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