Contents and Time-Course of Falsified Alprazolam Detections in New South Wales, Australia

Falsified alprazolam tablets (sometimes called 'counterfeit alprazolam') typically do not contain alprazolam and instead contain novel benzodiazepines or other drugs. We describe temporal changes in the number and contents of falsified alprazolam tablets in New South Wales, Australia.

We searched a database of analysed police seizures between January 2012 and March 2024 for falsified alprazolam (tablet presenting as Kalma, Mylan, Xanax, Sandoz or Alprax brands, but not containing alprazolam and/or contained other drugs). Falsified alprazolam tablets taken by patients presenting to NSW Health services for 5 months in 2020 were also tested.

We identified 809 falsified alprazolam tablet seizures, mostly Xanax (n = 406, 50%) or Mylan (n = 322, 40%) brands. The three most common drugs detected in falsified alprazolam tablets were the novel benzodiazepines etizolam (present in n = 228 samples, 28%), clonazolam (n = 224, 28%) and bromazolam (n = 178, 22%). Of all falsified alprazolam tablets, only 70 (8.7%) contained alprazolam. There were rare detections of non-benzodiazepine drugs including the opioids etodesnitazene and ortho-desmethyltramadol.

Our analysis highlights the variability in contents of falsified alprazolam tablets over time. This report highlights the potential value of surveillance systems involving analysis of police seizure data as part of a drug early warning system. Our results are of interest to the community who take falsified alprazolam tablets, and to health care workers managing cases of poisoning or dependence. This study highlights the need to continue developing the ability to detect, assess and respond to emerging falsified products, to facilitate clinical and public health responses.