So-called ‘designer’ drugs could be driving a culture of users using multiple drugs and contributing to an increasing pattern of drug-related deaths in Scotland according to a new study.

Published in the open-access journal, PLOS ONE, a team of researchers at UWS analysed 18 previously published studies that included data on the role of etizolam (one designer benzodiazepine) and gabapentinoids among drug-related deaths in Scotland as well as data on the drugs’ use and abuse. Although both drugs are unlikely to cause death on their own, they can cause adverse reactions when being used alongside each other or other opioids.

In 2021, the Scottish Parliament declared drug-related deaths to be a public health emergency.

The research group, led by Lucy Troup and including Robertson Medal winner Beata Ciesluk, found that both drugs are increasingly cited as contributing factors to drug-related deaths in Scotland. Gabapentinoid-related deaths increased from 2 to 367 deaths between 2008 to 2018, accounting for almost 1 in 3 (31%) of all drug-related deaths by 2018. Across Scotland, the use of opioids in combination with other substances is the most common factor resulting in both adverse side effects and deaths from etizolam and gabapentinoids. 

Data also revealed a rise in gapapentinoid prescriptions, especially their off-label use, which has been associated with misuse and illicit-market availability. This prescription trend is likely attributed to efforts to limit prescribing of opioids and benzodiazapines. Data on the use of etizolam, on the other hand, suggested an illicitly manufactured etizolam supply in Scotland, which can contribute to inaccurate dosing.

The study also revealed that whilst the data on the characteristics of individuals using these drugs was limited but suggested a higher rate of gabapentinoid prescriptions among older women. Etizolam-related deaths were more likely to be accidental among men and intentional among women. These conclusions both support a possible vulnerability among older women. 

“In recent years, Scotland has been experiencing a disproportionally high number of drug-related deaths compared to other European countries. There is a need for further research into the prevalence and risk of etizolam and gabapentinoids use in Scotland, but our study suggests that both substances may drive polydrug use and contribute to Scottish drug-related deaths.
Lucy Troup
“It’s essential that we understand the role that polydrug use, especially prescription drugs and designer benzodiazepines, play in drug related deaths to be able to effectively reduce risk from harm in people who use drugs.”
Lucy Troup

read the full PLOS ONE article