Increased Risk of Non-Fatal Overdose Associated With NPS-Type [‘street’] Benzodiazepine Use in Scotland, UK

Author: Andrew McAuley Norah Palmateer David Goldberg Tara Shivaji Trina Ritchie Kirsty License Daniel Carter Sharon Hutchinson

Theme: Epidemiology & Public Health Research Year: 2022

Drug-related deaths (DRDs) in Scotland increased for seven years in a row between 2014 and 2020,
consolidating Scotland’s place at the top of the United Kingdom and European drug-related
mortality charts. One of the defining features of this recent and rapid rise has been the role of
benzodiazepines, which are now involved in two-thirds of all DRDs. The majority of these deaths are
linked to use of NPS-type benzodiazepines [‘street-benzos’]. NPS-type benzodiazepines have been
identifed by the United Nations as a global threat to public health.This study aimed to estimate the
prevalence and determinants of street-benzo use and related harms among a national sample of
people who inject drugs (PWID).
Data from the 2019-20 Needle Exchange Surveillance Initiative (NESI) was analysed using logistic
regression. NESI is a voluntary, anonymous, biennial, cross-sectional, bio-behavioural survey of PWID
attending community-based services providing injecting equipment in mainland Scotland.
Prevalence of street-benzo use in the past six months among PWID in Scotland in 2019-20 was 52%
(1259/2436) and significantly associated with age (aOR 0.97, 0.96-0.98), frequent incarceration (aOR
1.32, 1.09-1.60), recent public injecting (aOR 3.65, 2.68-4.97), a recent OAT prescription (aOR 1.89,
1.52- 2.34), and a history of benzodiazepine prescription (aOR 1.89, 1.45-2.48). In addition, streetbenzo use was significantly associated with non-fatal overdose in the past year among PWID (aOR 2.48, 1.91-3.22).
This study found a high prevalence of street-benzo use among PWID in Scotland, especially among
populations at high risk of drug-related death, and an association between street-benzo use and
increased risk of non-fatal overdose. These novel findings highlight the scale of the street-benzo
issue Scotland faces and the urgency required to expand its harm reduction infrastructure to address
this unique element of the overdose crisis.
Disclosure of Interest Statement:
This work was supported by funding from Public Health Scotland. The funding source had no role in
study design; data collection, analysis, or interpretation; in the writing of the research; or in the
decision to submit this work for conference.

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