"I don’t remember most of my 20s, I don’t remember anything," 33-year-old Emma* tells me. We’re standing outside in a London park on a cold November day. The hood of her black padded coat obscures her face and she rubs the pads of her fingers nervously over her hands as she speaks. Occasionally, I notice tears gather in her eyes.
She is now completely clean but for the best part of a decade, Emma was addicted to diazepam (a benzodiazepine also commonly known as Valium) which she bought illegally – but incredibly easily – on the internet without a prescription in order to self-medicate her mental health.
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Exclusive: Seizures of illegal diazepam tablets entering the UK have doubled in a year - up to 1.3 million.
— Victoria Derbyshire (@VictoriaLIVE) December 5, 2019
One woman, 'Emma', told us her addiction had ruined what should have been the best decade her life.https://t.co/yo5GshA03s pic.twitter.com/Intbrq2FPn
Diazepam is commonly prescribed for anxiety, chronic pain, muscle spasms and seizures, and used during alcohol withdrawal. However, it is highly addictive and you can build up a tolerance to it quickly, all of which means doctors will not generally prescribe it for more than four weeks.
Public Health England recently warned that 12 million – that’s one in four – people were being prescribed potentially addictive drugs such as diazepam. They added that the number of people who are potentially addicted to such prescription drugs is unknown.
Some – like Emma – are resorting to buying it online when they can’t (or don’t want to) go to their doctor. An exclusive investigation by the BBC’s Victoria Derbyshire programme has found that Emma is one of a huge number of people turning to rogue online pharmacies and drug dealers to get the drug.
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I don't remember most of my 20s, I don’t remember anything.
Emma, 33
”
According to exclusive data obtained by Victoria Derbyshire from the Medicines and Healthcare products Regulatory Agency (MHRA), the amount of illegal diazepam being bought online and passing through Britain’s postal system on its way to users has increased significantly in recent years. And so, despite the moral panic about Xanax, this has made clamping down on illegal diazepam a priority for the UK Border Force.
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Over the last year, those exclusive figures show Border Force officers have seized more than 1.3 million doses of the drug. That has more than doubled since 2017 when they seized around 545,799 doses coming in from prominent source countries such as Sri Lanka, the Philippines and Singapore.
Emma’s problems began when she was suffering from extreme anxiety in her early 20s. "I went to the doctor crying and wanting to kill myself," she explains slowly. "She gave me some [diazepam] and then I just remember being given these pills and they made it all go away. Within about half an hour I felt good again, I didn’t want to kill myself anymore."
My exclusive report for @VictoriaLIVE - seizures of illegal diazepam entering our postal system after people buy online to self medicate for mental health, chronic pain and comedowns have doubled over a year to 1.3 million. But, some of it is fake and potentially dangerous pic.twitter.com/gmblhdXMnC
— Vicky Spratt (@Victoria_Spratt) December 5, 2019
However, when she went back to the doctor she was refused another prescription. "They told me they wouldn’t prescribe them alongside antidepressants, which I was also taking," Emma explains, "then instead of going to another doctor and explaining the situation I started buying them on the black market."
The 'black market' was not – as you might expect – the deep or dark web but easily accessible rogue online pharmacies and forums on what’s known as the 'clear web' – that’s the section of the internet that you access from any browser and is regularly indexed by big search engines like Google and Yahoo.
And that’s where Emma ran into trouble. At one point, she was spending hundreds of pounds a week online to feed her addiction and taking around 80mg of diazepam every day. To give you some idea of how serious this is, the National Institute for Health and Care Excellence (NICE) recommends 2-15mg daily for adults, which can be increased to 60mg only in situations where people are experiencing uncontrollable spasms.
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The issue of people buying drugs like diazepam illegally online and self-medicating has now become such a widespread problem that the NHS has set up a specialist clinic to deal with it. The Addiction to Online Medicine Service (AtOM) is headed up by Dr Owen Bowden-Jones, a consultant psychiatrist with over 20 years' experience in substance misuse.
As part of the investigation, I visited Owen at AtOM in west London. He told me that he was glad that illegal diazepam was getting press coverage because, until now, it has generally been overlooked despite the fact that the number of related deaths recorded in Scotland has been steadily rising since 2015. In part, he thinks this is because Xanax (which is also a benzodiazepine) is so heavily associated with a particular genre of rap music. Parents feared their children were listening to rappers promoting the drug and fuelled panic; diazepam, meanwhile, has been around longer and is more familiar, and has therefore slipped under the radar.
