Xanax is the most famous brand name version of alprazolam, a short-acting benzodiazepine prescribed to treat anxiety and panic attacks, typically on an as-needed basis. Anxiety conditions treated by Xanax include generalized anxiety disorder (GAD), anxiety associated with depression, and panic attacks. This medication is sometimes used to treat depression, but this is usually an off-label treatment because it is rare.
Alprazolam usually can be found as a tablet with both immediate-release and extended-release formulas. It also may be administered as a liquid.
Because Xanax is one of the most widely prescribed medications in the United States, it is also one of the most widely abused. The National Institute on Drug Abuse (NIDA) reported that the majority of emergency room admissions attributed to central nervous system (CNS) depressants were due to benzodiazepines.
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Although Xanax is often reported in instances of overdose and is widely abused, the Drug Enforcement Administration (DEA) has kept the medication listed as a Schedule IV substance, meaning it is easier to acquire through prescription than other substances like oxycodone.
The History of Xanax Use and Abuse
The first benzodiazepine in the U.S. was Librium, available to the general public in 1957. Valium became the most popular sedative after that, with songs and literature throughout the 1960s and 1970s pointing to barbiturates and benzodiazepines as problematic, widely abused drugs.
Action was not taken on benzodiazepine abuse in the U.S. until the 1980s, when this class of medications became the most widely prescribed in the country.
To this day, they are still among the most widely prescribed drugs despite their risks.
Alprazolam received its German patent in 1970, with the corresponding U.S. patent being granted in 1976. The pharmaceutical company Pfizer created Xanax, and the U.S. Food and Drug Administration (FDA) approved the benzodiazepine for prescription use in 1981.
Since then, generic versions have been created for prescription use, and different brand-name intensities have also been created. For example, Xanax XR (extended release) is manufactured by Pfizer while Alprazolam Intensol (liquid injection) is manufactured by West-Ward Pharmaceuticals.
How Xanax Works and Why It Leads to Addiction
Like other medications in the benzodiazepines family, Xanax works by binding to the gamma-Aminobutyric acid (GABA) receptors in the brain.
When binding to these receptors, benzodiazepines allow for the GABA neurotransmitter to remain more available to slow down communication between neurons.
People who have anxiety or panic disorders have receptors that use a lot of the GABA neurotransmitter, so there is not much available for neurons, leading to rapid firing and a sense of panic, stress, or tension. When there is more GABA available for the neurons, these communications slow down, leading to a feeling of calm, relaxation, and, for some, a pleasant high that may lead to addiction.
Anxiety disorders are among the most common forms of mental health conditions in the U.S. today, so benzodiazepine drugs like Xanax have an important place in treatment. According to a 2017 article in TheNewYorkTimes, data found via the National Institute of Mental Health (NIMH) reported that 38 percent of girls between the ages of 13 and 17, and about 26 percent of boys in the same age group, had an anxiety disorder. Anxiety is the leading mental condition reported on college campuses as of 2016, ahead of depression. In 2013, there were about 48 million prescriptions for alprazolam in the U.S.
Typical prescribed tablet doses include 0.25 mg (milligrams), 0.5 mg, 1 mg, and 2 mg. Prescription tablets are scored so they can be split in half. Liquid versions of this drug include a dropper with measurements on the side.
Xanax’s effects will begin in less than an hour after you take the drug, and the effects typically last one to two hours, depending on the dose. The drug’s half-life is about 11 hours. While the effects hit and peak quickly, metabolites remain in the body for a long time, increasing the risk of damage or overdose if you take more Xanax or mix it with other sedatives like alcohol.
Alprazolam has been reported as a preferred substance of abuse to equally potent doses of diazepam, most commonly known as Valium. This is likely due to Xanax’s faster action, getting into the bloodstream and binding to the GABA receptors faster than diazepam. The high occurs quickly, which can make it feel more intense. While it is important for some drugs like Xanax to have this action because the rapid onset can stop a panic attack, the speed that the drug becomes bioavailable also increases the risk of its abuse.
According to the Treatment Episode Data Set (TEDS), in the decade between 1998 and 2008, the number of people seeking treatment to end addiction to benzodiazepines tripled. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that there were 1.2 million admissions to the emergency room involving nonmedical abuse of prescription drugs in 2011, and Xanax was involved in 10 percent of those admissions; the total was around 123,744 that year.
Benzodiazepine abuse is often referred to as a “shadow epidemic” in the U.S., involved in many overdoses but rarely by itself. While most attention is focused on the approximately 70 percent of drug overdoses from opioid painkillers, benzodiazepines like Xanax are involved in about 30 percent of drug overdoses.
Short-Term Side Effects
When you start taking Xanax, even if you take it as prescribed by your doctor, you may experience some side effects. This is normal for a sedative, and if any of them bothers you, your doctor can adjust your dose, so you can get the positive effects of this medication without suffering too much sedation or discomfort. People who abuse Xanax, however, take this drug to get high, which means they take large doses that escalate over time regardless of the side effects.
