Rapid Action Drug Alerts and Response (RADAR) quarterly report
October 2023
A Management Information Statistics publication for Scotland
- Published
- 24 October 2023
- Type
- Statistical report
- Author
- Public Health Scotland
Trends
Police drug trends bulletin
This bulletin contains photos of drugs.
This update provides information on detections of street benzodiazepines and new synthetic opioids.
This information has been provided by Police Scotland’s Statement of Opinion (STOP) Unit to raise awareness of drug appearance and to demonstrate some of the substances present in Scotland’s drugs market.
Street benzos
'Street benzos' is a term used to describe benzodiazepines that are unlicensed or illicitly produced.
The most commonly encountered street benzo is white and stamped '10', with a half score on the reverse.
Historically, the most commonly detected active ingredient contained within street benzodiazepine tablets was etizolam. Etizolam still features highly, but the trend has shifted with bromazolam now found to feature in the majority of tablets sent for analysis.
Bromazolam is a class C controlled drug within the provisions of the Misuse of Drugs Act 1971.
Police Scotland has also noticed the re-emergence of 'baby blues' – small, circular, light blue tablets stamped with 'MSJ', as per the image below.
Street benzodiazepines will continue to be monitored via Operation Borzoi and any new tablet markings identified will be captured for circulation.
New synthetic opioids
The above was provided to the STOP Unit West via the Scottish Police Authority Forensics Services laboratory. These are paper tabs which were found to contain metonitazene.
Metonitazene is a potent new synthetic opioid (NSO). The supply and importation of metonitazene is controlled by the Psychoactive Substances Act 2016, but it will soon be a class A controlled drug within the provisions of the Misuse of Drugs Act 1971.
The person in possession of these tabs believed them to contain etizolam (benzodiazepine) and was unaware of the presence of metonitazene. This is the first time the STOP Unit have encountered metonitazene in this form.
RADAR intelligence and reports
36 reports were validated by RADAR between 5 July and 4 October 2023. A summary of reports is shown below for information.
Trends by primary drug type
The majority of submissions report polydrug use – the use of more than one substance at a time.
In the latest time period (5 July to 4 October 2023):
- Benzodiazepines were the most commonly reported drug of concern in 33% of reports. This was similar to the 35% quarterly average reported between July 2022 and June 2023.
- Cocaine was reported as the primary drug in 14% of reports, a decrease on the 22% average between July 2022 and June 2023.
- Heroin was reported as the primary drug in 14% of reports, an increase on the 3% average between July 2022 and June 2023.
- There was an increase in reports of nitazenes in Scotland and across the wider UK during this quarter, to 14%, up from an average of 4% between July 2022 and June 2023.
Drug harm reports to RADAR
Shown below are 36 reports of drug harms received by RADAR between 5 July and 4 October 2023.
Please note, many of these reports have not been confirmed by toxicology and should be considered anecdotal.
So far, RADAR has validated over 120 reports of drug-related information and harms received through the reporting form and mailbox. Reports validated prior to 5 July 2023 are shown in previous quarterly reports.
Report 2
Local authority: National (UK)
Reason for report: Deaths
Drug: Nitazenes
Appearance: Various
Summary: Alert issued on 26 July, due to an elevated number of overdoses (and deaths) in people who use drugs, primarily heroin, in many parts of the UK. In some of these cases, nitazenes have been detected including, isotonitazene, metonitazene, N-pyrrolidino etonitazene (etonitazepyne) and N-desethyl isotonitazene. Concerned that nitazenes have been detected in drugs sold as heroin and oxycodone, and (less commonly) benzodiazepines and synthetic cannabinoids. Read the alert here.
Report 3
Local authority: National (Northern Ireland)
Reason for report: Overdoses
Drug: Nitazenes
Appearance: Yellow tablets
Summary: Alert issued after overdoses and deaths linked to metonitazene.
Report 11
Local authority: National (UK)
Reason for report: New drug
Drug: Nitazenes
Appearance: Unknown
Summary: UK-wide reports of increased overdose and deaths. Areas particularly affected include the West Midlands, Merseyside, Northern Ireland and Wales.
Report 1
Local authority: Midlothian
Reason for report: Deaths
Drug: Street benzos
Appearance: Tablets, crushed tablets and powder
Summary: Multiple suspected drug deaths. Reports mention use of potent benzos, in the form of tablets and powder. A sample of one of the drugs suspected to be involved was sent to WEDINOS for testing – confirmed as bromazolam.
Report 4
Local authority: West Lothian
Reason for report: Adverse effects
Drug: Heroin
Appearance: Black powder, grainy
Summary: Patient reports heroin was 'really strong', almost black in colour and unlike anything they've seen before. Used a whole sachet of VitC (ascorbic acid) to break down 0.2 grams of heroin. Adverse effects after injecting: immediate collapse, difficulty breathing and loss of consciousness.
Report 7
Local authority: Fife
Reason for report: Concern
Drug: Benzos
Appearance: Tablets
Summary: Benzodiazepine tablets advertised for sale on social media – found to contain clonazolam.
