Alprazolam-related deaths in Scotland, 2004–2020

Abstract

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.

Predictors and motives of polydrug use in opioid users. A narrative review

“…Similar to the United States and Canada, the combined use of opioids with benzodiazepines and related drug deaths are also highly prevalent in Scotland. Of all drug-related deaths in Scotland in 2021 ( n = 1330), drug analyses showed that in 93% of the victim's body more than one drug was detected, 84% involved opiates or opioids (such as heroin, morphine and methadone), only 3% involved amphetamines and 69% involved benzodiazepines [45 ▪ ,46] mostly diazepam (68% of all benzodiazepines) and/or etizolam (31% of all benzodiazepines) [47]. Nonfatal overdoses in Tayside (Scotland) between December 2017 and May 2019 in a sample of people attending addiction treatment service ( n = 557) showed that methadone (58%), benzodiazepines (50%) and heroin (44%) were the most commonly self-reported drugs, whereas opioids and benzodiazepines were the most often co-used drugs (49%) [48].…”

Benzodiazepine Boom: Tracking Etizolam, Pyrazolam, and Flubromazepam from Pre-UK Psychoactive Act 2016 to Present Using Analytical and Social Listening Techniques

“…In Scotland, for example, deaths from BZDs, including diazepam and etizolam, increased from 26% in 2008 to 57% in 2022 of the total number of drug misuse deaths [ 5 , 6 ]. The implications of these BZD analogues’ DRDs, accidental or otherwise, are widely debated [ 7 , 8 ]. Often, BZD DRDs are related to the combined inhibitory effects of both BZDs on GABA A receptors, and other CNS depressants, such as opioids, on opioid receptors in respiratory control centres, thus facilitating respiratory depression when co-consumed, and potentially leading to deaths [ 9 , 10 , 11 ].…”

Anhedonia modulates benzodiazepine and opioid demand among persons in treatment for opioid use disorder

“…This process can be studied using self-administration (actual consumption) or hypothetical purchase tasks (simulated) and applying demand curve analysis to examine the intensity and elasticity of demand (53,54), which can also be conceptualized as amplitude and persistence of demand, respectively (55). Alprazolam is a rapid-onset BZD that is frequently misused (56)(57)(58)(59). Studies of rhesus monkeys have demonstrated that BZDs are self-administered, however, economic demand for BZDs is complexly related to a compound's selectivity and intrinsic efficacy at α1 subunit-containing GABA A receptors, as well as the animal's baseline history of self-administration (60)(61)(62)(63)(64).…”