Praise for Xanax rescheduling

Tightening restrictions on alprazolam (Xanax) prescribing has successfully lowered use and harm caused

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Tightening the restrictions on alprazolam (Xanax) prescribing has successfully lowered the use and harm associated with the highly addictive drug, Australian research shows.

Prescribing rates dropped 22%, and calls to the poisons centre halved in the year following the TGA’s decision to reclassify alprazolam from a Schedule 4 to a Schedule 8 medicine.

Since the change in February 2014, an increase had been seen in people being prescribed safer, benzodiazepines, the study found.

“Alprazolam is significantly more toxic, has no additional therapeutic benefit and is increasingly misused compared with other benzodiazepines,” the authors wrote.

“Our findings suggest that when one medicine within a class is more toxic and/or more commonly abused, selective rescheduling should be considered to address its misuse,” they concluded.

The University of Sydney and University of NSW researchers analysed a random sample of PBS prescribing data between January 2010 and July 2015.

The biggest impact of the rescheduling appeared to be on heavy-users of the drug.

“Although increasing barriers to prescribing benzodiazepines can have unintended consequences, we observed no significant change in poisonings associated with other benzodiazepines,” the authors wrote.

Because this study was restricted to PBS data, the research could not prove the same downwards trend was seen in patients on private prescriptions.

The findings come as other Australian research showed alprazolam rescheduling was also of benefit to those on opioid substitution therapy.

In this group of 57 participants, the reclassification was associated with reduced alprazolam use in the first three and after 12 months, with no apparent substitution to other benzodiazepines or drugs.

Benzodiazepine misuse was common among those on opioid-substitution therapy, and was tied to a greater risk of overdose, death and poorer opioid abstinence, the researchers said.

No unintended negative consequences of alprazolam rescheduling were identified in this high risk group, they said.

JAMA; online 6 June

International Journal of Drug Policy; online 10 June