and how we can stop it…
On 26th July 2021, police officers found the body of a 40-year old man, named Richard Beare, inside a flat in Penzance, Cornwall. He had fallen unconscious in bed, with heroin and a handful of pills nearby. There were fatal levels of benzodiazepines and heroin in his body, toxicology reports later confirmed.
Unfortunately, Richard’s death isn’t an isolated incident. There were 53 deaths related to drug poisoning registered in Cornwall and 8,859 across England and Wales during 2021, newly-released data from the Office of National Statistics shows.
There were 538 deaths involving benzodiazepines across England and Wales in 2021, which is a 13 percent rise since 2020. Similarly, deaths involving benzodiazepine analogues – substances with similar effects to benzos – increased from 62 to 171 in this time period.
Volteface spoke to Richard’s 38-year-old brother – Kitto Beare – who says, “Richard was always a really quiet, caring person. But he’d been struggling badly with his mental health since his teens. Things had worsened since the death of his friend – from benzos and heroin – the previous year.”
Kitto explains, “Though we hoped things would change for the better, we always feared the drugs would kill him in the end. It really did come as a massive shock to find out that a prescription drug contributed to his death though. And at such a young age.”
Overall, 96 percent of percent of benzodiazepine deaths in England and Wales during 2021 involved other prescription drugs or illegal substances. Just over one in four – or 26 percent – of benzodiazepine deaths involved alcohol, the ONS statistics highlight.
Ironically, this increase in benzodiazepine deaths comes at a time when prescriptions for the drug in England have fallen from 11.3 million in 2010 to 8.6 million in 2020, following warnings about the risk of dependency. But with no measures taken to limit demand, many patients feel unable to function without the drug and are – instead – turning to the illegal marketplace.
Volteface spoke to 42-year-old Paul, from St Helens in Merseyside, who used “street” Xanax between 2013 and 2020. He says “I’ve just left rehab. I attended a programme for benzodiazepine and cocaine addiction. My cousin was stabbed on the street in Europe. And I’d been doing coke during the day and benzos at night since then, as the six weeks of mental health support provided by the NHS wasn’t nearly enough to reduce my emotional pain.”
Paul explains, “Me and my mates would buy 1,000 pills at a time from a guy who manufactured them in a garage. Most bigger suppliers in the U.K. buy the active ingredients, like etizolam or alprazolam, on the internet in powder form. Then, they make them into pills themselves.”
“Doing it that way is less risky than ordering millions of pills from India or China. It’s usually about $300 for 100 grams. And you only need one gram to make 500 of the 2 mg pills, so it’s pretty cheap compared with other drugs,” he explains.
Police have seized significant quantities of the main ingredients in “street xanax” – etizolam and alprazolam – over the last two years. This includes a Kent factory with 28 million pills in June 2020 and a North Ayrshire manufacturing facility with 253,000 pills in March 2020.
Xanax reportedly retails for around 50 pence a pill on the Scottish street market, a study in the International Journal of Drug Policy shows. But prices in the north of England can vary from 35 pence to £2 a pill, depending on potency, quantities purchased and availability, Paul says.
From drug support workers to consumers, many people believe that lockdown increased the demand for benzodiazepines across England and Wales, especially in rural areas like Cornwall.
Paul explains, “Before lockdown, loads of heroin dealers were reluctant to sell benzos to their customers, as they often feel it reduces heroin sales. Similarly, if someone’s a heroin user dealer, their boss might be reluctant to give them stuff like Xanax because it can make people forgetful. And they end up literally forgetting where they put money or drugs, then not turning up to stuff.”
“But of course, when heroin ran low in the first lockdown for a bit, dealers were still able to get their hands on fake Xanax pretty cheaply. The pills are made in England, so there was still plenty of stock around.”
A significant proportion of people who use heroin rely on illegally obtained benzodiazepines to mask withdrawal symptoms or reduce anxiety and insomnia, research consistently shows. It’s a popular substitute when someone’s too ill to leave the house or has no cash – and it’s sometimes used alongside drugs like heroin to create a “super high”, the researchers say.
Steve Rolles, a senior policy analyst at the Transform Drugs Policy Foundation says, “Street benzos are often far more potent, long-acting and toxic than the prescription benzos we’re familiar with. You don’t know what you’re getting in terms of potency, adulteration or what it actually is.”
“This is a problem across the entire illegal drug market, as it’s unregulated. But it’s particularly acute with drugs like this, as they’re often formed into pills by amateur organised crime groups – or even random chancers knocking them out with a cheap press.”
Steve and the team at Transform believe there are several measures that could reasonably be applied to help people who are using benzodiazepines in a potentially problematic or harmful way. He says, “Many professionals are understandably reluctant to prescribe benzodiazepines, due to the risks of overdose when used alongside other substances like opioids, stimulants or alcohol.”
“However, there is a degree of evidence to suggest that benzodiazepine prescriptions can reduce harm by controlling levels of use in a quasi-clinical context. At least, this way, people would have regular contact with medical professionals regarding their use,” he explains.
“Prescriptions are sometimes frowned on, but we’ve reached a critical level of drug-related deaths where some of the more radical measures that would once have been viewed as quite risky measures need to be back on the table and considered once more,” he says.
Steve also notes that an increase in public understanding of emergency responses to benzodiazepine overdose, as well as better treatment modalities could improve health outcomes and reduce deaths.
And given that deaths from benzodiazepines and other drugs are at their highest levels since records began, it’s certainly time to amp up investment in harm reduction initiatives such as treatment facilities, emergency responses and education.
Rebecca Tidy is a freelance journalist specialising in criminal justice and drugs. Prior to this, she spent a decade researching policing and drug policy at Plymouth University and the University of Exeter. Tweets @DrRebeccaTidy