Report 8
Local authority: City of Edinburgh
Reason for report: Death
Drug: Protonitazene
Appearance: Unknown
Summary: Suspected drug death of person who reported they were buying protonitazene, pregabalin and diazepam online.
Report 10
Local authority: City of Edinburgh
Reason for report: Adverse effects
Drug: Cocaine
Appearance: Unknown
Summary: Increase in patients presenting with more severe injecting-related infections, as a consequence of injecting cocaine. Patients require longer admissions (several weeks, sometimes months). A rise in discitis (spine disc infection) has also been recorded.
Report 12
Local authority: City of Edinburgh
Reason for report: Adverse effects
Drug: Street benzos
Appearance: Unknown
Summary: Street Valium reported to be stronger than usual and involved in overdose. Unclear of pattern of use but it is believed that six tablets are enough to cause an overdose.
Report 15
Local authority: Scottish Borders
Reason for report: Trend
Drug: Street benzos
Appearance: White rectangular bar
Summary: Street benzos, sold as 'Xanax'. Sold as loose oblong bars stamped with 'XANAX'. Tested by WEDINOS – found to contain bromazolam. Adverse effects: confusion.
Report 16
Local authority: Scottish Borders
Reason for report: Trend
Drug: Street benzos
Appearance: White circular pill, half score on one side
Summary: Street benzo sold as loose pills. Tested by WEDINOS – found to contain lorazepam.
Report 18
Local authority: City of Edinburgh
Reason for report: Trend
Drug: MDMA
Appearance: Unknown
Summary: Report of reduced availability of MDMA powder in Lothians.
Report 19
Local authority: City of Edinburgh
Reason for report: Concern
Drug: Ecstasy
Appearance: Bright yellow pill, hard pressed with Bitcoin symbol
Summary: Reports of pills being promoted and sold via Telegram app. Concerned that amid a shortage of MDMA powder, pills may contain cathinones such as 4-CMC. A warning was issued in February 2023 in Greater Manchester, after Bitcoin pills were found to be 'variable' and contain MDMA, 4-CMC and caffeine – sometimes alone, sometimes in combination.
Report 21
Local authority: City of Edinburgh
Reason for report: Adverse effects, overdose
Drug: Cocaine
Appearance: Unknown
Summary: Multiple overdoses resulting in very unwell patients related to cocaine use. Overdoses were geographically widespread. Presentations included: seizures and cardiac arrest.
Report 22
Local authority: Falkirk
Reason for report: Adverse effects
Drug: Benzos
Appearance: White tablets
Summary: Increase in hospital presentations after taking benzos in the community. Loose pills with no markings sold as street Valium by street dealers. Patients overdosed after swallowing half of the number of pills they would usually consume. Adverse effects include: memory loss, loss of consciousness and renal failure.
Report 24
Local authority: Fife
Reason for report: Deaths
Drug: Ketamine
Appearance: Unknown
Summary: Multiple suspected drug deaths in people aged under 25. No obvious link. Reports mention ketamine, alcohol and MDMA.
Report 27
Local authority: Various (Clackmannanshire, Falkirk, Stirling, Midlothian, West Lothian)
Reason for report: New trend
Drug: Bromazolam
Appearance: Pinkish brown powder
Summary: Pink coloured powder sold as bromazolam for injecting. Sold in £10 bags – similar in size to usual tenner bag of heroin (0.2 grams). Linked to overdoses and adverse effects including: aggression or violence, amnesia, anxiety or panic, depression or low mood, difficulty breathing, injury, loss of consciousness, unusual behaviours and wounds.
Report 28
Local authority: City of Edinburgh
Reason for report: Adverse effects
Drug: Benzos
Appearance: Blue tablets, stamped 'MSJ'
Summary: Tablets sold as 'Valium' but with different and unexpected non-specified adverse effects. Shades of blue varied throughout batch – believed to be dyed with food colouring. Pills described as being smaller than standard benzos and inscribed with 'MSJ' on one side. Report mentions people swallowing eight or nine tablets.
Report 32
Local authority: Fife
Reason for report: Death
Drug: Unknown
Appearance: Unknown
Summary: Suspected drug death of a person aged under 25.
Report 34
Local authority: West Lothian
Reason for report: Adverse effects, overdose
Drug: Unknown
Appearance: Unknown
Summary: Individuals aged under 25, hospitalised with unspecified symptoms.
Report 35
Local authority: Fife and Tayside
Reason for report: Concern, trend
Drug: Ketamine
Appearance: Unknown
Summary: Concern over numbers of young people using ketamine.
Report 13
Local authority: West Scotland
Reason for report: Overdose
Drug: Cannabis edible
Appearance: Chocolate bar in 'Freddo'-like wrapper
Summary: Overdose after accidental ingestion.
Report 14
Local authority: North Lanarkshire, Glasgow City
Reason for report: Deaths
Drug: Unknown
Appearance: Unknown
Summary: Suspected drug deaths and increase in harms in people aged under 25.
