title: Alprazolam use and related harm among opioid substitution treatment clients - 12 months follow up after regulatory rescheduling.
abstract: Alprazolam, has been associated with disproportionate harms compared to other benzodiazepines, especially among people in opioid substitution treatment (OST). We examine the effect of the rescheduling of alprazolam in Australia, from Schedule 4 to Schedule 8 in February 2014 amongst a high-risk population of clients in OST.
  
  
  
  OST participants who reported recent (last month) alprazolam use were recruited from three Sydney clinics. Participants (n=57) were interviewed immediately prior to rescheduling and again three months and 12 months after rescheduling. We examined self-reported patterns of drug use, drug availability, mental and physical health. A linear mixed models approach was used to analyse changes in alprazolam and other benzodiazepine use.
  
  
  
  Mean days of alprazolam use in the past 28 days decreased from 13.7 to 7.1 days, and mean weekly alprazolam dose decreased from 15.1mg to 6.1mg at 12 months follow-up (p=0.001). Total weekly benzodiazepine use also reduced from a mean of 222mg diazepam equivalent to 157mg (p=0.044). Other substance use did not change significantly. Reported mode of cost price of street alprazolam doubled from $5 to $10 over the 12-month period.
  
  
  
  Alprazolam rescheduling resulted in an overall reduction in alprazolam and total benzodiazepine use, without substitution with other drugs, in the short term. Unintended harms were not observed. Rescheduling appears to have been effective in reducing alprazolam use in this high-risk population.
authors.affiliation: Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling St, Surry Hills 2010, Australia; Central Clinical School, University of Sydney, Sydney, NSW, Australia. Electronic address: Rachel.deacon@sydney.edu.au.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Deacon
authors.affiliation: Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling St, Surry Hills 2010, Australia; National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales 2052, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: Central Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Leung
authors.affiliation: Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling St, Surry Hills 2010, Australia.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Rivas
authors.affiliation: Alcohol and Drug Service, St Vincent's Hospital, Sydney, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Cubitt
authors.affiliation: Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling St, Surry Hills 2010, Australia; Central Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Monds
authors.affiliation: Alcohol and Drug Service, St Vincent's Hospital, Sydney, Australia; Faculty of Medicine, UNSW Australia, Sydney, Australia.
authors.forename: Nadine
authors.initials: N
authors.lastname: Ezard
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales 2052, Australia.
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.affiliation: Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling St, Surry Hills 2010, Australia; Central Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
mesh_terms: D000328:Adult; D000525:Alprazolam / Q000008:administration & dosage / Q000009:adverse effects*; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D040261:Harm Reduction; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D063487:Prescription Drug Misuse / Q000009:adverse effects* / Q000517:prevention & control; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D000525:Alprazolam
keywords: Alprazolam; Benzodiazepines; Opioid substitution treatment; Prescription drug misuse