title: Detection of alprazolam in three cases of methadone/benzodiazepine overdose.
abstract: Benzodiazepine abuse is common among clients at methadone maintenance clinics. Diazepam and lorazepam are readily detected by immunological screening methods and confirmed by GC/MS. Alprazolam has been relatively difficult to confirm. We recently reported a modification of an existing serum HPLC procedure which allows us to analyze whole blood. We report here three cases of fatal drug overdose caused by co-ingestion of methadone and alprazolam. In all three cases, alprazolam was detected by HPLC and could not be identified by alkaline extraction GC/MS. Postmortem blood concentrations of methadone were at the lower range or below the concentrations previously identified in methadone overdose fatalities, suggesting an increased risk from co-ingestion of methadone and alprazolam.
authors.affiliation: University of Alabama at Birmingham 35294, USA.
authors.forename: W O
authors.initials: WO
authors.lastname: Rogers
authors.forename: M A
authors.initials: MA
authors.lastname: Hall
authors.forename: R M
authors.initials: RM
authors.lastname: Brissie
authors.forename: C A
authors.initials: CA
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000525:Alprazolam / Q000032:analysis / Q000097:blood* / Q000506:poisoning*; D014151:Anti-Anxiety Agents / Q000032:analysis / Q000097:blood* / Q000506:poisoning*; D001569:Benzodiazepines / Q000032:analysis / Q000097:blood* / Q000506:poisoning*; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D004347:Drug Interactions; D062787:Drug Overdose; D005260:Female; D005554:Forensic Medicine; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008099:Liver / Q000737:chemistry; D008297:Male; D008691:Methadone / Q000032:analysis / Q000097:blood* / Q000506:poisoning*; D009294:Narcotics / Q000032:analysis / Q000097:blood* / Q000506:poisoning*; D015813:Substance Abuse Detection
chemical_list: D014151:Anti-Anxiety Agents; D009294:Narcotics; D001569:Benzodiazepines; D008691:Methadone; D000525:Alprazolam