Concern: Cocaine-related harms and increasing reports of crack cocaine use

Drug: Cocaine. A short-lasting stimulant drug.

Legal status: In the UK, cocaine is classified as a Class A drug under the Misuse of Drugs Act (1971).

Summary

• Cocaine and adverse effects associated with cocaine were the most common type of drug report for a specific substance to RADAR.
• Reports relate to the use of both cocaine powder and crack cocaine (two different forms of the same drug).
• Physical health harms described in reports included heart problems, respiratory issues, soft-tissue damage and rashes.
• Mental health harms described in reports included anxiety, depression and psychosis.

Further information

• Cocaine powder is a white, crystalline powder that is typically snorted, while crack cocaine is a rock-like substance that is typically smoked.
• When a drug is smoked, the effects are felt more quickly and are more intense and short-lived, than when snorted.
• Injecting cocaine increases risk and is linked to more harmful effects.

Concern: Benzodiazepine-related harms and increasing use of bromazolam

Drug: Bromazolam. A benzodiazepine, similar in structure to alprazolam. Benzodiazepines are a group of depressant drugs with sedative and anxiolytic (anti-anxiety) effects.

Legal status: In the UK, many benzodiazepines (including bromazolam) are classified as Class C drugs under the Misuse of Drugs Act (1971).

Summary

• Multiple reports submitted to RADAR related to ‘street benzos’. In particular, unexpected effects from drugs sold as diazepam and an increase in the availability of bromazolam.
• This is supported by toxicology data that shows a decrease in detections of etizolam and an increase in detections of bromazolam (and other novel benzodiazepines such as bromazepam, flubromazepam and gidazepam).
• Adverse benzodiazepine effects described in reports include drowsiness, confusion, memory problems and black-outs, impaired coordination and unconsciousness.

Further information

• The decrease in etizolam may be due to international control. In 2021, etizolam and alprazolam were controlled under the United Nations Convention on Psychotropic Substances (1971), increasing regulations on production and distribution. The increase in bromazolam detections may be due to its availability and its potential to be used as a substitute.
• As bromazolam is not licensed for medical use, all bromazolam is illicitly manufactured. It is common for bromazolam to be mis-sold as another drug (such as diazepam or etizolam) or contain unpredictable concentrations in each pill, increasing the likelihood of adverse reactions and overdose.
• Mixing benzodiazepines with other depressants, such as alcohol, gabapentinoids or opioids, can increase the risk of overdose and respiratory depression.

Concern: Counterfeit pregabalin linked to adverse effects

Drug: Pregabalin. A gabapentinoid drug with depressant effects. It can be prescribed as a medicine to treat epilepsy and nerve pain.

Legal status: In the UK, pregabalin is classified as a Class C drug under the Misuse of Drugs Act (1971).

Summary

• RADAR has received an increase in reports related to the use of non-prescribed pregabalin. We also received an alert on ‘capsules sold as pregabalin’ released by police in West Yorkshire. This was shared with the network for information. To receive future alerts, sign-up to the network.
• Reports described physical effects including dizziness, drowsiness and unconsciousness.
• Reports described psychological effects including confusion and memory problems.
• Although many reports of ‘fake drugs’ in the last quarter were linked to pregabalin, the trend of counterfeit or fake medicines extends beyond gabapentinoids with fake opioids and benzodiazepines also reported.

Further information

• Mixing pregabalin with other depressants such as alcohol, benzodiazepines or opioids, can increase the risk of overdose and respiratory depression.
• Illicitly manufactured drugs carry additional risks, as it may be contaminated with other substances or have unpredictable potency levels, increasing the likelihood of adverse reactions and overdose.
• Counterfeit pills can be designed to look identical to the real medication, but there are some potential signs that may indicate that a pill is fake, including differences in colour, size and shape compared to the real medication.
• The packaging may be made from lower-quality materials, have spelling or grammatical errors, or lack information such as dosage instructions, expiry dates, serial numbers and tamper-proof seals. Pills purchased from illegitimate sources or online marketplaces may be more likely to be counterfeit.

Concern: Nitazenes increasing in availability and detected in overdoses and deaths in Scotland

Drug: Nitazenes. A group of potent synthetic opioids.

Legal status: In the UK, clonitazene and etonitazene are classified as Class A drugs under the Misuse of Drugs Act (1971). In February 2023, the UK government announced 10 other nitazenes will soon be controlled as Class A drugs.

Summary

• Reports to RADAR indicate an increase in the availability of a new group of drugs called nitazenes, including N-pyrrolidino-etonitazene (etonitazepyne or NPE), metonitazene and protonitazene.

Further information

• Due to their unexpected presence in the drug supply and high potency, nitazenes pose a substantial risk of overdose, drug-related hospitalisation and drug-related death.
• A public health alert on ‘nitazene-type opioids in Scotland’ was published on 24 January 2023 and updated on 29 March 2023.

Report 1

Local authority: National

Reason for report: Adverse effects

Drug: Crack cocaine

Appearance: Unknown

Summary: Original report from Grampian but also similar reports from Glasgow, Fife and Dundee. Adverse effects from crack cocaine – skin irritation and rash on face, neck and body, particularly around the eyes and groin.

Report 2

Local authority: National

Reason for report: Alert

Drug: Pregabalin

Appearance: Red and white capsules with ‘signature’ branding

Summary: Alert from West Yorkshire police released after pregabalin capsules were suspected to be linked to multiple overdoses and hospitalisations.

Report 3

Local authority: Fife

Reason for report: Adverse effects

Drug: Crack cocaine

Appearance: Yellow crystal or rock, spongey in texture

Summary: Reports of adverse effects after smoking a ‘very small amount’ of crack, sold as ‘synthetic crack’ – chest pains, confusion, hallucinations, overheating, pale skin, panic, paranoia and slurred speech.

