New benzodiazepines, which are not controlled by international drug laws, come under the spotlight today in a new report released by the EU drugs agency (EMCDDA) (1). Often marketed as ‘designer benzodiazepines’, these substances are sold as ‘legal’ replacements for controlled benzodiazepines and are becoming increasingly available in Europe. They are monitored by the agency as new psychoactive substances (NPS) through the EU Early Warning System (EWS).
The EMCDDA currently monitors 30 new benzodiazepines, over 80% of which were detected for the first time between 2014 and 2020. Despite this relatively large number, the new benzodiazepine market in Europe is currently dominated by etizolam and flualprazolam — although this may change, as both substances were placed under international control in November 2020. In 2019, 1 240 seizures of new benzodiazepines were reported by the EU Member States (around 5% of NPS seizures).
Initially, the substances were sold as ‘legal highs’ or ‘research chemicals’ under their own names (e.g. phenazepam, pyrazolam). While this continues to be the case, increasingly, they are also used by criminal groups to manufacture fake versions of commonly prescribed benzodiazepine medicines (e.g. Valium®, Xanax®), which are then sold on the illicit market. Users may be unaware of the substances or doses they are taking, increasing the risk of severe poisoning, particularly if consumed with alcohol or other sedatives. As some new benzodiazepines (e.g. flualprazolam and etizolam) are placed under control, there is a risk that other substances will take their place. One possibility is the re-emergence of flubromazolam and deschloroetizolam, which were first notified in Europe in 2014.
‘New benzodiazepines have firmly established themselves on the new drugs market in Europe’, says EMCDDA Director Alexis Goosdeel. ‘It is likely that more substances from this group will continue to appear as users seek new drug experiences or alternatives to unavailable prescription medicines. Drugs today are everywhere and the boundaries between what is licit and illicit are increasingly blurred. Faced with a complex market and high demand, we must strengthen our ability to detect, assess and respond to new benzodiazepines and the public health and social harms they cause’.
An increase in insomnia and anxiety during the COVID-19 pandemic may lead more people to self-medicate with new benzodiazepines, or inadvertently use fake benzodiazepine medicines.
Similar to other NPS, some new benzodiazepines appear to be shipped from companies in China as bulk powders to Europe, where they are processed into finished products (e.g., tablets, capsules, blotters, and e-liquids for vaping). Produced by licensed pharmaceutical companies, benzodiazepines are the most widely prescribed group of medicines in the world and are used to treat a range of conditions (e.g. anxiety, insomnia, epilepsy, alcohol withdrawal). In most countries, benzodiazepines authorised as medicines are controlled under drug control laws and available by prescription only. This is in line with the 1971 UN Convention on Psychotropic Substances, which currently controls 38 benzodiazepines.