DDN April 2017 DDN April 2017 | Page 7

For information and resources: www.drinkanddrugsnews.com DOn’T wORRY – ThERE’S a pill fOR ThaT. By2008-9,Xanax hadbecome America’s most-prescribed psychiatricdrugat 44mscripts. By2014thatfigure hadpassed48m. www.good.is www.imshealth.com 200 x 2mg tablets (the equivalent of 4 x 10mg diazepam) worked out at around £1 a tablet. There is clearly no shortage of people offering alprazolam, with the product range including raw powder and pills in various strengths. Increased restriction on other sedating substances could further encourage its use. The existing non- regulated benzodiazepines were all automatically covered by the Psychoactive Substances Act 2016 (PSA), reducing legitimate access to these compounds via head shops and online suppliers. The ACMD has pushed for further regulation, suggesting they be made temporary class drug order (TCDO) drugs, with a view to later making them fully controlled drugs. However, the government has declined, arguing that this would reduce the capacity to control these drugs in custodial settings. Nonetheless, it is likely that all the novel benzodiaze pines will be scheduled at some point in the future. The ACMD and government are also concerned about the diversion of prescribed medicines, and the misuse of pregabalin is a key issue. Therefore it seems increasingly likely that this, alongside gabapentin, will be made a controlled drug in the coming months. So for anyone seeking non-prescribed sedation, the dark web and illicit markets will be the main source of drugs, and alprazolam is increasingly a feature. This will be especially true for people who have built up significant tolerance to benzo-type drugs pre-PSA, and who will need to cross-substitute with similarly strong benzos to stave off withdrawal. Someone with a 2g a day flubromazolam habit would probably need 80mg of diazepam for a similar effect. A discussion on an NPS forum made a similar point, highlighting a red 5mg alprazolam bar on the market, www.drinkanddrugsnews.com ‘There are now vendors based in the UK producing their own Xanax bars for our market… there’s one in particular that has just this week come out with red bars containing 5mg alprazolam...’ saying: ‘There are now vendors based in the UK producing their own Xanax bars for our market… there’s one in particular that has just this week come out with red bars containing 5mg alprazolam. These are pressed and sold in the UK. I do not think it is a coincidence that this is happening right after the Psychoactive Substances Act has come into force. No one with a clonazolam habit is going to get much out of diazepam after all… ‘This could be the start of an interesting new trend in the UK. Alprazolam has never previously been a big thing here, but some of these UK Xanax vendors are geared up specifically to sell in bulk to dealers. I don’t doubt this is a direct result of UK benzo users getting a taste of more potent benzos from the RC [research chemicals] scene. I also fully expect etizolam bars to come onto the UK market shortly, but I suspect these will be more popular given the street cred of Xanax.’ It is too soon to know if alprazolam will become a significant drug on the UK scene, but some of the key risks and issues are: • Alprazolam may crop up unexpectedly in compounds where it was not the sought-after drug. It may also crop up in a variety of strengths, with pills containing alprazolam ranging from 0.5mg to 5mg (equivalent of 20mg – 100mg of diazepam.) On its own this is a significant risk of overdose. This risk goes up significantly when used in combination with alcohol or opiates. • If alprazolam is appealing to a younger demographic, there is likely to be a high level of ignorance in relation to risks around benzodiazepine use. • As with other benzodiazepines, alprazolam can cause significant physical dependency and dangerous withdrawal symptoms. Tapered reduction may be required, including high-dose prescribing as part of a transfer from illegally sourced drugs. Alprazolam is certainly a significant drug – and a big problem – in America, and increasingly crops up in polydrug overdoses. From looking at its growing influence in this country, it would seem that the risks are very real. Kevin Flemen runs the drugs education and training initiative, KFx. Visit www.kfx.org.uk for free resources. April 2017 | drinkanddrugsnews | 7