Increased risk of non-fatal overdose associated with NPS-type [‘street’] benzodiazepine use in Scotland, UK

Friday, 25 November, 2022 - 10:50 to 12:20


Background: 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).

Methods: 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.

Results: 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, street-benzo use was significantly associated with non-fatal overdose in the past year among PWID (aOR 2.48, 1.91-3.22).

Conclusion: 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.


Presentation files

25 A8 1050 Andrew McAuley.pdf1.31 MBDownload



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