Nonmedical use of alprazolam in the UK: Results from a nationally representative survey

Hockenhull, Joanna; Amioka, Elise; Black, Joshua C.; Haynes, Colleen M.; Dargan, Paul I.; Dart, Richard C.

doi:10.1111/bcp.13959

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…This complements research published by McNamara et al on the increased use of these benzodiazepines in vulnerable populations in Ireland ( Mc Namara et al, 2019 ), a trend which has also emerged on a global scale ( Nielsen and McAuley, 2020 ). The lower number of deaths involving other NPS anxiolytic/sedatives may – like the established stimulants – be a case of anxiolytic/sedative NPS use being displaced by increasingly available MDA controlled benzodiazepines, such as alprazolam ( Hockenhull et al, 2019 ) and indeed etizolam itself – the latter both prior to and after its control under the MDA in May 2017.…”

Section: Discussionmentioning

confidence: 99%

Deaths from novel psychoactive substances in England, Wales and Northern Ireland: Evaluating the impact of the UK psychoactive substances act 2016

Deen

Claridge

Treble³

et al. 2021

J Psychopharmacol

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Background: ‘Legal highs’ began appearing in the UK in the mid-2000s. Whilst many of these substances were controlled under the 1971 Misuse of Drugs Act, novel compounds and new variants of controlled compounds were continuously being introduced to the recreational drug market. The Psychoactive Substances Act (PSA) was therefore implemented in 2016 as a blanket ban on all novel psychoactive substances (NPS). Aim: To evaluate the impact of the PSA on deaths following NPS use in England, Wales and Northern Ireland. Methods: Cases reported to the National Programme on Substance Abuse Deaths where death had occurred 3 years pre- or post-implementation of the PSA were extracted. Cases with NPS detected at post-mortem were analysed and compared against cases non-NPS cases. Results: 293 deaths with NPS detected were identified; 91 occurring before the PSA and 202 afterwards, indicating an 222.0% post-PSA increase. Contrastingly, non-NPS drug-related death case reporting increased by only 8.0%. Synthetic cannabinoid, anxiolytic/sedative and stimulant NPS were detected in the largest proportions of deaths pre-PSA; post-PSA stimulant NPS detections reduced whilst synthetic cannabinoid and anxiolytic/sedative detections increased. Post-PSA, average decedent age increased significantly (mean age pre-PSA 34.4 ± 10.8 vs post-PSA 38.3 ± 9.4), and they were significantly more likely to have been living in deprived areas (pre-PSA 50.0% vs post-PSA 65.9%). Conclusions: Reporting of deaths following NPS use has risen despite introduction of the PSA. Whilst deaths amongst younger individuals and those living in more affluent areas has reduced, additional approaches to prohibition are needed to curb their persistence in deprived demographics.

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Section: Discussionmentioning

confidence: 99%

Deaths from novel psychoactive substances in England, Wales and Northern Ireland: Evaluating the impact of the UK psychoactive substances act 2016

Deen

Claridge

Treble³

et al. 2021

J Psychopharmacol

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“…19,28 Additionally, young adults are exposed to pop culture with content that is open about taking drugs to self-medicate mental health issues, particularly alprazolam, so may be normalised to NMU of benzodiazepines. 29 The prevalence of last 12-month NMU of both only benzodiazepines and only Z-drugs were higher among those who had also used illicit drugs in the last 12 months than the general population. This pattern has also been seen in people with substance use disorders in the USA, with rates of benzodiazepine misuse 3.5-24 times higher than the general population.…”

Section: Discussionmentioning

confidence: 89%

“…It is recognised that young adults are more likely to misuse illicit and prescription drugs in general 19,28 . Additionally, young adults are exposed to pop culture with content that is open about taking drugs to self‐medicate mental health issues, particularly alprazolam, so may be normalised to NMU of benzodiazepines 29 …”

Section: Discussionmentioning

confidence: 99%

Nonmedical use of benzodiazepines and Z‐drugs in the UK

Hockenhull

Black

Haynes

et al. 2020

Brit J Clinical Pharma

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To estimate prevalence of last 12-month nonmedical use (NMU) of benzodiazepines and Z-drugs (the nonbenzodiazepine hypnotics zaleplon, zolpidem and zopiclone) in the UK. Methods: Data were collected using the Non-Medical Use of Prescription Drugs survey with poststratification weighting applied to be representative of the UK population (≥16 years). Participants were questioned about whether they had nonmedically used benzodiazepines and/or Z-drugs in the last 12-months and from where they had obtained the drug (including via a prescription, or illicitly from a friend/family member, a dealer or via the internet). Additional questions were asked about last 12-month use of illicit drugs (cannabis, cocaine, 3,4-methylenedioxymethylamphetamine [MDMA], non-pharmaceutical amphetamine, crack cocaine and/or heroin). Results: The study included 10 006 eligible participants representing approximately 52 927 000 UK adults. The estimated prevalence of past 12-month NMU of any benzodiazepine and/or Z-drug was 1.2% (95% confidence interval: 1.0-1.5) corresponding to approximately 635 000 adults; amongst this group only an estimated 4.6% (1.2-8.0) had NMU of both a benzodiazepine and a Z-drug. The highest prevalence of NMU for only Z-drugs was among those who had used heroin in the last 12-months (5.4%, 2.7-10.5), whilst the highest prevalence of NMU for only benzodiazepines was among those who had used illicit stimulants in the last 12-months: cocaine (5.9%, 3.8-8.9), amphetamine (5.6%, 3.1-10.0) and MDMA (5.2%, 3.1-8.8). The drug non-medically used was more commonly acquired without than with a prescription for both only benzodiazepines (70.2%, 59.4-81.1 compared to 51.3%, 41.5-64.6) and only Z-drugs (75.6%, 61.6-89.7 compared to 33.9%, 16.9-51.0). Conclusion: There is little overlap between benzodiazepine and Z-drug NMU suggesting distinct nonmedical use of the drugs; future studies need to explore whether this relates to personal preference, drug availability or other factors. A significant proportion are acquiring these drugs for NMU without a prescription, so without guidance and monitoring from a medical practitioner. While the dangers of mixing benzodiazepines and heroin/other opioids are well documented, there is a The authors confirm that the PI for this paper is Paul I. Dargan and that he had direct clinical responsibility for patients.

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“…However, in the UK context, some limited information is available. Hockenhull et al (2019) suggest that the estimated national prevalence rate for UK adults for non-medical use (NMU) of alprazolam was 0.08 (range 0.01–0.15)% with no statistically significant difference ( p = 0.898) between males and females. NMU rates in the last 90 days were higher amongst those aged 16–24 (0.37%) compared to those aged 25–34 (0.14%) and those aged 35 or more (0.01%), p < 0.001.…”

Section: Recreational Use In the Ukmentioning

confidence: 98%

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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Nonmedical use of alprazolam in the UK: Results from a nationally representative survey

Cited by 10 publications

References 9 publications

Deaths from novel psychoactive substances in England, Wales and Northern Ireland: Evaluating the impact of the UK psychoactive substances act 2016

Deaths from novel psychoactive substances in England, Wales and Northern Ireland: Evaluating the impact of the UK psychoactive substances act 2016

Nonmedical use of benzodiazepines and Z‐drugs in the UK

Alprazolam-related deaths in Scotland, 2004–2020

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