Increasing use of legally available drug use highlighted

The team, from the Centre for Forensic & Legal Medicine at the University, have identified several cases of phenazepam misuse and warn that it could become more widely used as a legal replacement for proscribed substances. Having identified a trend of misuse, a letter from the team discussing the issue is published today in the British Medical Journal.

Phenazepam is a type of benzodiazepine (psychoactive) drug developed in the 1970s for the treatment of epilepsy, alcohol withdrawal syndrome, insomnia, and anxiety. At present, it is available on prescription only in countries of the former Soviet Bloc, and is not currently controlled in the United Kingdom, most of Europe, or the United States.

As such, it can be purchased perfectly legally over the internet. Recent reports from Sweden, Finland, and the US describe it being used illicitly in place of similar drugs such as diazepam.

The Dundee team have identified nine cases in which postmortem blood samples contained phenazepam since January. Dr. Peter Maskell, a Lecturer in Forensic Toxicology at Dundee says this suggests that phenazepam use is on the increase in the UK, but stressed this did not indicate any impact on overall levels of drug use or fatalities.

"This many cases suggest that the use of phenazepam by drug misusers in the UK is on the rise" he said. "Phenazepam can be obtained legally on the internet so it could become more widely used as substitute for controlled benzodiazepines or designer drugs.

"It is important to note there is no evidence that people are taking more drugs as a result of the availability of phenazepam. Rather, it would seem it is increasingly being used as a replacement for other drugs, most notably diazepam, because we are seeing more instances of its use. Whether that is actually a deliberate switch on the part of users or because it is dealers are selling is unclear at this stage.

"Like other benzodiazepines, phenazepam can be addictive and mixing with other drugs such as heroin or alcohol increases the risk of drug interaction."

In the UK, concern about phenazepam was raised in 2010, when three people in the East Midlands and six people in Scotland were admitted to hospital after phenazepam overdoses. These cases and increased seizures of the drug by police led the Scottish Government to issue warnings about phenazepam.

Having been alerted about its presence, Dr. Maskell and his colleagues began screening postmortem blood samples for phenazepam in their forensic toxicology laboratory in Dundee from the end of January 2011.

In each of the nine cases in which phenazepam was detected in the blood of the deceased, there was a history of drug misuse and all occurred in men and women aged 31 to 45. Death was from the adverse effects of opiates in seven cases and from non-drug related causes in two.

Dr. Maskell continued, "Although we have detected use in nine cases, phenazepam cannot be directly identified as a cause of death in any of them. There is a key difference between this drug and other legally available substances which have hit the headlines in recent years.

"This is not a party drug likely to be consumed by casual users but is more likely to be seen in persons with a history of misuse, often with harder drugs such as heroin, methadone and other opiates."

Provided by University of Dundee