Substitution of illicit diazepam with etizolam within the United Kingdom drug market 2021 and service response

Background: WEDINOS was established formally in 2013, and provides a robust mechanism for the collection and testing of unknown / unidentified psychoactive substances and combinations of substances, and the production and dissemination of relevant, pragmatic harm reduction advice.

Method: Samples may be submitted anonymously via a wide variety of sources utilising the WEDINOS ‘sample and effects’ pack and record. Test results and ‘effects record’ data are collated and findings disseminated back via the website and quarterly bulletin. Since 2017, WEDINOS has been monitoring and reporting products that were purchased as diazepam, that were found to be substituted with a variety of ‘new benzodiazepines’, including: etizolam

Results: In 2021, 1,085 samples were analysed by WEDINOS submitted as diazepam. Age range of providers: 15 to 80yrs, median age 39yrs. 44 per cent (n=475) contained diazepam, the remaining samples were substituted with other substances. The most commonly profiled substitute was etizolam, identified in 24% (n=259). In recent years, etizolam has been identified in an increasing number of drug related deaths (DRDs) within the United Kingdom, particularly Scotland, where between 2015 and 2020 the number of times etizolam was mentioned in a DRD rose from 6% to 60% . However, the majority of the 2020 cases, involved multiple substances with only 1% mentioning etizolam in isolation .

Conclusions: Direct access submission of samples allows capture of evidence based local and national drug market trend data, enabling drug services to provide pragmatic information. Combining this with other data sources such as hospitalisations, toxicology and DRD data further enables services to provide targeted information relating to specific substances and contraindications, in this instance addressing poly-drug use involving street purchased 'diazepam'.