Report 20
Local authority: Lanarkshire
Reason for report: Adverse effects, death
Drug: Cocaine
Appearance: Unknown
Summary: Death suspected to be related to cocaine use. Presented to hospital with serotonin syndrome-type symptoms, seizures, agitation and overheating.
Report 25
Local authority: Renfrewshire
Reason for report: New trend
Drug: Cocaine
Appearance: Unknown
Summary: Service reporting strong cocaine in circulation, estimated to be about 'twice as strong as usual prop' (high purity cocaine). Sold for the same price for the same quantity as usual – 0.2 grams sold for £20. This is usually enough for a short hit (20-30 mins) but now able to be used for multiple doses when injecting or smoking and the effects are lasting twice as long. Easy to take too much and overdose – effects were immediate and intense.
Report 26
Local authority: Renfrewshire, Glasgow City
Reason for report: Deaths
Drug: Various
Appearance: Unknown
Summary: Multiple suspected drug deaths. Reports mention cocaine alongside alcohol, heroin and benzos. Report also highlights possible seasonality in overdoses as they also spiked in August 2022.
Report 29
Local authority: Glasgow City
Reason for report: Adverse effects, new drug
Drug: Benzos, heroin
Appearance: Unknown
Summary: Increase in presentation of tissue necrosis in individuals with no evidence of recent substance injection – individuals report exclusive consumption of street benzos (swallowed) or heroin (smoked). Difficulty reversing overdose presentation with naloxone – suspected synthetic opioid or xylazine involvement. Adverse effects include: anxiety or panic, difficulty breathing, loss of consciousness, pinpoint pupils and wounds.
Report 30
Local authority: Glasgow City
Reason for report: Adverse effects, overdose
Drug: Street benzos
Appearance: Unknown
Summary: Increase in overdoses observed in homeless service. Mainly related to street benzos (but in context of polydrug use). On average, reports mention consuming 5 to 14 pills. There has been a change in the overdose presentations in recent months including:
- more intensive emergency care required – cardiopulmonary resuscitation (CPR), oxygen, intubation
- increased vomiting and aspiration of vomit
- vitals and responses fluctuating from normal to low, and back again
- breathing more unusual – longer time between breaths
- more pressure needed on pressure points to get responses
- drifting in and out of consciousness – more difficult to keep them conscious
- more naloxone required and going back into overdose after naloxone is administered
- after effects last longer (tired, grouchy, just not 100%)
- not making sense when speaking, plus other unusual effects – hallucinations and psychosis.
Report 33
Local authority: Argyll and Bute
Reason for report: Trend
Drug: Nitazenes, street benzos
Appearance: White circular pill
Summary: Street benzo sold as diazepam in blister packs labelled Bensedin. Tested by WEDINOS – found to contain bromazolam and metonitazene.
Report 5
Local authority: Highland
Reason for report: Concern, adverse effects
Drug: Heroin, benzos
Appearance: Unknown
Summary: Reports of increased overdoses and harms from police custody and hospital emergency departments, potentially related to benzodiazepines and heroin. Concerned that drugs are contaminated with opioids like fentanyl, but not confirmed by testing.
Report 6
Local authority: Shetland Islands
Reason for report: Overdose
Drug: Heroin
Appearance: Unknown
Summary: Multiple overdoses suspected to be related to heroin.
Report 9
Local authority: Aberdeen City
Reason for report: Deaths
Drug: Heroin
Appearance: Unknown
Summary: Multiple suspected drug deaths. No obvious links. Reports mention tablets and injecting drug use – heroin.
Report 17
Local authority: Shetland Islands
Reason for report: Adverse effects
Drug: Street benzos
Appearance: Unknown
Summary: Reports of adverse effects from the use of 'fake Valium'.
Report 23
Local authority: Aberdeen City
Reason for report: Deaths
Drug: Various
Appearance: Unknown
Summary: Multiple suspected drug deaths. No obvious link. Reports mention crack cocaine, oxycontin, pregabalin and prescription medicines.
Report 31
Local authority: Aberdeenshire
Reason for report: Adverse effects, overdoses
Drug: Various
Appearance: Unknown
Summary: Multiple suspected drug deaths. No obvious links. Reports mention polydrug use – heroin, methadone, crack cocaine, dihydrocodeine, Valium and other street-bought tablets.
Report 36
Local authority: Aberdeen City
Reason for report: Deaths
Drug: Various
Appearance: Unknown
Summary: Multiple suspected drug deaths of people aged under 25. Reports mention cocaine, alcohol and pink pills.
Reporting drug harms
The information in the regional breakdown can be used by local areas for their own drug-trend surveillance. Please encourage people and services in your area to share information on trends, incidents and harms related to drugs, such as:
- adverse effects including overdose
- routes of administration
- new substances or patterns of use
- testing data.
Anyone can make a report by using our reporting form or by emailing phs.drugsradar@phs.scot