Legal Status

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.

Routes of Administration

ORAL

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.

SNORTING

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 or INJECTING

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.

Effects

Physical effects may include:

  • Sedation
  • Dizziness
  • Muscle relaxation
  • Motor control loss
  • Respiratory depression
  • Seizure suppression
  • Decreased heart rate
  • Perception of bodily heaviness
  • Physical euphoria
  • Visual effects
  • Blurred vision
  • Slurred speech

Psychological effects may include:

  • Amnesia
  • Anxiety suppression
  • Confusion and slowing of thoughts
  • Euphoria
  • Disinhibition
  • Compulsive redosing
  • Dampening of emotions
  • Lethargy

Tolerance, Dependence and Withdrawal

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.

Overdose

Signs of an overdose include confusion, impaired coordination, diminished reflexes and coma. Overdose death has been reported with alprazolam alone and with a single alprazolam tablet and alcohol. Fatalities from taking alprazolam alone are thought rare, however 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.

Harm Reduction Advice

  • Wherever possible, do not use on your own.
  • Look after your friends.
  • Alprazolam is 20 times the potency of diazepam. Try a small test amount (e.g. 0.25mg) and wait at least 1 hour before taking any more.
  • Do not drive or operate machinery as accidents can occur from everyday activities… like trying to stand up.
  • Place sleeping people in the recovery position.
  • Injecting crushed tablets in a solution is very dangerous as the tablets contain high amounts of filler which can lead to collapsed veins and cause serious vascular and tissue damage.
  • Be aware that tolerance and dependency can develop quickly.
  • It is best not to take alprazolam on a regular basis and for more than 4 weeks due to the tolerance and dependence that can develop.
  • If you have been using on a regular basis alprazolam should not be stopped suddenly. Always reduce use gradually with your doctor’s supervision.
  • The risk of overdose is much higher when alprazolam is taken together with alcohol, opioids or any other depressant drugs.
  • Naloxone will not reverse the effects of benzodiazepine drugs like alprazolam.

 

More information can be found here Download PDF File

 

You can also read the Public Health England Briefing 

 

 

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