EU Drug Market: New psychoactive substances — Distribution and supply in Europe: Benzodiazepines

This resource is part of EU Drug Market: New psychoactive substances — In-depth analysis by the EMCDDA and Europol.

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Last update: 27 June 2024

Background

First developed in the 1950s, benzodiazepines such as diazepam (Valium) and alprazolam (Xanax) are one of the most important groups of medicines that specifically produce sedation and sleep (Sternbach, 1978; EMCDDA, 2021b). They are the most widely prescribed group of medicines in the world, and are used to treat anxiety, insomnia, epilepsy and alcohol withdrawal. However, there is a high risk of abuse, and they can rapidly cause tolerance and dependence. This can lead to severe, and sometimes life-threatening, withdrawal symptoms. Because of this public health risk, there are often strict restrictions on prescribing them.

Given the high demand for commonly prescribed benzodiazepines, they are a major target for criminal groups that divert legitimate products from the market, sell unlicensed products or make fake versions of legitimate medicines. In the latter case, this includes using both controlled and new benzodiazepines and, potentially, other unrelated substances. Fake diazepam and alprazolam tablets are particularly common. Information about the market for new benzodiazepines in Europe, including supply chains, is limited. However, an important source of fake medicines containing these substances appears to be vendors on darknet markets and the surface web.

Many new benzodiazepines are potent substances (EMCDDA, 2021b; El Balkhi, 2020). The dose used in fake medicines can also be significantly higher than those used in legitimate licensed medicines. Increasingly, new benzodiazepines are involved in acute poisonings and deaths, particularly in parts of northern Europe (Essink et al., 2022; Kriikku et al., 2020; Rice et al., 2021), where many of the deaths linked to new benzodiazepines involve high-risk drug users who also use opioids and other central nervous system depressants (Kriikku et al., 2020; Rice et al., 2021; McAuley, 2022). Of note, the imposition of restrictions on prescribing benzodiazepine medicines over concerns of their abuse has been associated with an increase in the availability and use of new benzodiazepines in some places, including Scotland (the United Kingdom) and the United States (McAuley, 2022).

New benzodiazepines are also sold as substances in their own right for recreational use, to enhance or prolong the effects of other drugs (such as opioids), and to self-medicate (EMCDDA, 2021b). In a similar way to synthetic cannabinoids, new benzodiazepines infused into paper and clothing can be smuggled into prisons, and cases have been reported in the United Kingdom. This poses a high risk of overdose and, given the popularity of benzodiazepines in prisons in Europe, requires active surveillance (Daly, 2022; Ford et al., 2018).

Production

Most bulk quantities of new benzodiazepines are sourced from China as powders. To a lesser degree, etizolam tablets are sourced from India. In Europe, the powders are typically made into tablets, including fake diazepam and alprazolam tablets (EMCDDA and Europol, 2019).

Situation

As of 31 December 2023, the EMCDDA was monitoring 36 new benzodiazepines, including one that was reported in 2023 (see Figure Number of new benzodiazepines reported for the first time in Europe, European Union, 2005-2023).

In 2022, 752 seizures of new benzodiazepines were reported to the EU Early Warning System by the Member States, representing around 3 % of the total number of seizures of new psychoactive substances, similar to the number of seizures of new opioids. This amounted to approximately 4.2 kilograms of material, 70 617 tablets and capsules, and 17.3 litres of liquids (see Figures Seizures of new benzodiazepines reported to the EU Early Warning System: trends in number of seizures and number of tablets and capsules seized, European Union, 2005-2022).

Despite the relatively large number of new benzodiazepines appearing in Europe, in 2022 the market continued to be dominated by a small number of substances (see Figures Seizures of new benzodiazepines reported to the EU Early Warning System: number of seizures, quantity of material seized for all forms reported in weight and quantity of tablets and capsules, European Union, 2022).

The number of new benzodiazepines seizures and the quantity seized vary between countries in Europe, with most of seizures taking place in northern Europe (see Figures Seizures of new benzodiazepines reported to the EU Early Warning System by country: numbers of seizures, quantity of material seized for all forms reported in weight, and quantity of tablets and capsules, European Union, 2022).

Following the international control of etizolam and flualprazolam, which came into force in November 2020 (CND, 2020a, b), producers and distributors appeared to switch to other new benzodiazepines, such as flubromazolam, clonazolam and bromazolam. Subsequently, flubromazolam and clonazolam were internationally controlled in 2021 (CND, 2021b, c). As a result, it is likely that these substances will be replaced by others, such as bromazolam, as countries, particularly producer countries, implement control measures. In 2023, there were signs in both Europe and the United States of an increase in detections of bromazolam (CFSRE, 2022; Drug Enforcement Administration, 2022).

Source data

All of the source data used in graphics and data tables may be found in our Data catalogue.

References

Consult the list of references used in this module.