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. 2022 Sep;36(9):1020-1035.
doi: 10.1177/02698811221104065. Epub 2022 Aug 1.

Alprazolam-related deaths in Scotland, 2004-2020

John Martin Corkery  1 , Amira Guirguis  1   2 , Stefania Chiappini  1 , Giovanni Martinotti  1   3 , Fabrizio Schifano  1
Affiliations

Alprazolam-related deaths in Scotland, 2004-2020

John Martin Corkery et al. J Psychopharmacol. 2022 Sep.

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.

Keywords: Alprazolam; Scotland; United Kingdom; Xanax; deaths; fatalities; mortality.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors are unaware of any potential conflicts of interest. However, FS was a full member of the UK Advisory Council on the Misuse of Drugs (ACMD) and its NPS Committee (2013–2019); JC was a member of the ACMD’s Working Groups on drug-related deaths (1999–2000 and 2016–2017) and is currently a co-opted member of the Technical Committee (2016 to date) and NPS Committee (2009 to date). JC was responsible for producing drug statistics for the Home Office (1994–2002), acted as the UK Focal Point on Drugs’ expert on drug-related deaths for the European Monitoring Centre for Drugs and Drug Addiction and mortality related to drug use (2000–2015), and contributed to the UK Annual Report Questionnaire to the United Nations Office on Drugs and Crime over the period 1994–2013. GM has been a consultant and/or a speaker and/or has received research grants from Angelini, Janssen, Lundbeck, Otsuka, Pfizer, Recordati. SC and AG have nothing to declare. The views expressed here reflect only the authors’ views and not necessarily those of the Home Office, the ACMD or the authors’ respective institutions.

Figures

Figure 1.
Figure 1.
Alprazolam-related deaths registered in the United Kingdom, 2004–2020.
Figure 2.
Figure 2.
Alprazolam-related deaths in Scotland, by month of occurrence, aggregated data, 2015–2020.
Figure 3.
Figure 3.
Alprazolam-related deaths in Scotland, by month of occurrence, 2015–2020.
See this image and copyright information in PMC

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