A dangerous game

A dangerous game - DDN feature on people dependent on benzodiazepines / benzos

We’ve written before in this column about the challenges faced by people dependent on benzodiazepines (DDN, July/August 2023, page 18). At a time when the street benzo supply is increasingly contaminated with nitazines, it’s more important than ever that this group is able to access effective treatment. Nevertheless, at Release we are still seeing too many services around the country failing to protect people who use benzos from significant and avoidable harms.

Max had been self-medicating his anxiety with illicit alprazolam for some time. Struggling to manage this by himself, he reached out to his GP for support. His doctor explained that they would not be able to prescribe any benzos, and instead referred Max to his local drug service. Already receiving OST from the service, Max requested additional support for his alprazolam use. However, they too explained that they were unable to prescribe benzos, and tried to refer Max back to his GP – acting in contradiction to section 4.10.1 of the ‘Orange Book’ guidance.

With no way to obtain a safe supply of medication, Max ran out of his illicit supply and found he was unable to acquire more. He soon began experiencing withdrawals – at first hallucinations and delusions, followed by his first seizure.

An ambulance was called and he experienced numerous seizures while in A&E that went untreated – he was instead administered the antipsychotic drug haloperidol, which exacerbated his symptoms. This was compounded when he did not receive any methadone for more than 24 hours, putting him unnecessarily into further withdrawal from opiates. ‘It was like I was an animal,’ he later said. ‘They looked at me like I was subhuman.’

The hospital did not have any alprazolam in stock, so said they would order some in. To try to mitigate some of Max’s symptoms, a nurse prescribed cyclizine and chlordiazepoxide. A day later she returned to find Max alone in a room on the mental health ward, experiencing further seizures, delusions, vomiting and bowel incontinence. The medications had never actually been administered. ‘This is not patient care,’ the nurse remarked.

On the morning of his third day in hospital, Max was seen by an alcohol liaison nurse. They informed Max that, despite what he had been told previously, they would be unable to prescribe any benzos to manage the withdrawals. Instead, he was advised – in spite of his continuing poor health and delusions – to discharge himself, go home and self-taper.

street benzos
‘Unfortunately, many services are far too reluctant to prescribe benzos for dependency.’

Unfortunately, many services are far too reluctant to prescribe benzos for dependency. Release has heard multiple stories like Max’s of people seeking treatment and being bounced back and forth between their drug service and their GP. No one wants to take responsibility for prescribing to dependent benzo users, and as a result they can end up experiencing dangerous and unnecessary withdrawals.

The Office for Health Improvement and Disparities (OHID) has issued clear guidance that benzo dependency sits under the remit of the local drug service. Despite this, many people are still refused by their service, instead having to rely on an inconsistent and increasingly toxic illicit market. Where services are willing to prescribe, they will often only do so on a strict and inflexible reduction regime, offering none of the longer-term holistic thinking that is more common with OST.

Without support from his local drug service, GP or hospital, Max has been left to manage his benzo dependency by himself, slowly reducing his daily dose at home. He even reached out to the commissioner for the region to make them aware of the gap in provision and to try to find a resolution, but received no reply.

As Dr Kate Blazey made clear in our earlier piece, it’s time the sector changes its approach to benzodiazepine use. Until medical professionals recognize the heightened risks of telling these patients to self-taper using an unstable and contaminated illicit supply, people like Max will continue to suffer and potentially die, and a growing number of new and unknowing synthetic opioid users will remain locked out of treatment.

Shayla Schlossenberg, ReleaseShayla Schlossenberg is drugs service coordinator at Release

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