Responding to the identification of nitazenes within the illicit diazepam market

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.  Samples are analysed utilising ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry.

Results of analysis and ‘effects record’ data are collated and findings disseminated back via the website and quarterly bulletin.  

Since June 2021, WEDINOS has been monitoring and reporting products that were purchased as prescription only medications, that were profiled following analysis as containing a nitazene

Results:

From the first identification of a nitazene in sample submitted to WEDINOS April 2021, through to the first identification of a nitazene in sample submitted as diazepam in March 2023, 54 other samples had been profiled as containing nitazanes, primarily submitted as another opioid oxycodone. Over the summer of 2023 (Jun-Sep), there was a shift in identifications to routinely and predominantly identifying nitazenes in samples submitted as diazepam.

As many of these samples were submitted within what appeared to be pharmaceutical packaging, concerns where raised about a population of individuals who were possibly buying substances online and being mis-sold potent opioids in place of a benzodiazepine. It was also likely that these individuals were not engaged with specialist drug services.

It was therefore essential to raise awareness of nitazenes, the products they were being identified within and to raise awareness of naloxone amongst a group of people who use drugs that may never have thought about carrying an opiate antidote previously.

This included proactive media engagement through Public Health Wales communications team warning of high potency synthetic opioids being identified in the illicit benzodiazepine market. Engaging with local health board harm reduction leads and specialist needle and syringe programmes to include the aforementioned information in naloxone training. Development of a one-side national information sheet disseminated to services working with people who use drugs. Information provided to the Welsh Royal College of Emergency Medicine and the Welsh Ambulance Service for awareness around individuals reporting acute effects relating to benzodiazepine consumption, who may have unknowningly consumed opioids. 

Conclusions: 

Direct access submission of samples from end users allows capture of evidence based local and national drug market trend data, enabling drug services to provide pragmatic information. As well as alerting medical services to potentially differences between self-reports of drug consumed, compared to effects observed and actual substance consumed.