May 2021 Update on Benzodiazepines

Benzodiazepines are a widely prescribed group of medicines with a range of clinical uses that include treating anxiety, insomnia, acute muscle spasms and managing alcohol withdrawal.However, this group of medicines are often used outside of prescribing recommendations with tablets obtained without a prescription by suppliers and online stores.

This market is changing with falsified medication becoming more prominent in Ireland. Tablets have been found to contain new benzodiapines which can be more risky while there is also a risk of products containing mixtures of substances pressed into one single product.

Over the last decade, of concern is the emergence of ‘new’ benzodiazepines with an increase in the number, type and availability. The EU Early Warning System has detected an increasing number of ‘new’ benzodiazepines available on Europe’s drug market. Some may have been approved for use in some countries in the past, others may be found in patent literature but were never been brought to market, whereas some are novel compounds produced in illicit manufacturing plants.

New or falsified benzodiazepines appearing on the market are of concern due to high potency at low doses. This can produce strong sedation, respiratory depression and amnesia. Additional adverse effects include loss of coordination, drowsiness, dizziness, blurred vision, slurred speech, and, in some cases, death. Risks are increased if one or more substances are used by the person, or if tablets are pressed to contain one or more substance.

What has been found in Ireland?

The benzodiazepine market is changing with increased amounts of falsified tablets emerging. As well as this, there are tablets available that are licenced for use in other countries but not in Ireland. A number of advisory notices have been issued by the HSE since 2019 to raise awareness of the increased risk of overdose among people who use benzodiazepines in Ireland.

We have identified:

Falsified tablets that are made to look like medication but contain new benzodiazepines (Etizolam) or a number of substances
Xanax sticks that can contain the active ingredient (alprazolam), contain a new more potent benzodiazepine (for example, Etizolam) or a number of substances (for example Flualprazolam, Etizolam, Alprazolam).
Nike brand tablets containing Tramadol and Alprazolam
Medication used in other countries that may have higher doses such as Ksalol brand tablets known as 'Castles'. These tablets are currently being investigated regarding drug related deaths that occured in Finland.
Paper found to contain Etizolam