Misuse of benzodiazepines. Specify the formulation when prescribing.

EDITOR, - John Strang and colleagues comment that doctors who prescribe benzodiazepines to injecting drug users should consider the likelihood of the drugs being injected, given the degree of misuse of benzodiazepines among this population.1 We agree that there is a considerable problem and estimate the prevalence of use of benzodiazepines by injecting drug users entering treatment at Liverpool Drug Dependency Clinic to be 44% based on a random sample of 100 (M Shaw et al, unpublished findings). We would go further and advocate care in prescribing benzodiazepines to all patients. A study in Liverpool of 23 people who misused temazepam intravenously showed that most obtained their supply from sources other than their general practitioner.2 They most commonly obtained temazepam off the street (18 users) or from friends (13) (there was some overlap in means of supply). To have maximal impact on reducing the prevalence of injection of temazepam and other benzodiazepines, we suggest a dual approach. We agree that a change in the regulations governing prescribing is needed to limit the general availability of temazepam capsules, the formulation most susceptible to intravenous misuse. Prescribers may not be aware that capsules may be routinely dispensed unless the prescription states the required formulation. Our clinical impression, based on experience of dealing with dispensaries in the Liverpool area, is that up to half may prescribe temazepam capsules …