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Restrictions on alprazolam prescribing have failed to curb usage, with sales of bigger packs on the increase 

Measures introduced in 2017 to prevent potentially harmful usage of alprazolam have failed to impact on usage of the drug, new Australian research has revealed. 

From February 1, 2017, the 2mg listing of alprazolam was delisted from the PBS, while the number of refills was reduced to zero and pack sizes were reduced from 50 to 10 tablets, although prescribers could request approval for larger amounts if they regarded it as clinically necessary. 

Now a review by University of Sydney researchers has shown that while overall dispensing has dropped by 51%, the proportion of larger, lower dose packs had increased.

The proportion of packs of 51 to 100 tablets increased from 23% to 45% of all alprazolam prescriptions, while dispensing of packs of more than 100 tablets rose to 16% of scripts.

“Most people dispensed alprazolam were still receiving treatment outside the restrictions and best-practice recommendations, particularly with increased pack sizes to work around the reductions in refills per prescription,” said the authors. 

“A substantial proportion of people were still receiving amounts well above the recommended dosages and durations of therapy.”

“Notwithstanding the reduction in dispensings, among individuals who were still being dispensed alprazolam after the intervention, prescribers appeared to compensate for the elimination of 2mg tablets and refills by prescribing increased quantities, despite the introduction of a new smaller packs size.”

“Further, Poison Information Centre data suggest that the intervention was associated with minimal changes to dispensing of the 2-mg tablet strength, as prescribing appears to have shifted to the private market,” they added.

There had been a slight increase in calls to the NSW Poisons Information Centre following the regulatory changes.

The research was published online first on JAMA Open Network.

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