Alprazolam, better known by its brand name Xanax, is a commonly prescribed anxiolytic medication. Alprazolam is a fast onset, short-acting medication used for the treatment of anxiety and panic disorders.
- It is in the benzodiazepine class of medications and exerts its effects by inhibiting certain types of brain activity to decrease anxiety.1 It is among the most commonly prescribed psychotropic medications in the United States.2
- It is frequently prescribed in tablet form, in both immediate- and extended-release formulations. Prescription guidelines will vary between the two. The drug should only be used as directed because any misuse of this benzodiazepine can be harmful or even life-threatening.1
- Even with the known dangers, many people take Xanax in excess of prescribed guidelines or use it as a recreational drug—often in combination with alcohol and other drugs. The effects sought by these users include: a sense of euphoria, relief from stress or anxiety, feelings of calm, a release of tension, and sedation.3
- In some instances, people may attempt to misuse Xanax by either snorting or injecting the crushed tablets to experience more rapid or more intense effects. While such methods of misuse may occur with alprazolam alone, they often happen in the setting of additional substance use. For example, some stimulant users may use alprazolam to ease the adverse symptoms they would otherwise experience as part of the stimulant comedown.4
- Additionally, the co-abuse of benzodiazepines and opioids is common, as users report getting a stronger euphoric high when they combine the two.5
Xanax Side Effects
Although Xanax is a commonly prescribed medication, it does have some fairly well-known side effects, even when used as prescribed. These effects may include:1,6
- Low blood pressure.
- Blurry vision.
- Slurred speech.
- Appetite/weight changes.
- Dry mouth.
- Changes in libido.
The incidence and magnitude of some of the effects may be greater with misuse. Very serious side effects that may be more likely when the drug is misused include:1,6,7
- Profound confusion.
- Shortness of breath.
- Impaired memory.
- Anterograde amnesia (blackouts).
- Changes in seizure threshold.
- Abnormal behavior or mood changes.
- Suicidal ideation.
Xanax may also heighten the known risks of other medications such as opioids. For example, opioids are associated with a risk of respiratory depression, and taking a benzodiazepine like alprazolam in combination with this drug type can worsen this effect. In fact, a number of studies conducted on the concurrent use of opioids and benzodiazepines suggest that up to 80% of unintentional opioid overdose deaths may involve benzodiazepines.5
Health Risks of Snorting Xanax
People may attempt to snort Xanax because they think it will enable them to feel the effects of alprazolam faster and more intensely than the intended route of ingestion allows. The crushed medication, when snorted, initiates a more rapid onset of the drug’s effects, greater potency, and a modestly increased abuse potential.8
There are many potential health risks associated with snorting any particulate substances, including crushed Xanax. These include:9,10
- Chronic inflammation of the nasal passages.
- Airway irritation.
- Frequent runny nose.
- Hoarse voice.
- Loss of smell.
- Problems swallowing.
Also, because snorting Xanax can result in an amplification of drug effects,8 the potential for adverse events could also be greater (e.g., impaired cognition, profound sedation, accidents/injury, intensified respiratory depression with or without additional drugs on board, overdose, etc.).
Health Risks of Injecting Xanax
Xanax is not one of the benzodiazepines that is commonly injected, mainly because it is not water-soluble and not easy to make into an injectable solution.6 However, some people do attempt to dissolve the drug in other solutions such as alcohol in order to inject it. Attempting to inject alprazolam can cause serious health problems for the individual, including:10,11
- Infection: Unsanitary or improperly used needles and syringes can cause infections at injection sites. Some infections may be severe, may spread throughout the body, and could require surgical intervention/amputation to prevent life-threatening complications.
- HIV: The human immunodeficiency virus that progresses to AIDS is spread through shared needles.
- Hepatitis: Much like HIV, hepatitis can be passed from one person to another via a shared needle.
- Sudden overdose: Because injected Xanax enters the bloodstream instantly, there could be an increased risk for an accidental overdose.
