Characteristics and time course of benzodiazepine-type new psychoactive substance detections in Australia: results from the Emerging Drugs Network of Australia - Victoria project 2020-2022

Rebekka Syrjanen; Shaun L Greene; Courtney Weber; Jennifer L Smith; Sarah E Hodgson; Rachelle Abouchedid; Dimitri Gerostamoulos; Jacqueline Maplesden; Jonathan Knott; Hans Hollerer; Joe-Anthony Rotella; Andis Graudins; Jennifer L Schumann; EDNAV project research group

doi:10.1016/j.drugpo.2023.104245

Characteristics and time course of benzodiazepine-type new psychoactive substance detections in Australia: results from the Emerging Drugs Network of Australia - Victoria project 2020-2022

Int J Drug Policy. 2023 Dec:122:104245. doi: 10.1016/j.drugpo.2023.104245. Epub 2023 Nov 7.

Affiliations

¹ Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia.
² Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia. Electronic address: shaun.greene@austin.org.au.
³ Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia; East Metropolitan Health Service, Department of Health, Perth, Australia.
⁴ Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia.
⁵ Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Bendigo Health, Emergency Department, Bendigo Hospital, Bendigo, Victoria, Australia.
⁶ Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia.
⁷ St Vincent's Hospital Melbourne, Emergency Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
⁸ The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia; Melbourne Health, Emergency Department, Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁹ Western Health, Emergency Department, Footscray Hospital, Footscray, Victoria, Australia.
¹⁰ Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia; Northern Health, Emergency Department, The Northern Hospital, Epping, Victoria, Australia.
¹¹ Monash Health, Monash Toxicology Unit, Emergency Service, Dandenong Hospital, Dandenong, Victoria, Australia; Monash University, Department of Medicine, Clinical Sciences at Monash Health, FMNHS.
¹² Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia; Monash University, Monash Addiction Research Centre, Frankston, Victoria, Australia.

PMID: 37944339
DOI: 10.1016/j.drugpo.2023.104245

Abstract

Introduction: The emergence of benzodiazepine-type new psychoactive substances (NPSs) are a growing international public health concern, with increasing detections in drug seizures and clinical and coronial casework. This study describes the patterns and nature of benzodiazepine-type NPS detections extracted from the Emerging Drugs Network of Australia - Victoria (EDNAV) project, to better characterise benzodiazepine-type NPS exposures within an Australian context.

Methods: EDNAV is a state-wide illicit drug toxicosurveillance project collecting data from patients presenting to an emergency department with illicit drug-related toxicity. Patient blood samples were screened for illicit, pharmaceutical and NPSs utilising liquid chromatography-tandem mass spectrometry. Demographic, clinical, and analytical data was extracted from the centralised registry for cases with an analytical confirmation of a benzodiazepine-type NPS(s) between September 2020-August 2022.

Results: A benzodiazepine-type NPS was detected in 16.5 % of the EDNAV cohort (n = 183/1112). Benzodiazepine-type NPS positive patients were predominately male (69.4 %, n = 127), with a median age of 24 (range 16-68) years. Twelve different benzodiazepine-type NPSs were detected over the two-year period, most commonly clonazolam (n = 82, 44.8 %), etizolam (n = 62, 33.9 %), clobromazolam (n = 43, 23.5 %), flualprazolam (n = 42, 23.0 %), and phenazepam (n = 31, 16.9 %). Two or more benzodiazepine-type NPSs were detected in 47.0 % of benzodiazepine-type NPS positive patients. No patient referenced the use of a benzodiazepine-type NPS by name or reported the possibility of heterogenous product content.

Conclusion: Non-prescription benzodiazepine use may be an emerging concern in Australia, particularly amongst young males. The large variety of benzodiazepine-type NPS combinations suggest that consumers may not be aware of product heterogeneity upon purchase or use. Continued monitoring efforts are paramount to inform harm reduction opportunities.

Keywords: Benzodiazepine-type NPS; Early warning system; NPS; Toxicosurveillance.

MeSH terms

Adolescent
Adult
Aged
Benzodiazepines / adverse effects
Humans
Illicit Drugs*
Male
Middle Aged
Psychotropic Drugs / adverse effects
Substance Abuse Detection / methods
Substance-Related Disorders* / epidemiology
Victoria / epidemiology
Young Adult

Substances

Psychotropic Drugs
Illicit Drugs
Benzodiazepines