Benzodiazepine Abuse on the Rise

The steady illicit use of benzodiazepines, especially alprazolam, should not be ignored.

Most of the uproar about the abuse of pharmaceuticals over the past several years has centered on analgesic opiates—oxycodone and hydrocodone, to be specific. There is no question that these drugs deservedly occupy the attention of those involved in trying to prevent drug abuse, educate the public, or arrest those breaking the law.

However, always in the background is another source of abuse and diversion regarding the benzodiazepines of the world. No drug in this category is more abused than alprazolam, ranking a strong third behind the 2 most abused pain medications. Alprazolam gets into a user’s system faster, making it the popular choice of abusers over diazepam and similar sedatives.

The strongest form of alprazolam (2 mg) consistently brings $3 per pill on the illicit market, and the desire for this drug never seems to lessen anywhere in the United States. Because alprazolam is relatively cheap compared with the cost of opioids, it’s not unusual for patients to be able to sell all of their entire monthly supply to willing prescription drug seekers.

The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that the number of emergency department visits concerning the abuse of alprazolam doubled between 2005 and 2010, peaking at 123,744 visits in 2011. This rise was seemingly unnoticed, as the abuse of prescription opiates was also surging during this time, with the combination of the 2 drugs, or the addition of alcohol, being potentially deadly. SAMHSA also indicates that alprazolam was the 13th-most commonly sold medication in 2012, and it was the psychiatric medication most commonly prescribed in 2011.

“The nonmedical use of alprazolam can lead to physical dependence, causing withdrawal symptoms such as tremors and seizures. If alprazolam is combined with alcohol or other drugs that depress the central nervous system— such as narcotic pain relievers—the effects of these drugs on the body can be dangerously enhanced,” according to the SAMHSA report.

To add to the legitimate prescribing and dispensing of alprazolam in the United States, several years ago my office uncovered an incredible operation that had its source in Mexico. One of our Ohio citizens was traveling every 2 weeks from Southwest Ohio to a little town just north of San Antonio, where he met an individual who brought him 100,000 alprazolam tablets for $0.50 each. Our enterprising trafficker then brought the tablets back to Ohio, where he was able to fetch $1 per pill, making a tidy $50,000 profit every 2 weeks! These pills, of course, were then sold for $3 each on the Ohio illicit market.

This went on for more than 3.5 years, with millions of dosage units entering the United States and making their way to Ohio. Once we discovered this activity, we were able to buy 7000 of the pills. When approached by law enforcement, the entrepreneur decided it was best to cooperate. He took us to Texas, where, along with the Texas Department of Public Safety, we were able to make one last buy from the border crosser, seizing 100,000 of the benzodiazepine tablets.

Once we made this arrest, I was naïve enough to think that we had stopped the flow of this pharmaceutical, but quickly discovered that our Ohio guy was only one of many that were trafficking in the same drug and distributing it in their own part of our country. It remains a popular drug in the night scene of Miami Beach, for example, as well as other party locations.

I don’t think anyone would suggest that we discontinue our vigilance on the abuse and diversion of pain medications, but the steady illicit use of benzodiazepines, especially alprazolam, should not be ignored either. It has been, and continues to be, a major source of misuse and abuse in the prescription drug scene, often being part of the polypharmacy that contributes to unintentional prescription overdose deaths.

Cmdr Burke is a 40-year veteran of law enforcement and the current president of the National Association of Drug Diversion Investigators. He can be reached by e-mail at burke@choice.net or burke@naddi.org or via the website www .rxdiversion.com.