Alprazolam belongs to a class of benzodiazepines called triazolobenzodiazepines and is classed as a depressant drug.
Signs of an overdose include confusion, impaired coordination, diminished reflexes and coma. You can overdose from taking alprazolam by itself (although this is rare) and just one alprazolam tablet with alcohol can be fatal. Also, simultaneous use of alprazolam with any other benzodiazepines or depressant drugs such as heroin, methadone, buprenorphine (Subutex/Suboxone), gabapentinoids (Pregabalin and Gabapentin) and alcohol greatly increases the risk of non-fatal and fatal overdose through respiratory depression.
Benzodiazepine use is often a factor in drug related deaths in opioid users, with benzodiazepines a contributing factor in 28% and present in 72% of Scottish drug related deaths. Figures for alprazolam deaths alone are not available, but between 2012 to 2016 the number of deaths where benzodiazepines were mentioned rose from 284 to 406 in England and Wales.
If taken over an extended period alprazolam causes physical and psychological dependence. In particular there is evidence of rapid tolerance, dependence and withdrawal among opioid users. Tolerance will develop to the sedative-hypnotic effects within a short period of continuous use. Sudden withdrawal for dependent individuals is potentially dangerous, sometimes resulting in seizures or death.
Effects can include increased anxiety, agitation, confusion and panic attacks, and can lead to acute psychosis in vulnerable people. Withdrawal should be medically supervised, usually by substituting with a longer acting benzodiazepine such as diazepam and tapering the dose over an extended period. There is evidence that benzodiazepines with a short elimination half-life cause a more severe withdrawal than those with a long elimination half-life. Alprazolam withdrawal syndrome is reported to be especially intense and/or long lasting.
Swallowing alprazolam tablets is the safest route of use. Some online forums suggest a more rapid onset of effects if the tablets are chewed or ground to a powder and swallowed in a cigarette paper (bombed/parachuted) as powder may be absorbed more quickly.
A recent UK report describe a ‘ketamine-like’ effect when alprazolam is snorted. Some websites claim snorting increases potency but most user forum discussions maintain snorting is ineffective. The effects felt are due to powder slipping down the throat after snorting and are more rapid due to the drug being in powdered form.
Smoking alprazolam is thought ineffective. Alprazolam is non water soluble. Injecting any sort of crushed tablet may cause serious vascular and tissue damage due to the filler content and overdose is also more likely. Alprazolam has been reported as an adulterant in UK heroin and in a recent Scottish incident was sold as heroin.
Alprazolam is not available on the NHS, but is available in 0.25mg (250mcg) and 0.5mg (500mcg) tablets with a private/online prescription. Other websites offer alprazolam in 1mg and 2mg doses without a prescription.
Alprazolam is controlled by the Misuse of Drugs Act as a Class C schedule 4 drug. Possession is legal if the drug was obtained with a prescription. Possession without a prescription could lead to a charge (maximum sentence up to 2 years). Supplying or attempting to supply alprazolam carries penalties of up to 14 years and/or a fine.
Drug screening: Alprazolam will cross react with most benzodiazepine immunoassays but it will be present in urine at much lower amounts than diazepam because the effective dose is 20 times lower. It is detectable after high doses. Not all immunoassays use the same antibodies so their sensitivity to alprazolam may vary.
More information can be found here
You can also read the Public Health England Briefing
