Diazepam Is Killing Scotland's Drug-Using Poor

Photos by Harrison Reid

I meet Jack and his friends in a dank bar near Cowgate Street in Edinburgh, Scotland, on a filthy gray evening in February. Strewn with broken glass and smattered with the acrid remnants of stomach bile, red cabbage, and whatever else made up that particular meal before it found its way onto the street, this delightful area of Edinburgh is known to locals as "the Street of Shame." That's maybe because, despite being very pleasant during the day, come evening it's flooded with hordes of drunken jocks, bedraggled students in fancy clothes, and cackling bachelorette parties, all of whom swarm toward the cheap bars on this side of the city, leaving pools of vomit in their wake.

Jack begins by telling me about the evils of methadone and the legend of how it came to Britain, care of German chemists, American soldiers, and Adolf Hitler himself. In the last days of the Second World War, Hitler relied on amphetamines to stay awake and, according to urban legend, then took methadone to help him sleep. Jack explains that there's an anagram hidden in the word methadone: "the mad one." We both laugh. Then we search for anagrams in the word Valium, but there are none. After methadone, Valium is the drug that is killing Scotland. In 2011 it contributed to or was responsible for 32 percent of the country's drug-related deaths.

When Valium, or diazepam as it's also known, turned 40, drug manufacturer Hoffmann-La Roche held a celebration where they unfurled a banner that read, "Thanks for the happiness and relaxation you have given us over the years." Clearly, that banner could have made even a seasoned drug lobbyist wince, so for opponents, it was more than a little crass. However, there was no party for Valium’s 50th, which passed, unacknowledged, at the beginning of 2013.

Thanks to "Mother's Little Helper" and the majority of late-20th-century American fiction, many of us have been left with the mistaken belief that Valium is the preserve of the clinically bored, middle-aged housewife, when really the drug is killing Scotland's poorest men. It has been detected in the bodies of 72 percent of all victims of drug-related death.

Jack can attest to Valium’s power—he's been addicted to it for 19 years and took 28 pills before meeting me. While he concedes that they were "whites" (the lower strength two milligram tablets, as opposed to the stronger "blues"), that amount is still more than nine times the effective daily dose for anxiety, but Jack shows few signs of diminished alertness. This is partly because his tolerance to the drug has ballooned over the decades, but also because one of Valium’s dangers lies in the fact that some users show few signs of intoxication, despite having consumed enormous amounts. Jack tells an anecdote to illustrate.

“This guy took a handful of Valium and went out to rob a couple of houses. While he was out, he went into someone’s kitchen and there was a half-eaten takeout pizza in the fridge. He got a plate, sat down at this comfy seat, and started eating. Everything he had to steal was piled at the door, ready to walk out with. Suddenly, it was the morning. The police stormed into the house, screaming 'Wake up! Wake up!' They caught him red-handed, and that’s dead, gospel truth. People made fun of him for years and years and years. He never lived it down. Imagine him in jail: 'What are you in for?' 'Well…'”

Unfortunately, this was one of the only moments of levity in a series of sad, disturbing anecdotes about the drug. Jack feels it has ruined his cognition and permanently affected his memory, a side effect Professor Malcolm Lader highlighted in 1982 in evidence presented to the Medical Research Council that demonstrated brain shrinkage in long-term users similar to that experienced by acute alcoholics. As a result of those warnings being ignored, Jack has now been prescribed Valium for 19 years, which equates exactly half of his life.

Professor Lader has called Valium, and benzodiazepines, the family of drugs Valium belongs to, "the biggest medically induced problem of the late 20th century." But when we spoke, he was keen to point out that doctors, for the most part, have cut prescribing rates. Unfortunately, the Scottish police and prison service are still struggling to cope with the result of the drug’s popularity.

“If someone’s got no tolerance to Valium, and they take five blues, they could be your best friend but then suddenly think you’re their worst enemy,” Jack warns. “They’ll end up stabbing you by the end of the night.”

Valium is a tranquilizer and is often still prescribed for that reason, but it can actually have the opposite effect on some. When mixed with alcohol, the result can be a horrible extreme of violence, coupled with absolutely no memory of what you've done. Which doesn't, of course, sound that tranquil. Services ranging from charities to the prison service warn of this phenomenon and ex-prisoners report, anecdotally, that it was an exception rather than a rule to meet someone serving a life sentence who hadn’t mixed Valium with alcohol at the time of their crime.

Statistics from the Criminal Justice System show in no uncertain terms that the perpetrator of a murder is more likely to be obliterated on Valium than cranked up on crack cocaine, which is only one of many reasons why it seems a little odd that Valium enjoys the light sanctions afforded to Class C, Schedule 4 drugs. Wads of repeat prescriptions led to a booming illegal trade in Valium, which has worsened through ease of importation from abroad, as well as crude, domestic manufacture.

Steve, an addiction worker with homeless people in Edinburgh, described a batch of phony Valium he'd come across the previous year.

“It wasn’t Valium, but it looked like Valium, smelled like Valium, and tasted like Valium,” Steve says, describing a scare involving the similar, but cruder, Russian tranquilizer phenazepam. Until last year, the drug was legal to import, linked to serious hospitalizations, and believed by some agencies to be used to mimic blue Valium tablets. “This stuff was like, a hundred times stronger. These guys thought, I can take 20 of these pills no problem, but they weren’t coming down for two weeks. They were walking around in a bubble. It became very, very dangerous for a while.”

After this episode, researchers at Dundee University began screening postmortem blood samples for phenazepam. Over six months, the drug was present in nine deaths. All of the deceased had a previous history of drug use, involving harder drugs like heroin. But that's not exactly surprising; because it's illegal, heroin varies in quality. To allow for this, addicts have long compensated by relying on alcohol and tranquilizers to supplement whatever their substandard horse is lacking. All of the addicts I spoke with referred to a time when Valium and similar drugs were abundant, cheap, or even prescribed, and therefore free. As the NHS has cut supply, some have resorted to drastic measures.

We don’t routinely test for phenazepam, so it’s difficult to know how prominent its role is in drug overdoses or in the faking of Valium, but what’s certain is that the enormous quantities of Valium available for sale on the internet are not all real. Online pharmacies will happily ship to the US, but buyers run the risk of being ripped off. As a result, certain internet forums seem to be ideal environs for those concerned with bulk sales rather than small-scale fraud. One site, easily found using all search engines, features a cast of characters willing to send customers free samples of ten and happy to meet them face-to-face to make the trade. At $50 for 100, they're extremely cheap.

These pills could be dangerous tranquilizers or simply inert placebos—talcum powder stamped in a dodgy pill press. Regardless, they will certainly be blue, and Roche is still a brand of choice. Fifty years after Mother’s Little Helper was born, its curse lives on in Scotland, where it will continue to kill the poorest and most desperate long after it's forgotten by the NHS and reconciled to the drawer by history.

Follow Will on Twitter (@williampnicoll) and see more of Harrison's work here.

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