Alprazolam Abuse During Methadone Maintenance Therapy

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