On Saturday 1st February 2014 alprazolam will become a Schedule 8 poison. On this day, all stocks must be transferred into a drug safe, and documented as for other controlled drugs.

Alprazolam was selected from an original proposal to reschedule all benzodiazepines partly because the 2mg tablets are now by far the most common of all forged prescriptions since flunitrazepam set the lead in 1997. While there was an overall decline of 8% in demand for benzodiazepines under the Pharmaceutical Benefits Scheme (PBS) between 2002 and 2009, alprazolam demonstrated a contradictory increase of 28%.

Compared with other benzodiazepines, alprazolam does not show any improved clinical benefit. However, it is more often abused because the potent action and rapid elimination trigger more severe withdrawal symptoms. It may also be more toxic when overdosed.

Mr Stephen Marty, Chair, Pharmacy Board of Australia, has expressed concern over the public nature of discussions around the assignment of alprazolam to Schedule 8. Mr Marty fears this will provide the public a chance to stockpile it for later use (or misuse), and potentially increase the risk of hold-ups, burglaries and forgeries.

Sales by one major wholesaler have so far remained relatively flat over the first nine months of 2013, whereas PBS dispensing reports show a decline of more than 20% during the same period, possibly reflecting the administrative barrier of prior authority approval.

Healthcare facilities are often proactive in protecting their staff from drugs with a potential for abuse, by applying discretion to increase controls without waiting for government mandate.

This may be a time to step ahead of the pack.

References:

  1. Delegates of the Secretary to the Department of Health and Ageing. Reasons for scheduling delegate’s interim decision and invitation for further comment. Canberra: Medicines and Poisons Scheduling Secretariat. May 2013.
  2. Department of Human Services. Pharmaceutical Benefits Schedule Item Reports, Medicare Australia Statistics. Canberra, Australia.
  3. Public submissions on scheduling matters referred to ACCS #7, ACMS #8 and the joint ACCS-ACMS #5 (March 2013). p. 1–194.