Characteristics of Alprazolam‐Related Deaths Compiled by a Centralized State Medical Examiner

Shah, Neel; Abate, Marie A.; Smith, Michael J.; Kaplan, James A.; Kraner, James C.; Clay, David J

doi:10.1111/j.1521-0391.2012.00298.x

Cited by 12 publications

(15 citation statements)

References 18 publications

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“…This is obviously due to the fact that pregabalin with high doses produces benzodiazepine-like effects and thus possesses considerable abuse potential as such or as an opioid booster [25]. Alprazolam is the benzodiazepine with a high abuse liability [26], and it shows the highest FTI of all benzodiazepines in our material. Swedish researchers published FTI values for sedative and hypnotic drugs based either on fatal mono-intoxications or multi-drug intoxications [12].…”

Section: Discussionmentioning

confidence: 91%

Fatal toxicity index of medicinal drugs based on a comprehensive toxicology database

2016

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The fatal toxicity index (FTI) is the absolute number of fatal poisonings caused by a particular drug divided by its consumption figure. Consequently, it is a useful measure in evaluating toxicity of the drug and its relevance in fatal poisonings. In this study, we assessed the FTI of medicinal drugs in 3 years (2005, 2009, and 2013) in Finland. As the measure of drug consumption, we used the number of defined daily doses (DDD) per population in each year. There were 70 medicinal drugs in Finland for which the mean FTI expressed as the number of deaths per million DDD over the three study years was higher or equal to 0.1. The Anatomical Therapeutic Chemical (ATC) classification system was used for the classification of the active ingredients of medicinal drugs according to the organ or system which they act on. Of these 70 drugs, 55 drugs (78.6 %) acted on the nervous system (denoted by ATC code N), 11 (15.7 %) on the cardiovascular system (C), three (4.3 %) on the alimentary tract and metabolism (A), and one (1.4 %) on the musculoskeletal system (M). The nervous system drugs consisted of 20 psycholeptics, (ATC code N05), 20 psychoanaleptics (N06), eight analgesics (N02), six antiepileptics (N03), and one other nervous system drug (N07). The highest individual FTIs were associated with the opioids methadone, dextropropoxyphene, oxycodone, tramadol, and morphine; the antipsychotics levomepromazine and chlorprothixene; and the antidepressants doxepin, amitriptyline, trimipramine, and bupropion. Buprenorphine was not included in the study, because most of the fatal buprenorphine poisonings were due to smuggled tablets. A clearly increasing trend in FTI was observed with pregabalin and possibly with bupropion, both drugs emerging as abused substances.

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Section: Discussionmentioning

confidence: 91%

Fatal toxicity index of medicinal drugs based on a comprehensive toxicology database

2016

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“…The first large-scale studies identifying alprazolam-related deaths started in the early 2000s, but were chiefly concerned with documenting deaths from all drugs ( Austin et al, 2017 ; Goldberger et al, 2011 ; Haukka et al, 2017 ; Hedegaard et al, 2018 ; Ossiander, 2014 ; Simonsen et al, 2021 ), other drug classes ( Bishop-Freeman et al, 2021 ; Chan et al, 2006 ; Jönsson et al, 2007 ; Mariottini et al, 2021 ), psychotropic drugs ( Pfeifer et al, 2019 ) or benzodiazepines ( Kriikku et al., 2020 ), with such deaths being incidentally uncovered. On the other hand, some studies had alprazolam deaths as their primary focus ( Darke et al, 2014 ; Jones and Holmgren, 2013 ; Rintoul et al, 2013 ; Shah et al, 2012 ; Wolf et al, 2005 ). In addition, some studies have looked at the toxicity of alprazolam compared to other drugs ( Ojanperä et al, 2016 ), benzodiazepines ( Isbister et al, 2004 ; Skov et al, 2016 ), other antidepressants ( Buckley and McManus, 2004 ; Jönsson et al, 2014 ) or ‘z’ drugs ( Reith et al, 2003 ).…”

Section: Discussionmentioning

confidence: 99%

Alprazolam-related deaths in Scotland, 2004–2020

et al. 2022

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Background: The benzodiazepine drug alprazolam, a fast-acting tranquiliser, cannot be prescribed on the National Health Service in the United Kingdom. Illicit alprazolam supply and consumption have increased. Concern about increasing numbers of alprazolam-related fatalities started circulating in 2018. However, statistics on this issue are very limited. This study examined patterns in such mortality in Scotland. Methods: Statistics on deaths where alprazolam was mentioned in the ‘cause of death’ were obtained from official mortality registers. Anonymised Scottish case-level data were obtained. Data were examined in respect of the characteristics of decedents and deaths using descriptive statistics. Results: Scotland registered 370 deaths in 2004–2020; 366 of these occurred in 2015–2020: most involved males (77.1%); mean age 39.0 (SD 12.6) years. The principal underlying cause of death was accidental poisoning: opiates/opioids (77.9%); sedatives/hypnotics (15.0%). Two deaths involved alprazolam alone. Main drug groups implicated: opiates/opioids (94.8%), ‘other benzodiazepines’ (67.2%), gabapentinoids (42.9%), stimulants (30.1%), antidepressants (15.0%). Two-thirds (64.2%) involved combinations of central nervous system (CNS) depressants. Discussion: Alprazolam-related deaths are likely due to an increasing illicit supply. The fall in deaths in 2019–2020 is partially due to increased use of designer benzodiazepines. Treatment for alprazolam dependence is growing. Clinicians need to be aware of continuing recreational alprazolam use. When such consumption occurs with CNS depressants, overdose and death risks increase. Conclusions: More awareness of alprazolam contributing to deaths, especially in conjunction with other CNS depressants, is needed by consumers and clinicians. Improved monitoring of illicit supplies could identify emerging issues of medicines’ abuse.

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“…Interestingly, the rate of disclosure and nonhazardous use was very high at 76% for sedatives/hypnotics, agents that are associated with a high potential for abuse and nonmedical use. [20][21][22] This disclosure rate may have been confounded by the fact that most of the (12.6) anxiolytics and sedatives were directly prescribed from our clinic. Almost a third of the 52 nondisclosed controlled substances were also being abused.…”

Section: Discussionmentioning

confidence: 99%

Disclosure of Use and Abuse of Controlled Substances Among Psychiatric Outpatients

Centeno

Baig

Lee

et al. 2015

Journal of Psychiatric Practice

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Characteristics of Alprazolam‐Related Deaths Compiled by a Centralized State Medical Examiner

Abstract: Controlled substance monitoring programs should be routinely used as one mechanism to help prevent potential drug misuse/abuse. Our findings provide a baseline for ongoing alprazolam-related death surveillance.

Cited by 12 publications

References 18 publications

Fatal toxicity index of medicinal drugs based on a comprehensive toxicology database

Fatal toxicity index of medicinal drugs based on a comprehensive toxicology database

Alprazolam-related deaths in Scotland, 2004–2020

Disclosure of Use and Abuse of Controlled Substances Among Psychiatric Outpatients

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