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Alprazolam Abuse During Methadone Maintenance Therapy FREE

William W. Weddington, Jr, MD; Anne C. Carney, MA, CRC
JAMA. 1987;257(24):3363-3363. doi:10.1001/jama.1987.03390240069016
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To the Editor.—  Alprazolam (Xanax), a short-acting triazolobenzodiazepine, has been demonstrated to be a potent anxiolytic,1 efficacious for panic disorder.2 In two drug abuse clinics in Baltimore and Chicago, we have noted abuse of and dependency on alprazolam by opiate-dependent patients receiving methadone maintenance therapy. We have received reports that physicians in emergency departments and medical clinics are willing to prescribe alprazolam rather than other benzodiazepines to walk-in patients, particularly if the individual complains of "panic attacks" and anxiety.Taking 20 to 40 1.0-mg alprazolam tablets after ingesting methadone produces a high without pronounced sedation. Five patients receiving methadone maintenance therapy have required hospitalization for detoxification from alprazolam. Reportedly, alprazolam is also being used and abused by nonopiate-drug abusers, much as diazepam was abused prior to increased physician awareness.Unfortunately, it is now common knowledge on the street that the usual urine toxicology screens for benzodiazepines often give

REFERENCES

Rickels K, Csanalosi I, Grisman P, et al:  A controlled clinical trial of alprazolam for the treatment of anxiety . Am J Psychiatry 1983;;140:82-85.
Sheehan DV, Coleman JH, Greenblatt DJ, et al:  Some biochemical correlates of panic attacks with agoraphobia in their response to a new treatment . J Clin Psychopharmacol 1984;;4:66-78.
Klein E, Uhde TW, Post RM:  Preliminary evidence for the utility of carbamazepine in alprazolam withdrawal . Am J Psychiatry 1986;;143:235-236.
Busto U, Sellers EM, Narranjo CA, et al:  Withdrawal reaction after long-term therapeutic use of benzodiazepines . N Engl J Med 1986;;315:854-859.

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Rickels K, Csanalosi I, Grisman P, et al:  A controlled clinical trial of alprazolam for the treatment of anxiety . Am J Psychiatry 1983;;140:82-85.
Sheehan DV, Coleman JH, Greenblatt DJ, et al:  Some biochemical correlates of panic attacks with agoraphobia in their response to a new treatment . J Clin Psychopharmacol 1984;;4:66-78.
Klein E, Uhde TW, Post RM:  Preliminary evidence for the utility of carbamazepine in alprazolam withdrawal . Am J Psychiatry 1986;;143:235-236.
Busto U, Sellers EM, Narranjo CA, et al:  Withdrawal reaction after long-term therapeutic use of benzodiazepines . N Engl J Med 1986;;315:854-859.
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