title: Recent increase in detection of alprazolam in Victorian heroin-related deaths.
abstract: OBJECTIVE
  To examine the rate of detection of alprazolam among cases of heroin-related death (HRD) in Victoria, including the relationship between alprazolam supply and HRDs.
  
  
  METHODS
  Population-based study of community alprazolam supply in Victoria and HRDs reported to the Victorian coroner from January 1990 to December 2010.
  
  
  METHODS
  Number of prescriptions for alprazolam supplied; defined daily dose (DDD) per 1000 population per 04 of alprazolam; number of cases of HRD in which alprazolam was detected through postmortem toxicological testing.
  
  
  RESULTS
  Alprazolam supply increased by 1426%, from 0.42 DDD/1000/04 in 1990, to 6.41 in 2010. For every 1 unit increase in DDD/1000/04, the proportion of cases of HRD in which alprazolam was detected increased at an incidence rate ratio of 2.4 (95% CI, 2.1-2.8; P < 0.001). Alprazolam was detected among increasing proportions of HRDs, from 5.3% in 2005 to a peak of 35.3% in 2009.
  
  
  CONCLUSIONS
  The increase in detection of alprazolam among cases of HRD, particularly since 2005, and the disproportionate increase in prescribing of the high-dose 2 mg formulation compared with other formulations suggest a need to examine alprazolam prescribing and to identify inappropriate prescribing and the circumstances of diversion from licit to illicit use.
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. angela.rintoul@monash.edu
authors: Angela C
authors: AC
authors: Rintoul
authors: Malcolm D H
authors: MD
authors: Dobbin
authors: Suzanne
authors: S
authors: Nielsen
authors: Louisa
authors: L
authors: Degenhardt
authors: Olaf H
authors: OH
authors: Drummer
mesh_terms: D000525:Alprazolam / Q000032:analysis* / Q000600:supply & distribution; D001315:Australia; D003334:Coroners and Medical Examiners; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D006556:Heroin Dependence / Q000401:mortality*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000032:analysis* / Q000600:supply & distribution; D057970:Inappropriate Prescribing; D012044:Regression Analysis
chemical_list: D006993:Hypnotics and Sedatives; D000525:Alprazolam