fbpx Circumstances and toxicology of sudden or unnatural deaths involving alprazolam | NDARC - National Drug and Alcohol Research Centre

Circumstances and toxicology of sudden or unnatural deaths involving alprazolam

image - Anxiety 280 3
Date Commenced:
Project Supporters:

Australian Government Department of Health;
NSW Health

Project Members: 
Associate Professor Michelle Tye
Senior Research Fellow, NHMRC Emerging Leader Investigator
Project Main Description: 

There has been a great deal of clinical concern regarding alprazolam (Xanax) abuse, so much so that the Therapeutic Goods Administration reclassified the drug effective 1 February 2014 from Schedule 4 (prescription only medicine) to Schedule 8 (controlled drug). This project investigated alprazolam positive cases of sudden or unnatural deaths presenting to the NSW Department of Forensic Medicine over a 17 year period.

Project Collaborators: External: 

Professor Johan Duflou
Department of Forensic Medicine, Sydney South West Area Health Service; UNSW; University of Sydney

  1. Determine the characteristics, circumstances and causes of death of sudden or unnatural deaths involving alprazolam
  2. Determine the toxicology of sudden or unnatural deaths involving alprazolam
Design and Method: 

Case series.  All cases presenting to the New South Wales Department of Forensic Medicine between 1995-2012 in which alprazolam were detected were retrieved.


412 cases were identified. There was a large increase in the annual number of cases, from three in 1997 to 86 in 2012. By 2012, 4.5% of all DOFM case presentations involved alprazolam. The mean age was 41.3 yrs and 66.5% were male. Circumstances of death were: accidental drug toxicity (57.0%), deliberate drug toxicity (10.4%), suicide by means other than drug overdose (12.6%), disease (10.0%), accident (5.1%), homicide (2.4%). The major factor driving the increase in cases was accidental drug toxicity involving  alprazolam, rising from 0 in 1997 to 58 in 2012. A history of drug/ alcohol problems was noted in 80.4%, and 56.6% were injecting drug users. The median alprazolam concentration was 0.08 mg/L (range 0.005-2.10 mg/L), with 37.4% of cases having concentrations of ≥0.1 mg/L. In 94.9% of cases, drugs other than alprazolam and its metabolites were present, including all accidental overdoses. The most commonly detected drugs were opioids (64.6%), other benzodiazepines (44.4%) and alcohol (34.5%). A third (31.8%) of cases were HCV positive.  


Darke, S., Torok, M. and Duflou, J. (2014) Circumstances and toxicology of sudden or unnatural deaths involving alprazolam, Drug and Alcohol Dependence, 138 pp.61-66. DOI: 10.1016/j.drugalcdep.2014.01.023 


Novel data on harms associated with alprazolam use.

Project Research Area: 
Project Status: 
Year Completed: