Counterfeit ‘Xanax®’ tablets: A comparative study of clinical and seizure data in Victoria, Australia

Abstract Background and aim There is growing evidence of counterfeit benzodiazepine products containing other substances, including non‐regulated benzodiazepine‐type new psychoactive substances (NPSs). This study sought to compare detections of seized suspect counterfeit alprazolam products with clinical cases that reported use of an alprazolam‐containing product to better characterise community use. Design and setting Observational study set in Victoria, Australia, using data from the Victoria Police Drug Sciences Group (which compiles information about seized drugs submitted for evidential analysis and intelligence purposes) and the Emerging Drugs Network of Australia – Victoria (EDNAV) project (a prospective, observational study collecting clinical and analytical data for illicit drug‐related presentations across a network of hospitals in Victoria, Australia). Cases Police seizures expected to contain alprazolam (March 2020 and August 2022) and EDNAV cases with a reported exposure to an alprazolam‐containing product (September 2020 and August 2022). Measurements Descriptive study outlining drug detections in seized tablets and blood samples from EDNAV cases, comparing patterns of detection and changes over time. Findings A total of 623 police seizures were analysed, most commonly products labelled as ‘Xanax®’ ( n = 266), ‘Kalma®’ ( n = 196) or ‘Mylan®’ ( n = 124). Thirty percent of seizures contained alprazolam only. A benzodiazepine‐type NPS was detected in 375 seizures (60.2%). Exposure to non‐prescribed alprazolam was reported in 11.2% ( n = 125/1112) of EDNAV cases, with 68.8% identifying as male and a median age of 26 years (range 16–68 years). Eighty‐seven cases reported the use of ‘Xanax®’. Alprazolam was detected in 19 EDNAV cases. A benzodiazepine‐type NPS was detected in 78.4% of EDNAV cases. Both datasets saw a shift in detections from etizolam (2020) to clonazolam (2021) and then clobromazolam (2022). Conclusions Suspect counterfeit alprazolam products seized by police in Victoria, Australia, in 2020 and 2022 commonly contained other drugs and/or new psychoactive substances, with an apparent limited consumer awareness of the tablet composition.