Top Prescription Drugs of Abuse?Part 2

Pharmacy Times
Volume 0

John Burke, director of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 36-year veteran of law enforcement. For information, he can be reached by email at, by phone at 513-336-0070, or via the Web site

The benzodiazepines continue to be among the top prescription drugs of abuse. Drugs in this class are used by themselves, in combination with other prescription drugs, with alcohol, and with other illicit drugs.

Some experts think that the benzodiazepines are as big a problem as the prescription opiates. As with prescription drug abuse in general, it is difficult to determine the extent of the problem, but no one disputes the devastation that these drugs have caused abusers. High-level abusers require a gradual tapering of benzodiazepines in order to accomplish a safe and effective rehabilitation attempt.

As a young officer in Cincinnati in the late 1960s and early 1970s, I remember the abuse problems with diazepam on the streets. Along with prescription opiates, it was a popular street drug that was sold and exchanged for heroin and other street drugs.

Diazepam continues to be an abuse problem, and it brings approximately $1 to $2 a pill on the street. Abusers can reach 30 pills a day and, in some cases, considerably higher levels. In addition to being abused by itself, diazepam also can be used in an attempt to mitigate uncomfortable feelings that are associated with coming down off of other prescription or illicit drug highs.

One of the more interesting diazepam scams involved an individual who used his dog to doctor-shop veterinarians. He told the veterinarians that his lapdog, Dolly, had a lot of anxiety, and that diazepam (Valium) had successfully been used in the past. He would visit 5 veterinarians each month, and, if Dolly did have anxiety, she never received the drugs!

Although diazepam has definitely been the strongest benzodiazepine of abuse over the past several decades, alprazolam seems to have become the choice over the past couple of years. The reason seems to be that more and more alprazolam is being prescribed, and to possibly a younger group of patients.

A local school principal recently told me about an 11-year-old and two 12-year-old students who were prescribed alprazolam (Xanax). Apparently, these students were coming to school and telling fellow students how good they felt taking the pharmaceutical, and urging the fellow students to persuade their parents to take them to their physician for their own prescription.

Alprazolam also has become a favorite of abusers because it enters the system faster than other similar drugs. This speed can help create the rush that abusers crave, accounting for the increase in diversion.

Street values of alprazolam are about $3 per pill, and it was the top prescription drug that our task force purchased from street sellers last year. In a recent arrest of some high-level drug dealers in southwest Ohio, we recovered 21,800 alprazolam tablets from a single individual. Incidentally, because we did not have an automated pill counter at the time of the seizure, we weighed the pharmaceuticals until they could be counted. You might be interested to know that 21,800 alprazolam tablets weigh just over 7 pounds! We are attempting to pursue the source of these drugs, which is likely outside the United States.

Other benzodiazepines certainly have abuse potential?such as lorazepam and oxazepam. As I write this article, our undercover officers have just purchased more than 150 clonazepam tablets from a local dealer who has been supplying several abusers with benzodiazepines and hydrocodone.

Benzodizaepines continue to be in demand by a wide array of abusers in the United States and abroad. There is no indication that this trend will not continue as it has for several decades. The additional concern, however, is that these drugs will continue to be prescribed to younger patients, causing more widespread abuse among 12- to 17-year-olds.

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