(From June Bulletin MPBVic) This item has been prepared by the Department of Human Services.
Recent evidence suggests that alprazolam is more subject to non-medical use, and causes a disproportionally higher level of serious harm, than other benzodiazepines.
Alprazolam is a drug with particularly high potency and short onset of action, which makes it a preferred drug for recreational abuse. As with other benzodiazepines, inappropriately high doses can cause anterograde amnesia. Anecdotal reports suggest that among the benzodiazepines, non-medical use is particularly associated with harmful experiences such as seizures, traffic accidents and crime-related harm.
Alprazolam is now the most commonly reported benzodiazepine among Australian injecting drug users who report injection of benzodiazepines.
Many witnesses giving evidence to the Victorian Drugs and Crime Prevention Committee’s Inquiry into Benzodiazepines and other Pharmaceutical Drugs in Victoria expressed concerns that alprazolam, when used for recreational purposes, can be particularly dangerous. They commented on its highly addictive qualities. The Senior Pharmacist at Turning Point Alcohol and Drug Centre commented that for the drug-using population, alprazolam provides the effect they want. Others commented that alprazolam appears to feature more prominently in crime-related activity such as diversion and theft.
The Pharmacy Board of Victoria stated that it was not uncommon for alprazolam (Xanax) tablets (100) to be prescribed and dispensed as private (non-PBS) prescriptions and then on-sold on the street for $5 per tablet.
The Victorian Interhospital Liaison Group expressed concern that alprazolam is one of the most widely abused of the benzodiazepines and that management of withdrawal was particularly difficult.
Most recently, alarming reports from several Needle Syringe Programs (NSPs) describe the effects of high-dose non-medical use of alprazolam by their clients causing problems of anger and aggression, as well as violent
and threatening behaviour, which the users do not remember the next day. During these episodes it is not possible to reason with or calm individuals. Alprazolam tablets are also known as ‘angry pills’. Some NSPs report that people affected by high doses will commit crimes such as shoplifting but will be unaware of their surroundings.
When they recover in the police cells they do not remember the actions that led to their arrest. When intoxicated they appear to be more at risk of either committing or being the subject of violence, as well as of falls and other injury as a result of intoxication.
There has been particular concern in Tasmania about prescribing and non-medical use of alprazolam. A circular to pharmacists in that state noted that serious injury and death has resulted from the practice of injecting alprazolam alone, or with other drugs, to produce a heroin-like ‘high’.
Alprazolam should only be prescribed when there is a clear indication for its use, after taking into account the risks to the patient and the burden of harm to the community.The recommendation of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) is that alprazolam has a limited role in the treatment of panic disorder and anxiety. The initial approach should be psychological measures, such as cognitive behavioural therapy. First line drug therapy for panic disorder is stated to be the newer antidepressants, particularly paroxetine and sertraline. Benzodiazepines are listed as second line therapy along with tricyclic antidepressants and the MAOI’s. This approach is supported by the PBS approval, which is ‘for the treatment of panic disorders where other treatments have failed or are inappropriate’.
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