Sedative Abuse Sends More Patients to Emergency Department

Visits to US emergency departments (EDs) involving the antianxiety drug alprazolam have increased in recent years, especially among young adults in their mid-20s and early 30s, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The report finds that the number of ED visits involving the nonmedical use of alprazolam, sold as Xanax, Xanax XR (Pharmacia and Upjohn), and Niravam (UCB Pharma, Inc), doubled from 57,419 to 124,902 between 2005 and 2010 and then remained stable at 123,744 in 2011.

Nonmedical use includes taking more than the prescribed dose; taking a drug that was prescribed for another person; being deliberately poisoned with a drug by another person; or documented misuse or abuse of a drug.

Dangerous Combinations

The majority of alprazolam-related ED visits (about 81%) involved other drugs (both legal and illicit) or alcohol; 63% of those patients used alprazolam with another prescription medication, including 36% who used it with painkillers such as oxycodone.

"When used as directed, alprazolam is safe and effective, but misuse can result in serious health consequences," SAMHSA administrator Pamela S. Hyde said in a statement. "This report highlights the need to educate people about the dangers of misusing or sharing prescription medications and the importance of properly disposing of unused medication."

The report notes that alprazolam has been shown to be "significantly more toxic" than other benzodiazepines if more than the prescribed amount is taken. And if alprazolam is combined with other drugs that depress the central nervous system, such as narcotic pain relievers, the effects of these drugs on the body can be "dangerously enhanced."

Between 2005 and 2011, there was a 3-fold increase in alprazolam-related admissions involving adults aged 25 to 34 years. Visits from persons in this age group accounted for about a third (32%) of all the ED visits in 2011. "This suggests that adults aged 25 to 34 may have the greatest need for interventions addressing nonmedical use of alprazolam," SAMHSA says.

Alprazolam, used to treat anxiety, insomnia, depression, and panic disorders, was the 13th most commonly sold medication in 2012 and was the psychiatric medication most commonly prescribed in 2011.

Data for the report came from SAMHSA's Drug Abuse Warning Network (DAWN), a public surveillance system that monitors drug-related ED visits in the United States. To be a DAWN case, an ED visit must involve a drug either as the direct cause of the visit or as a contributing factor.

According to SAMHSA, in 2011, there were over 1.2 million ED visits overall related to the nonmedical use of prescription drugs.

SAMSHA news release. Published online May 22, 2014. Full article

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