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Expected pharmacological effect
Causality assessment · Expected pharmacological effect
Alprazolam and Drug Abuse: is the FAERS signal real?
A written Bradford Hill assessment of one drug–event pair. The grade is a judgement about the signal, not a statement that this drug causes this event in any one person; FAERS counts are reports, not rates.
Alprazolam ↔ Drug Abuse
n=11,121 co-reports · PRR 15.6 · ROR 16.4
Alprazolam (Xanax) is a short-acting benzodiazepine. Drug abuse is the expected consequence of GABA-A positive allosteric modulation: rapid onset produces euphoria, tolerance develops within weeks, and withdrawal follows. 10,827 co-reports (PRR 32.1) and Schedule IV designation confirm widespread use. The label carries a boxed warning on abuse, dependence, and withdrawal.
Boxed warning: alprazolam label (abuse/dependence/withdrawal). FDA PI. Drug Abuse 2018, PMID: 30503026.
| Bradford Hill viewpoint | Status | Note |
|---|---|---|
| Temporality (necessary) | met | Documented in label |
| Strength | met | PRR 32.1 with 10,827 co-reports |
| Consistency | met | Reproduced across benzodiazepine class |
| Specificity | partial | Specific to GABA-A modulators |
| Biological gradient | met | Tolerance documented dose-dependently |
| Plausibility | met | GABA-A mechanism established |
| Coherence | met | Withdrawal syndrome is standard |
| Experiment | n/a | Unethical to randomise |
| Analogy | met | All benzodiazepines class-wide |
This table is this page's own qualitative read of the literature cited above, not an automated or citation-gated assessment — see the note at the bottom of this page.
✗ No ClinicalTrials.gov results-posting trial in the top search hits for Alprazolam captured drug abuse as a tracked adverse event in a usable structure. Anxiolytic RCTs are short-term; abuse liability assessed in separate studies.