This advisory notice has been issued by the HSE National Clinical Lead for Addiction Services to notify service providers of the on-going risk of counterfeit benzodiazepines containing new psychoactive substances (NPS).
NPS or new types of benzodiazepines appearing on the market are of particular concern due to the high potency of these substances even at low doses.
NPS benzodiazepines can produce strong sedation and amnesia. Additional adverse effects include loss of coordination, drowsiness, dizziness, blurred vision, slurred speech, and, in some cases, death.
Naloxone will have no effect on reversing symptoms from NPS benzodiazepines.
Risks are increased if one or more substances are used by a person, or if tablets are pressed to contain one or more substance.
Bromazolam…
Recently, Bromazolam has become a common NPS benzodiazepine appearing on the Irish market.
Bromazolam can appear in a variety of different types of pills, but has been commonly found as round blue or white pills. A small number of samples have been reviewed by the HSE National Drug Treatment Centre Laboratory this year which contained Bromazolam. Bromazolam produces strong sedative and sleep-inducing effects and as a result there is a significant risk of overdose.
Blotter paper benzodiazepines
New benzodiazepines may also appear in new forms such as on ‘blotter paper’, which can be harder to identify in terms of contents and potency of the product.
Service providers in the community and in forensic settings should be aware of these developments.
Variety of benzodiazepines obtained by the HSE through ‘Back of house’ drug monitoring in festival settings.
Due to the variety of tablets available nationally, this area is difficult to monitor and service users should be advised to treat all counterfeit tablets with caution. These new benzodiazepine products can cause severe sedative effects and symptoms cannot be reversed through the use of naloxone. Overdose responders should consider this possibility in cases where severe sedative effects are not reversed following the
administration of naloxone.
Over the last decade, the EU Early Warning System on new psychoactive substances (NPS) has detected an increasing number of ‘new’ benzodiazepines on Europe’s drug market. In response to this emerging trend, the HSE has issued a number of advisory notices since 2019 on different types of products appearing such as Etizolam, Flualprazolam, counterfit ‘Xanax sticks’ and products which contain both a benzodiazepine (alprazolam) and an opioid (Tramadol). In addition, products which aren’t licensed for sale in Ireland such as ‘Ksalol’ known as ‘castles’ have become a prominent feature on this market and have led to health concerns.
It is always safer not to use prescription medications outside of prescribing guidelines or as directed by your prescribing doctor and safer not to source counterfeit tablets, as you can never be sure of the contents of such tablets. However, people who use these medications should be provided with information on how to minimise harms. Harm reduction information and posters can be download from http://www.drugs.ie/newbenzos
We request that services share these messages with your client group within services, through your harm reduction interventions directly with people who use and through your social media channels.
Prof Eamon Keenan, HSE National Clinical Lead – Addiction Service
Rialto Community Drug Team 