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Recent increase in detection of alprazolam in Victorian heroin-related deaths

The use of benzodiazepines by opioid-dependent people is widespread.14 The 2011 Victorian Illicit Drug Reporting System (IDRS), a sentinel survey of people who inject drugs (PWID), reported 92% lifetime and 71% recent (in the past 6 months) use among PWID.5 PWID use benzodiazepines for a number of reasons: to enhance the intoxicating effects of heroin or other opioids, manage anxiety, or manage withdrawal symptoms.3

The contribution of benzodiazepines to heroin overdose is well established.6,7 Alprazolam is a benzodiazepine registered in Australia for short-term treatment of anxiety and panic disorder. It is not recommended as first-line treatment because of concerns about risks of dependence and its potential for misuse.4,8

Alprazolam, like other commonly misused drugs, has a rapid onset and offset of action and high potency.8