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People are experiencing high anxiety or severe depression or sometimes chronic pain and they find that these drugs make them feel better and their dose just goes up and up and up.
Dr Owen Bowden-Jones, Addiction to online medicine service
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"The main drug we have seen here is actually diazepam," Owen explains to me in one of the treatment rooms. He thinks the internet has been "a game changer" when it comes to addiction because prescription drugs are easier than ever to access from multiple sources. "People can get them via social media, as well as websites which look like real pharmacies," he explains.
"People are experiencing high anxiety or severe depression or sometimes chronic pain and they find that these drugs make them feel better and their dose just goes up and up and up."
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This is where the real danger lies. When you’re buying any drug online, you don’t really know what you’re getting. The Border Force figures only account for doses of real but illegal diazepam which has been seized as it enters the postal system but it’s also possible that what someone buys is completely fake and contains a placebo or another substance entirely.
“Sometimes I’d pay £100 a day. As a mum, that money should be spent on my children”
— Victoria Derbyshire (@VictoriaLIVE) December 5, 2019
‘Sarah’ was addicted to diazepam – illegally buying it online and from drug dealers on the street
She says she would have lost her children without supporthttps://t.co/sXoooY3xmN pic.twitter.com/c54Tsv9mmO
Owen explains that this can potentially be fatal because "coming off those high doses of diazepam can be more dangerous than heroin withdrawal."
"If people are addicted to it and they stop suddenly then they are at risk of having a seizure and of course that could potentially be life-threatening."
This is something 31-year-old Jasmine knows all about. Like Emma, she bought diazepam online for anxiety throughout her 20s: "I – or anyone – can buy it for about £20 without even having to meet a dealer face to face. It’s almost too easy."
Jasmine started taking diazepam to take the edges off her comedowns after partying at the weekend. "It got to the point where I wouldn’t buy drugs for a big night out without buying the small blue pills. I had absolutely no idea I was becoming addicted to them, though."
At the height of her addiction, she was taking "somewhere between 40 and 60mg a day."
She tells me: "I was taking it at work when things got a bit stressful. I was fully functioning but I was completely addicted. I think they were actually making my anxiety worse, which is why I needed to keep taking them. But when I took it at work, I felt so much better. I could cope with my full inbox, with my overbearing boss and with the constant feeling that I was going to have a panic attack."
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Jasmine is now clean, having gone through recovery. However, this is only because she accidentally bought a batch of fakes from a dodgy website and went into withdrawal, which forced her to confront how serious what she thought was a casual drug habit that helped her anxiety had become.
"I was sweating…I was depressed…I was lying on my sofa crying…couldn’t speak to anybody, couldn’t go out…tried to force myself out of the house at one point and I was seeing things – it was horrendous," she tells me, sitting calmly but visibly upset.
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Coming off high doses of diazepam can be more dangerous than heroin withdrawal.
Dr OWEN-BOWDEN JONES, ADDICTION TO ONLINE MEDICINE SERVICE
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Jasmine sought emergency medical help and was told she was at risk of having a seizure. She attempted to taper her dose and slowly come off diazepam with the supervision of an NHS addiction specialist. However, she says, "it actually took two attempts to get clean."
Both Emma and Jasmine say they wish they’d known just how addictive diazepam is and how great the risks were when they started buying it online. "I think, because you can get it from a doctor there is this idea – even if it’s wrong – that it’s safer than party drugs," Jasmine reflects. "It’s terrifying what it can do, and when you’re in that bubble they dampen down your anxiety so you don’t think about it. When you’re taking them you don’t really care [about the consequences]."
As part of the investigation for Victoria Derbyshire I visited a postal hub where Border Force officers seize packages which they suspect contain illegal drugs. Maggie, an officer who has been working in this area for over 10 years, told me that diazepam – or pills purporting to be it – have been a constant throughout her career.
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As parcels whizz around the room on conveyor belts after being unloaded from lorries which have come straight from the airport, Maggie walks me over to several cages full of parcels.