Drugs That Are Commonly Snorted
Many abusers of drugs will attempt to snort their drug(s) of choice in order to obtain a faster or more intense high. Some people will use one or more of these drugs in combination with Xanax. Other drugs that are commonly snorted, and could be used in conjunction with Xanax via an intranasal route, include:12,13
- Cocaine: This stimulant drug, derived from the coca plant, is most commonly snorted.
- Amphetamines: Like cocaine, pharmaceutical amphetamines (e.g., Adderall or dextroamphetamine) are also psychostimulant drugs. These therapeutic medications are routinely prescribed to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. Those abusing these drugs will often crush and snort them for a quick euphoric high.
- Opiate painkillers: Prescription painkillers, such as Percocet, Vicodin, and OxyContin, are commonly crushed and then snorted. Opioids and benzodiazepines are abused together all-too-frequently, and the combination may be deadly.
- Heroin: Another opioid, some forms of heroin may be snorted for a rapid high. Heroin users also sometimes add benzos to the mix to boost the euphoria and intensify the subjective high.
Drugs That Are Commonly Injected
Some of the most commonly injected drugs, many of which may also be abused in combination with Xanax, include:12
- Heroin: Heroin abuse frequently progresses to injection use.
- Prescription opioids: People may abuse opioids by injecting them, and doing so may significantly increase the risk of overdose, especially if benzodiazepines are used as well.
- Amphetamines: There is a wide range of pharmaceutical amphetamines, including Adderall, Dexedrine, and Desoxyn, that can be injected after the pills are crushed and combined with water or another liquid.
- Cocaine: Though cocaine is most commonly snorted, it can also be injected.
- How a drug is taken may change some of its associated risks. In the case of Xanax, the medication is intended for oral use. When taken in prescribed doses, enteric absorption (through the gastrointestinal tract) allows for the drug to become active safely and gradually.
- In the case of extended-release formulations, oral routes allow for the time-release mechanism to function as designed. As discussed, when Xanax is crushed and either injected or snorted, drug effects may be felt more rapidly and more intensely. The likelihood of accidental overdose is increased, as are other health risks, as outlined above.
- If you are taking Xanax in ways other than prescribed and need help to stop, there are treatment options for you. Treatment may require an initial period of medical detox, as benzodiazepine withdrawal can be a significantly distressing, and sometimes life-threatening, situation.14
- In a detox environment staffed with medical professionals, you will be given medications to prevent serious adverse events and to increase your comfort. You may also undergo a slow, monitored taper off of Xanax or a replacement sedative to manage your withdrawal.14
- The thought of withdrawal can be a frightening one, but staff at these programs know how to care for you and make you as comfortable as possible. They can also help you make the transition into ongoing addiction treatment so that you can gain a strong foothold in recovery.
- U.S. National Library of Medicine, Medline Plus. (2018). Alprazolam.
- University of Washington. (2018). Commonly Prescribed Psychotropic Medications.
- Center for Substance Abuse Research. (2013). Benzodiazepines.
- Motta-Ochoa R, Bertrand K, Arruda N, Jutras-Aswad D, and Roy É. (2017). “I love having benzos after my coke shot”: The use of psychotropic medication among cocaine users in downtown Montreal. Int J Drug Policy, 49, 15-23.
- Gudin, J. A., Mogali, S., Jones, J. D., & Comer, S. D. (2013). Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgraduate medicine, 125(4), 115-30.
- Pfizer. (2016). Xanax alprazolam tablets, USP.
- McIntosh B, Clark M, Spry C. (2011). Benzodiazepines in Older Adults: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines. Canadian Agency for Drugs and Technologies in Health.
- Reissig, C. J., Harrison, J. A., Carter, L. P., & Griffiths, R. R. (2014). Inhaled vs. oral alprazolam: subjective, behavioral and cognitive effects, and modestly increased abuse potential. Psychopharmacology, 232(5), 871-83.
- National Institute on Drug Abuse. (2018). What is cocaine?
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Garretty et al. (1997). Benzodiazepine misuse by drug addicts. Ann Clin Biochem,34, 68-73.
- U.S. Department of Justice, Drug Enforcement Administration. (2017). Drugs of Abuse.
- National Institute on Drug Abuse. (2018). Prescription Stimulants.
- Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 4 Physical Detoxification Services for Withdrawal From Specific Substances.