Description
Alprazolam (commercialised or often sold under the trade name Xanax) is a popular benzodiazepine drug prescribed for the treatment of anxiety, stress, depression, panic attacks, and sleep disorders. In the UK, it is taken by private prescription patients and people sourcing them through the unregulated market, the latter due to its relaxant properties which help individuals ‘chill out’ and feel more sociable.
In recent years, many illegally pressed alprazolam pills have been found to contain (or be totally composed) of other drugs, including novel benzodiazepines and opioids. Even pills seemingly branded with commercial names and bought in blister packs may have been pressed in illegal contexts, meaning they could have other substances within them. Getting their contents checked through drug checking services is key.
Tolerance to alprazolam develops very quickly, requiring higher doses to achieve the same feeling. Regular and/or high dosing can lead to dependence, and potentially life-threatening withdrawal symptoms if stopped abruptly.
Desirable Effects
- Relaxation
- Sleepiness/sedation
- Occasional mild euphoria (happiness)
Undesirable Effects
- Drowsiness
- Dizziness/loss of co-ordination
- Headaches
- Blackouts/amnesia
- Respiratory depression when used in combination with opioids or other central nervous system depressants
What does it look like?
Small pills, usually oval or rectangle ‘bars’, though can be other shapes. They come at different strengths (0.25mg, 0.5mg and 1mg being the most common). They come in a range of different colours (white, orange, baby blue and pink/red most often), with the colour usually linked to the strength of the pill. They are also found (rarely) in capsule form.
Method of Use
Swallowed: pill or capsule
Pharmacology
Alprazolam is a GABA-A receptor positive allosteric modulator. This means that alprazolam increases the effects of GABA, our brain’s main inhibitory neurotransmitter which turns down nerve signals, thereby calming the brain and subsequently the mind.
Alprazolam has a high oral bioavailability of 80–90%, meaning it is efficiently absorbed when taken by mouth. Following oral administration, alprazolam is quickly absorbed and metabolised by the body. Peak concentrations in blood plasma (proportionate to the dose) occur approximately 1–2 hours after ingestion. Immediate release alprazolam has a duration of around 6 hours.
Alprazolam is metabolised in the liver by the CYP3A4 enzyme. It is advised not to take alprazolam alongside eating/drinking grapefruit or other CYP3A4 inhibitors (e.g. combined contraceptive pill, some SSRIs, antifungals, and antiretrovirals) when taking alprazolam. Alprazolam and its metabolites are mainly removed from the body in urine by the kidneys, with 50% removed within 11–16 hours, depending on formulation and individual variations.
When alprazolam is taken long term, the brain’s GABA receptors become desensitised, requiring higher doses for the same effect. It is advised that people taking alprazolam long term do not stop suddenly using (quitting cold-turkey). Desensitised GABA receptors take a while to get back to baseline, meaning they will be unable to keep nerve signals in check without alprazolam which may lead to dangerous withdrawal symptoms such as seizures. Instead, it is advised to gradually taper the dose down under medical supervision.
As alprazolam turns down brain signals, combining the drug with other depressant drugs increases the risk of overdose. Drinking alcohol alongside alprazolam can cause severe sedation, intoxication and blackouts. In combination with opioids, alprazolam can slow down breathing to dangerous, potentially fatal, levels.
History
Alprazolam was one of several drugs created by Dr Jackson B. Hester Jr. for the Upjohn Company (now part of Pfizer), who applied for the patent in 1969 and brought it to market as ‘Xanax’ in 1981. The patent expired in 1993 and, while Pfizer still holds the trade name ‘Xanax’, a number of generic variants have since come on to the market. Some illicit producers of alprazolam use Xanax logos and typography to make their product look genuine.
The non-prescribed use of the drug has been recorded since the earliest days of its release, and has been associated with the death of several high profile individuals including rapper Lil Peep and actor Heath Ledger (although in both cases, toxicology reports highlighted multi-drug combinations, including fentanyl, oxycodone, diazepam, and more).
Alprazolam’s efficacy as a sedative means it has been widely prescribed, and the quick build-up of tolerance has meant many who started taking it under doctors’ guidance have been driven to obtaining it on the unregulated market in order to sustain their increased needs. In 2022, several young people across the UK reported taking non-prescribed alprazolam and other benzos to self-medicate for anxiety and other unmet mental health needs.
In the early-to-mid 2020s, WEDINOS detected many counterfeit alprazolam pills across the UK containing novel benzodiazepines and opioids including tramadol and metonitazene, which have been connected to traffic fatalities.
Law
Possible offences
- Possession
- Maximum sentence – 2 years/fine/both
- Possession With Intent To Supply
- Maximum sentence – 14 years/fine/both
- Supply (including being concerned in supply, conspiracy to supply, aggravated supply and offer to supply)
- Maximum sentence – 14 years/fine/both
- Production
- Maximum sentence – 14 years/fine/both
In practice maximum sentences are rarely used, for more detailed and accurate information go to our sentencing page.
