Systematic postmarketing surveillance needed for misused psychoactive pharmaceutical drugs

To the Editor: I would like to thank Rintoul and colleagues for bringing together data from varied sources to highlight an important public health issue.1 The 1426% increase in supply of alprazolam they identified over the 20-year period from 1990 to 2010 was particularly striking.

Alprazolam is indicated as a second-line treatment for panic disorder where other therapies are ineffective, or for short-term treatment of anxiety disorder. As these conditions have not had a > 1400% increase in incidence, while alprazolam use reported by the Victorian Illicit Drug Reporting System increased more than eightfold from 2005 to 2011 and detection of alprazolam in heroin-related deaths has increased,1 it is reasonable to believe that alprazolam prescriptions are increasingly being diverted for illicit purposes.

Certainly, increasing availability of alprazolam and its subsequent misuse is reflected in the patients I see presenting for drug treatment. Many of my patients misuse alprazolam obtained through either doctor shopping or the black market.

Other consequences of using alprazolam not captured in coronial data include non-lethal overdoses; destabilisation of drug treatment; impairment of judgement leading to greater injury risk, high-risk substance use or criminal behaviour; and memory difficulties that impair patients’ ability to self-care.

Limiting alprazolam supply by categorising it as a Schedule 8 medication (now scheduled to occur in February 2014), instituting real-time prescription monitoring of all drugs of dependence (not just opiates), and improving the capacity of drug treatment services to manage benzodiazepine dependence would help reduce the harms related to its misuse.