Preventing Unnecessary Prescription of Xanax: A Possible Intervention

As a potent anti-anxiety medication, Xanax (alprazolam) has become one of the most commonly prescribed drugs for the treatment of panic disorder in adults. However, there are unique risks associated with this particular medication, as well as similarly acting drugs within the same class. Prolonged use of Xanax can lead to tolerance and dependence. Even in adults with no history of drug or alcohol problems, the misuse of Xanax is a real danger. In drug users, the acquisition of these pharmaceuticals through doctor-shopping or outright theft is a serious concern. Likewise, the risks for drug users are especially worrisome. This population often mixes opioids with Xanax, a potentially lethal combination. In the Australian state of Tasmania, the problem of Xanax abuse grew to epidemic proportions in the middle of the 2000s. An analysis of the situation proved that a combination of education and tighter regulatory practices were needed to curb the rampant spread of prescription drug abuse, particularly Xanax abuse and trafficking.

Health statistics indicated that since the early 1990s, the prescription of Xanax in Tasmania had increased at a much faster rate than in mainland Australia. In fact, by 2007 the prescription rate per capita in Tasmania was twice the rate of the rest of the nation. Authorities were at a loss as to why these numbers showed such a disparity. One theory holds that because heroin is relatively rare in Tasmania, drug users turned to Xanax for its analogous effects. No matter the reason, health officials knew that something had to be done. Their solution to the crisis was a two-step intervention. First, a series of educational sessions sought to improve prescribing practices among general practitioners. Next, a tightening of regulatory controls effectively reduced the flow of Xanax into the general population.

The interventions did have a measurable effect. Prescriptions for Xanax began to decline almost immediately, although they did not fall to the levels of mainland Australia. Attendance at the educational sessions was also not as high as authorities had hoped. Only about one in four of Tasmania’s general practitioners attended one of the sessions. Regulatory controls have restricted access to Xanax, but authorities fear that drug users will simply find alternatives. It remains to be seen whether the interventions represent a long-term solution or simply a brief reprieve from drug abuse problems in Tasmania.

When the benzodiazepine drugs, of which Xanax is a leading example, came onto the market in the 1960s, they were hailed as a safer and more effective alternative to barbiturates. Experience has shown, however, that Xanax has a high potential for misuse and abuse. For doctors, this knowledge means prescriptions for these sorts of drugs must be considered on a case-by-case basis. The danger of over-prescription is very real. Public health officials must also be on the watch for doctor-shopping and other drug-seeking behaviors among the population. For patients, this means following the doctor’s instructions to the letter. Patients should not take higher doses then prescribed or for longer than necessary. Awareness of the dangers is the first step in avoiding them, especially with prescription drugs.

Hooper, S., Bruno, R., Sharpe, M., & Tahmindjis, A. (2009). Alprazolam prescribing in Tasmania: a two-fold intervention designed to reduce inappropriate prescribing and concomitant opiate prescription. Australasian Psychiatry, 17 (4), 300-305.

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