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Circumstances and toxicology of sudden or unnatural deaths involving alprazolam

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Date Commenced:
2012
Project Supporters:

Australian Government Department of Health;
NSW Health

Project Members: 
Dr Michelle Tye
NHMRC Early Career Fellow
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

Aims: 
  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.

Findings: 

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.  

Output: 

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 

Benefits: 

Novel data on harms associated with alprazolam use.

Project Research Area: 
Project Status: 
Completed
Year Completed: 
2013