Scotland has been grappling with a disproportionately high number of drug-related deaths compared to other European countries, a crisis that has intensified over recent years. This increase has been largely driven by a rise in polydrug use, with particular emphasis on the involvement of designer benzodiazepines like etizolam and prescription drugs such as gabapentinoids. The systematic review published in PLOS ONE delves into the intricacies of these substances’ roles in the escalating drug-related fatalities within Scotland.

Substance Use Patterns in Scotland

The review identifies a marked increase in the average number of substances involved in Scottish drug-related deaths, highlighting a shift in the pattern of drug use. While opioids, cocaine, and alcohol have long been entrenched in the Scottish drug culture, the emergence of etizolam and gabapentinoids has added a new dimension to the problem. National Records of Scotland have noted a significant presence of these substances in toxicology reports, indicating their rising impact.

The Role of Gabapentinoids and Etizolam

Etizolam, a designer benzodiazepine, has been increasingly detected in Scottish toxicology reports. The review presents data showing that etizolam was the second most common benzodiazepine linked to deaths, featuring in 67.5% of cases where benzodiazepines were mentioned. Similarly, gabapentinoids, initially prescribed for conditions like neuropathic pain, have seen a surge in prescriptions, reflecting their increased presence in drug-related deaths since 2015.

Polydrug Use: A Critical Determinant

Polydrug use, particularly involving opioids, is identified as a key determinant of adverse effects and fatalities associated with both etizolam and gabapentinoids. The concurrent use of these substances amplifies the risk of fatal outcomes, a pattern that has been consistently observed across various studies included in the review. The data reveal a prevalence of these substances among older populations, with a notable impact on older women.

Prevalence and Prescription Trends

The review cites a significant rise in the prescription rates of gabapentinoids in Scotland, coupled with a high prevalence of etizolam use. This trend is evidenced by data from Scottish prisons, where etizolam has been predominantly detected. Moreover, gabapentinoids prescriptions have shown a strong correlation with the increase in drug-related deaths, underscoring the need for careful monitoring of their use.

Challenges in Addressing the Crisis

Addressing the crisis requires a nuanced understanding of the factors contributing to these deaths. The review notes that the literature on the individual characteristics of at-risk users is limited, yet it provides insights into the demographic trends associated with these substances. The high variability in the strength of illicit etizolam samples further complicates efforts to mitigate risks, highlighting the challenges in controlling its availability.

Implications for Policy and Research

The findings call for enhanced research and policy measures to curb the rising trend of drug-related deaths. The review suggests that improved toxicology screening, awareness of polydrug use risks, and careful prescription practices could play a pivotal role in mitigating harms associated with etizolam and gabapentinoids. Additionally, the need for high-quality research involving diverse methodologies is emphasised to inform policy and intervention strategies effectively.

Source: PLOS ONE