The number of drug deaths in Dundee linked to etizolam has risen by more than 500%.
An investigation by Wave FM News found 42 drug death victims in 2018 had so-called fake Valium in their systems.
That is compared to 34 in 2017, 21 in 2016 and just eight in 2015.
In stark contrast, only three such deaths were recorded in Aberdeen last year – and none in the previous three years – while the figure in Edinburgh in 2018 was just two.
Glasgow was the worst Scottish city with 174 such deaths last year, a huge rise from 11 in 2015.
There were 14 in Fife last year and three in Perth and Kinross.
Etizolam tablets are used to treat insomnia and panic attacks in certain countries – though it is not licensed in the UK. It can make the side effects of other drugs worse and make them more likely to be fatal.
Dave Barrie (pictured right), the service manager at Dundee’s Addaction charity, said he is worried about the rising number of deaths linked to etizolam.
He said: “It doesn’t surprise me, but it’s extremely concerning.
“We’ve been aware of this upward trend with etizolam over the last few years, so when you’re reading the figures, it’s a stark reminder of the reality. It’s a significant amount of fatalities linked to a dangerous illicit drug.
“There will be different factors at play – things like availability and demand.
“Addaction has been aware that illicit etizolam and alprazolam are known as fake Valium on the street and there’s been a growing market in cities like Dundee, and others in Scotland.
“There’s a high demand and there’s a high supply and availability.
“I know over the years that general prescribing advice around this group of drugs has been to reduce, because prescribing of drugs like diazepam comes with issues and concerns.”
He added: “Drugs like etizolam will often be used to help people come down off stimulants like cocaine, so the drugs often come hand-in-hand, and often people are using more than one, which is obviously extremely dangerous in terms of fatal overdose.”
Public Health Minister Joe FitzPatrick, MSP for Dundee West, is also concerned.
He said: “The increase in etizolam being implicated in deaths is clearly worrying.
“We continue to work with Police Scotland, NHS boards and organisations such as the Scottish Drugs Forum, to increase awareness of the health-related dangers of misusing prescription-type drugs.
“Our national alcohol and drug strategy, published last November, takes a comprehensive approach to tackling this issue.
“I am also convening an expert group to examine drug deaths.”