Report 4

Local authority: Edinburgh

Reason for report: Adverse effects

Drug: Pregabalin

Appearance: Unknown

Summary: Pregabalin (thought to be fake) reported to be very strong and causing seizures in seasoned users.

Report 5

Local authority: Edinburgh

Reason for report: New drug, adverse effects

Drug: Diazepam     

Appearance: Pill stamped with ‘KB10’

Summary: Drug sold as diazepam or Valium suspected to be involved in deaths.

Report 6

Local authority: Stirling, Falkirk

Reason for report: New drug, adverse effects

Drug: Diazepam     

Appearance: White, hexagonal pill

Summary: Separate patients reporting the presence of a white hexagonal ‘Valium’ referred to as ‘hulk’, causing adverse effects – days of black-out, no recall of previous day(s’) events and loss of consciousness. Reported as stronger than any other Valium they have previously ingested. Purchased as loose pills from a dealer in Glasgow.

Report 7

Local authority: East Lothian

Reason for report: Adverse effects

Drug: Diazepam     

Appearance: White pill, stamped with letter 'Y' on tablet, small (similar to size of contraceptive pill)

Summary: Adverse effects after swallowing pills thought to be diazepam - unable to recall events (losing days), decreased energy and drowsiness. Purchased as loose pills for £1 per pill.

Report 8

Local authority: Edinburgh

Reason for report: Adverse effects

Drug: Crack cocaine

Appearance: Yellow rocks

Summary: Low priced, yellow crack cocaine causing serious side effects.

Report 9

Local authority: East Lothian

Reason for report: New trend, adverse effects

Drug: Codeine

Appearance: Unknown

Summary: Reports of young people drinking cough mixture with crushed up codeine.

Report 10

Local authority: Fife

Reason for report: New trend – changing drugs market

Drug: Diazepam

Appearance: Unknown

Summary: Use of online marketplaces to purchase drugs with buying incentives such as discounts and a range of payment options, including the use of bank transfers and cryptocurrencies.

Report 11

Local authority: Edinburgh

Reason for report: Adverse effects

Drug: Valium

Appearance: Unknown

Summary: Strong pills, sold as ‘Valium’, posing risk for inexperienced users, particularly in the homeless population.

Report 12

Local authority: Fife

Reason for report: New trend

Drug: Ketamine and cocaine

Appearance: White powder

Summary: Use of 'kit-kat' or ‘CK’ – ketamine along with cocaine or crack cocaine. Reports of snorting, injecting and swallowing. First reports a few years ago in homeless sector but now mainly younger people.

Report 13

Local authority: Edinburgh

Reason for report: New trend

Drug: Heroin

Appearance: Unknown

Summary: Heroin, referred to as ‘scab’ reported as being available. Strength reported as a concern for inexperienced users.

Report 14

Local authority: Edinburgh

Reason for report: New trend

Drug: Synthetic cannabinoids

Appearance: Unknown

Summary: Adverse effects (unknown) of synthetic cannabinoids suspected to be cut with opioids.

Report 15

Local authority: Edinburgh

Reason for report: New trend, adverse effects

Drug: Various

Appearance: Unknown

Summary: Adverse effects (unknown) related to fake Valium, Xanax (alprazolam) and pregabalin.

Report 16

Local authority: Ayrshire and Arran

Reason for report: New trend, adverse effects

Drug: Bromazolam

Appearance: White crystalline powder

Summary: Reports of adverse effects after swallowing bromazolam powder.

Report 17

Local authority: Glasgow

Reason for report: Adverse effects

Drug: Pregabalin, polydrug use

Appearance: Red and white capsules with ‘signature’ branding

Summary: Cluster of near-fatal overdoses. Those affected reported the use of multiple substances including alcohol, cocaine, benzodiazepines, gabapentin, opioid substitution therapy drugs and pregabalin. Several (not all) reported the use of pregabalin matching the alert – see national report 2.

Report 18

Local authority: Dumfries and Galloway

Reason for report: New drug

Drug: Pregabalin

Appearance: Red and white capsules with ‘signature’ branding

Summary: Reports of pregabalin use in the region.

Report 19

Local authority: Aberdeen City, Aberdeenshire and Moray

Reason for report: Adverse effects

Drug: Unknown, injecting

Appearance: Unknown

Summary: Slightly higher than average reports of bacterial infections in people who inject drugs.

Report 20

Local authority: Aberdeen

Reason for report: New drug, adverse effects

Drug: Pregabalin

Appearance: Red and white capsules with ‘signature’ branding

Summary: Drug service clients reporting use of illicit pregabalin called ‘signature’.

Report 21

Local authority: Highland

Reason for report: Adverse effects, suspected death

Drug: Pregabalin

Appearance: Red and white capsules with ‘signature’ branding

Summary: Capsules, thought to be pregabalin, found at the scene of a death where polydrug use suspected to be involved.

Report 22

Local authority: Aberdeen

Reason for report: Adverse effects

Drug: Pregabalin    

Appearance: Red and white capsules with ‘signature’ branding

Summary: Adverse effects after swallowing four capsules – over-sedated (passed out for 13 hours), overdose, loss of consciousness, memory loss, confusion, low mood, physical injury and unusual behaviour. Purchased in blister packet from street dealer.

Report 23

Local authority: Aberdeen

Reason for report: Adverse effects

Drug: Crack cocaine

Appearance: Unknown

Summary: Significant concerns related to crack cocaine. Adverse effects in multiple clients – memory problems, paranoia, psychosis and unusual behaviour. Reported to be due to a change in the way crack cocaine is cut. Some clients report crack cut with mephedrone (referred to as ‘magic’ and ‘crunch’).