DETECTION OF ALPRAZOLAM IN 3 CASES OF METHADONE BENZODIAZEPINE OVERDOSE/

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 relative ly difficult to confirm. We recently reported a modification of an exi sting 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 detect ed by HPLC and could not be identified by alkaline extraction GC/MS. P ostmortem 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 methadon e and alprazolam.