Frontline workers respond to the growing challenge of benzos

27 July 2021 Written by Ursula Hofeldt, Outreach Coordinator
Ambulance Commercial Street

The landscape of drugs is changing all the time and as frontline workers, it can be challenging to keep up with recent trends and feel confident giving out harm reduction advice and information to the people we work alongside. In Scotland, the recent rise in counterfeit benzodiazepines (benzos) is putting users at risk and providing new challenges for frontline workers.

‘Consumption roulette’: Street benzos putting people at risk

In 2021, Scotland has so far seen an increase in fatal and non-fatal overdoses amongst people experiencing homelessness [1]. The drug deaths are mainly linked with counterfeit or ‘street’ benzos, continuing a trend from 2015. In 2015, benzodiazepines accounted for about a quarter of drug related deaths in Scotland – compared to the most recent statistics from 2019 where benzodiazepines were implicated in about 70% of those deaths. Etizolam in particular have caused this concerning development and in 2019, etizolam was implicated in almost 2 out of 3 drug deaths in Scotland [2].

Street benzos (also known as street Valium) are extremely cheap and easy to get hold of since they are mainly produced locally, something that has made them popular during the pandemic. Street benzos are mostly sold as Valium (diazepam) but often contain a mix of benzodiazepines, especially etizolam. This makes them unpredictable when it comes to effects, duration and toxicity and some of them stay in the body for longer than traditional benzodiazepines.

All these factors make it difficult for users to manage doses and tolerance which puts people at a high risk of overdose – especially when street benzos are mixed with other drugs or alcohol. In addition to the high risk of overdose, benzos also cause drastic mood swings and memory loss. Furthermore, tolerance and dependency develop quickly, making it difficult for people to stop taking the drug even if they have only been taking benzos for a short period of time.

Recent changes in the benzos market have created a sense of uncertainty among both frontline workers in Scotland and the people they work with. Consultations with frontline workers in Scotland spoke of a perfect storm of social isolation and anxiety due to the pandemic and the easy accessibility of street benzos.

Many frontline workers have also experienced clients passing away which impacts on workers as well as their other clients who are affected by the deaths of their peers. One frontline worker described street benzos as “a roulette”, while others recognised that even experienced benzo users are concerned – “No one is an expert anymore”.

Supporting frontline workers: Benzos training with Crew

In response to this development, the Scottish Frontline Network set up an online working group in February 2021, which met regularly. This group enabled frontline workers to share their experiences, support each other, and gather an understanding of what was happening on the frontline.

The meetings highlighted a need for more reliable information about benzos and how to advise clients. Therefore, to better equip frontline workers to deal with this challenging situation, we set up two online training sessions. The sessions were run in partnership with Crew, a harm reduction and outreach charity in Edinburgh, and brought together frontline workers from different services in Scotland, including housing, homelessness, and medical services.

The webinars gave context to the current situation and provided participants with key harm reduction messages. Moreover, the training sessions created a space where people could talk about the impact of benzos on the people they work with, how they are managing the current situation, and what support they need to respond.

“I feel more confident in identifying the risks of using street Valium and being able to pass harm reduction advice on to my client group. It will allow me to have more open and honest conversations with my clients – which will in turn build healthy trusted relationships and hopefully improve engagement and lead to clients receiving the support they need”

                       - frontline worker who joined one of the training sessions

“The training consolidated knowledge gained informally from working in frontline services – that improves confidence. A really useful session.”

                      - frontline worker who joined one of the training sessions

The webinars were extremely popular and sold out very quickly, highlighting that this is an important issue for frontline workers in Scotland. When asked about what would make them feel better supported in reaction to current drug trends, frontline workers highlighted the need for more awareness, information sharing, honest discussions in the community about the use of benzos, and promotion of harm reduction messages.

Therefore, the Scottish Frontline Network will continue to focus on this topic as we work to influence change and find out how we can best help frontline workers respond to these issues.

Influencing change through the Scottish Drug Deaths Task Force

Following the two training events, we collated the key topics that had been discussed. These findings were then shared to inform the work of The Scottish Drug Deaths Task Force. The taskforce was set up to tackle Scotland’s unique challenge and identify evidence-based strategies to help those most at risk. One of the subgroups in the task force focuses specifically on tackling benzodiazepines and their role in Scotland’s drug deaths – this work is ongoing and feeds into the development of national standards for Medical Assisted Treatment (MAT) in Scotland.

The working group recently published an interim guidance response for benzodiazepine harm reduction. Here, they call the harm associated with street benzos in Scotland “a public health emergency” and argue for a change in approach to both prescription and treatment as they call for a person-centred and trauma-informed response from services who engage with people using benzodiazepines.

At the Scottish Frontline Network, we are proud to have engaged in these difficult conversations with frontline workers in Scotland and we are happy that the voices of frontline workers will help shape the national response to the current situation.

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  1. Further reading: Meeting of the Parliament 17 June 2021 - Drug-related Deaths and “You know, we can change the services to suit the circumstances of what is happening in the world”: a rapid case study of the COVID-19 response across city centre homelessness and health services in Edinburgh, Scotland
  2. National Statistics, 2020: Drug-related deaths in Scotland in 2019

This article first appeared on the UK Frontline Network site on July 26, 2021