes that act as prodrugs to controlled substances (Grigg & Lenton, 2023) and for cathinones (Kuropka et al, 2023). Although both MDMA and cathinones have important hallucinogenic effects, the decision to include them under prodrugs of stimulants was made due to structural similarity to amphetamines.…”

Public health surveillance of new psychoactive substances: recent developments

“…In Australia, sentinel surveys are conducted among people who regularly use ecstasy and other stimulants through the Ecstasy and Related Drugs Reporting System (EDRS) and of people who regularly inject drugs through the Illicit Drug Reporting System (IDRS). Grigg et al [25] examined interview data from both monitoring systems collected in 2021 to investigate the use and sourcing of nonprescribed benzodiazepines, including illicitly manufactured products which may contain novel benzodiazepines. In another recently published article based on surveys of persons who inject drugs, McAuley et al [26] analyzed data from the 2019-2020 Needle Exchange Surveillance Initiative, a biennial, cross-sectional survey of individuals attending community-based services providing injecting equipment in Scotland, to determine the prevalence of nonprescribed benzodiazepine use and the associated risk of recent nonfatal overdose.…”