BACKGROUND: Engagement with the illicit street tablet market in Middlesbrough, North-East England, has been shown to impact treatment engagement, and the area appears to have a unique z-drug market, potentially not observed in other areas. When combined with high levels of injecting opioid and polydrug usage, this context may account for the steep increases in drug-related deaths reported locally. However, little is known about the volume, dosage, frequency, drivers, and dislikes of street tablet usage from the perspective of those who use drugs. In areas of high drug-related harm, local drug market intelligence is crucial to co-developing acceptable harm reduction and treatment offers that are attractive to those most at risk from a drug-related death.

METHODS: This project used a peer research model. The peer researcher engaged a group of high-risk individuals (traditionally underserved by standard research processes) in a survey regarding street tablet usage, drivers, dislikes, and desired treatment options.

RESULTS: A small but notable sample of 38 individuals engaged with the survey, the majority of whom (60%) were not involved in drug treatment, with a high proportion of street homelessness (38%). Street tablets were perceived as a multifunctional remedy to achieve a range of perceived mental and physical effects or for pragmatic purposes, such as cost. Most (89% and 87%, respectively) respondents [with current or historical use] (n = 38) reported extensive illicit pregabalin and zopiclone usage. When only looking at those currently using street tablets (n = 32), 100% were using zopiclone, with nearly all reporting this in combination with pregabalin (n = 31, 96%). Reported drivers of tablet usage included attempts to self-medicate due to untreated mental health conditions. Self-dosage rates were substantially higher than the recommended therapeutic dose rates.

CONCLUSIONS: Collaborating with the peer workforce in areas of high need relating to drug harms was an acceptable way of engaging some of the most vulnerable individuals at risk from mortality and morbidity in the research process. Our data highlights this population's complex, high-dose, polydrug use. There was an appetite to develop harm reduction interventions for illicit street tablet usage amongst the population sampled. Further work should develop tailored harm reduction advice for complex issues such as street tablets and opioid co-use.