"I like the look of this one," she says, picking one up and putting it under her arm. In a nearby office with specialist drug testing facilities we put on protective clothing and she sets about opening it up. Thousands of blue pills spill out of plastic containers which have been disguised to look like pots of skin cream.
"We do see smaller batches which are clearly for one person’s use," Maggie explains, "and then we see bigger ones, like this, which may be entering the country with intent to supply." She estimates that the package we have opened contains somewhere "in the region of 8-8,500" tablets.
Maggie has seen it all and I ask if this still shocks her. "Yes," she replies firmly, "the problem is that the pills might not be what we think they are. Recently we’ve been finding illegal diazepam laced with fentanyl, which is worrying."
Fentanyl is a prescription painkiller which is 100 times more potent than morphine. When taken under prescription it is safe but it can be lethal when taken without medical supervision in conjunction with other drugs. The rapper Mac Miller died from an overdose of fentanyl, cocaine and alcohol last year.
We don’t know exactly how many fake (or counterfeit) diazepam pills are floating around but this should be a major area of concern. They can contain higher doses of diazepam, other substances entirely or, indeed, be laced with potentially deadly drugs like fentanyl.
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I was taking it at work when things got a bit stressful. It meant I could cope with my full inbox, with my overbearing boss and with the constant feeling that I was going to have a panic attack.
Jasmine, 31
”
As part of the Victoria Derbyshire investigation I bought diazepam illegally from three different rogue online pharmacies. I was able to order 14 10mg pills for £24.99 from one pharmacy and a packet of 21 for £50 from another.
I wasn’t sure whether any of the packages would be intercepted by officers like Maggie but they all arrived at my door within days. All three of them looked as though they had been posted from within the UK, suggesting that these websites – all of which had pictures of doctors in lab coats on their homepage and seemingly legitimate chatbots to help me with my purchase – are nothing short of window-dressing for an online drug dealer.
I took the diazepam I had bought to experts at TICTAC, a drug identification initiative at St George’s University Hospital in south London, to see what was actually in them.
Two of the batches I ordered did contain diazepam but one was actually a completely different drug: flualprazolam. Owen told me that this is a 'designer drug' which is not available on prescription anywhere.
Flualprazolam, he explained, "is a benzodiazepine originally synthesised in the 1970s but never marketed. It is thought to have similar potency to alprazolam (Xanax). Compared to diazepam, flualprazolam, like alprazolam, tends to act faster and is generally more potent with a greater abuse liability."
"Someone using a tablet they thought was diazepam but was actually flualprazolam, would probably find that the tablets worked faster and 'felt' stronger than what they might expect. It is also likely to be more addictive than diazepam."
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Hardyal Dhindsa is the national lead on drug and alcohol abuse for the Association of Police and Crime Commissioners. He told the Victoria Derbyshire programme that for all the talk about an opioid crisis in the United States, we are facing a crisis of our own in the UK right now.
He said he is concerned that, despite the fact that multiple bodies are trying to deal with the issue, more needs to be done. "Online requires better legislation, better monitoring... It’s hard to see how we’ll tackle this because availability online is so easy. More needs to be done through the health service, the enforcement agencies and public health departments."
However, as Owen pointed out when I went to visit him, "we have to look at the reasons why people are taking these drugs if we want to treat addiction."
Jasmine and Emma’s stories bear a striking resemblance. They were suffering with their mental health, unable to get what they felt they needed from the doctor, and so took matters into their own hands. In doing so, they put their physiological health at great risk and their mental health issues went untreated, too. If more people are buying diazepam illegally because they won’t or don’t feel they can go to their doctor about their mental health, we need to work hard to better understand why.
"I’m telling my story because I want people to know how addictive diazepam is," Jasmine, who now sees a mental health professional for talking therapy to deal with her anxiety added. "You might think it’s helping your anxiety, but it might be making it worse. It’s not a quick fix for any stress in your life and the more you rely on it, the more of a hold it has over you."
The MHRA said:
"Selling prescription only medicines outside of the legal supply chain is a serious criminal offence. Diazepam is scheduled under the Misuse of Drugs Act, and classified as a prescription only medicine for a reason. Prescription medicines are, by their very nature, potent and must be prescribed by a healthcare professional based on their clinical judgement and access to patient records."