A white oval pressed pill with score lines and ‘2’ on one side expected to contain alprazolam was found to contain paracetamol and tramadol instead. No alprazolam was detected.

What does this mean?

Benzos (expected) are drugs typically used to sedate and treat anxiety. Tramadol (detected) is an opioid with SNRI-like properties, commonly used for short-term relief or severe pain. This is the first time that tramadol has been detected in an expected benzo sample at CanTEST.

Effects of using tramadol with benzos can have serious side effects, like profound sedation and respiratory distress, and your risk of harm is increased if you use other depressants with tramadol.

Avoid combining tramadol with: SSRIs (e.g. sertraline), SNRIs (e.g. venlafaxine), MAOIs (e.g. phenelzine, moclobemide); Tricylcic antidepressants (TCAs); Ketamine and analogues; Mirtazapin; Antihistamines (sedating); Gabapentinoids (e.g. pregalbin, gabapentamin); Buproprion; antipsychotics (or other drugs that lower the seizure threshold); MDMA or other serotonergic drugs and stimulants like cocaine and amphetamine (these can cause serotonin toxicity – when a person’s entire body is overloaded with serotonin).

Signs of serotonin toxicity include confusion, agitation, overheating, seizures, fits, fast/irregular heavy rhythm, muscle tension, uncontrolled movements (e.g. shaking foot/leg, wobbling eyes), nausea/vomiting, loss of consciousness.

Carry Naloxone – it can reverse an opioid overdose. It will not cause harm to administer if someone is showing signs of an overdose and you’re unsure if they’ve consumed opioids. Signs include lowered/loss of consciousness, breathing slowly or not at all, tiny/pinpoint pupils, discoloured lips/nails, cold or clammy skin, choking/coughing/gurgling or snoring sounds. Always keep naloxone on hand. Search ‘Take Home Naloxone’ to get locations for free naloxone anywhere in Australia. You can get Nyxoid spray naloxone for free from CanTEST.

Alprazolam is not readily available from Australian pharmacies. While other brands containing alprazolam can be obtained on prescription, ‘Xanax’ bars are not available in Australia. This means you can expect most if not all ‘Xanax’ bars to be counterfeit, containing novel benzodiazepines of or in addition to alprazolam.

Start low, go slow. Try a test dose first and never use alone.

Test your stuff! A global trend is that unregulated or counterfeit pharmaceuticals, such as benzodiazepines, are becoming more common and very convincing, making them hard to distinguish from legitimate pharmaceutical products. In some cases, there are several different benzos inside a single pill, or something completely unexpected – drastically raising the risk for users.

Be alert for signs of an overdose. Think someone has overdosed? Call 000 for an ambulance immediately.