Experts are pushing for benzodiazepines to be made Schedule 8 drugs, amid mounting evidence of diversion, abuse and serious harm — particularly with alprazolam.
Submissions to a federal review, seen by Australian Doctor, urge regulators to stem the flood of benzodiazepines to the street, where they are increasingly being used alongside heroin in a potentially fatal cocktail.
In a submission asserting "strong support" for restricting the entire class, doctors from the Victorian Institute of Forensic Medicine say benzodiazepine abuse is now endemic and wreaking "devastating consequences".
Benzodiazepines now feature in 50.3% of drug-related deaths in Victoria, second only to opioid analgesics at 51.4%, their submission says.
Dr Matthew Frei (pictured), clinical director of Turning Point Alcohol and Drug Centre, Melbourne, said while it was unrealistic to restrict the whole class, there was a strong case to reschedule alprazolam — the "champagne of benzodiazepines".
"Without a doubt, it's the preferred benzodiazepine in people with a background of substance use," he said, estimating tablets changed hands for at least $5.
"As time goes on, there's a progressive accumulation of evidence about problems with alprazolam.
This is the nature of Australian drug users — they like this drug — so it's inevitable that we're going to have to look at special measures to deal with its misuse."
The comments follow research published Monday in the Medical Journal of Australia, finding alprazolam prescribing in Victoria has soared 1426% over the past two decades.
The 2mg formulation — said to be the most popular on the street — accounted for 28% of alprazolam scripts in 2010, up from just 4% in 1998.
The study also found alprazolam was implicated in a rising proportion of heroin-related deaths, peaking at 35% in 2009.
"We'd had a lot of anecdotal reports from people working in the drug and alcohol sector saying they had seen increasing problems associated with alprazolam use," said lead researcher Angela Rintoul, of Monash University's department of epidemiology and preventive medicine.
"People working in needle and syringe programs have had clients come in and throw chairs around and cause a lot of problems for staff. This sort of violence, also theft and amnesia, seem to have been increasing over the last several years."
Alprazolam is generally used to enhance the effects of heroin, or to reduce anxiety on withdrawal, Ms Rintoul said.
Submissions to the TGA review are not publicly available.
Australian Doctor has seen submissions from the Victorian Alcohol and Drug Association, which supports rescheduling alprazolam, and Barwon Health psychiatry trainee Dr Steven Moylan, who supports rescheduling all benzodiazepines.
However, Aged and Community Services Australia, the peak body for religious organisations providing care, has opposed the move, warning it could have huge ramifications for the aged care sector.