Common side effects associated with Xanax, especially Xanax abuse, include the following:
- Sleepiness or drowsiness
- Dry mouth
- Impaired physical coordination
- Slurred speech
- Acting or appearing drunk
- Memory problems
- Low physical and mental energy
- Feeling sedated
- Rebound anxiety or nervousness
It is extremely rare for a doctor to prescribe Xanax in high doses, especially if the drug will be taken regularly for several weeks. This pattern is more likely to indicate drug abuse or addiction. In large doses, benzodiazepines like Xanax can cause the following:
- Slowed reflexes
- Mood swings
- Erratic or hostile behavior
- Euphoria or feeling high
Long-Term Brain Damage
Long-term consumption of any benzodiazepine is not recommended because tolerance and dependence can occur rapidly. Specifically, people who abuse Xanax can quickly develop a tolerance for the sedative, hypnotic, and anticonvulsant actions of the drug — that is, the substance quickly becomes less useful for calming panic, inducing sleep, or reducing seizures. The anxiolytic and amnesiac effects — or the reduced anxiety and increased memory loss effects — appear to remain consistent, and there is not a reduction in the drug’s impact. This means that people who abuse Xanax in increasing doses are likely to experience less chronic anxiety, but more likely to experience blackouts and memory loss with higher doses while experiencing less intoxication and sedation.
Abusing Xanax has been associated with long-term brain damage affecting mood, emotions, and cognition, including chronic depression, psychotic episodes, aggression, and impulsive behavior. If you notice that you are taking Xanax in a problematic way — either more than prescribed or without a prescription — it is important to get help to end this drug abuse before you develop long-term harm.
Brain damage caused by long-term Xanax abuse, especially cognitive problems, takes a very long time to heal, if the problem ever goes away. One study found in a six-month follow-up that cognitive damage remained even though the study participants had quit abusing alprazolam.
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Overdose Requires Medical Treatment
Overdoses involving benzodiazepine drugs, especially Xanax, have been on the rise in the past several years; however, benzodiazepines are not the leading drug involved in overdose deaths. Although it is possible to overdose on Xanax by itself, most overdoses and related deaths involving alprazolam and related drugs also involve other sedatives, especially opioid narcotics, alcohol, or both.
Warnings on Xanax clearly state that taking benzodiazepines with opioid painkillers is dangerous because it can lead to an overdose, so it is important to speak with your doctor if you take one of these medications and receive a prescription for the other.
It is also important to avoid drinking alcohol if you take Xanax because the two drugs work on the GABA receptors in the brain. When combined, alcohol and Xanax can increase sedation to the point that you pass out, struggle to breathe, or suffer other overdose symptoms. Similarly, mixing benzodiazepines like Xanax and Klonopin, Valium, Librium, Halcion, and other drugs, or mixing Xanax with other sedatives like barbiturates or sedative-hypnotic drugs, can lead to an overdose.
Other overdose symptoms associated with Xanax include:
- Extreme confusion and an inability to mentally keep up with events
- Intense drowsiness to the point of passing out
- Very impaired coordination, like being very drunk
- Suppressed breathing
- Low blood pressure
- Slowed or irregular heartbeat
Suffering an overdose on any drug, including Xanax, can be fatal. It is extremely important to call 911 to get emergency medical treatment for anyone exhibiting the above symptoms.
Flumazenil is a medication found to temporarily reverse benzodiazepine overdoses, so applying this substance may be useful in treating a Xanax overdose. However, it does not work as well for an overdose involving multiple substances, which is more common with Xanax overdose.
Withdrawal Symptoms Require Medically Supervised Detox
If you take Xanax regularly as prescribed by your doctor and you want to stop, you and your physician will work together to taper off this prescription drug. Taking benzodiazepines like Xanax consistently for more than two weeks can lead to tolerance and dependence even if you do not abuse the medication.
With a doctor’s oversight, tapering off Xanax is a simple process that takes a few days; however, if you abuse Xanax and do not have a doctor’s oversight to taper off this medication, you may experience withdrawal symptoms if you try to quit. Attempting to quit cold turkey, or cease taking the medication suddenly, can lead to uncomfortable symptoms and cravings for most drugs. In the case of benzodiazepines, there are life-threatening side effects associated with the withdrawal process.
Without tapering or other medical assistance, the withdrawal symptoms associated with alprazolam can be varied and dangerous. They include:
- Rebound anxiety
- Insomnia and other trouble sleeping
- Blurry vision
- Physical discomfort
- Aggression and mood swings
While many of these symptoms are manageable with some over-the-counter medication and rest, seizures can be life-threatening, which is why your prescribing doctor will work with you to taper off the drug. People who abuse Xanax, however, are not likely to have a specific medical professional who prescribes this drug for them, and they may abuse the benzodiazepine in large doses that increase the risk of withdrawal symptoms. Additionally, the cravings associated with Xanax withdrawal may lead to relapse, and that can trigger an overdose.
People who abuse Xanax for a long time, in large doses, are more likely to develop benzodiazepine withdrawal syndrome (BWS) than people who work with medical professionals to safely taper or detox from the drug. This syndrome can prolong the experience of withdrawal for months, leading to intense discomfort, increased risk of relapse and overdose, and strong cravings. A study involving 17 patients with panic disorder treated by alprazolam found that 15 of the patients had a recurrence in panic attacks and nine experienced new symptoms, including:
- Tachycardia (rapid heartbeat)
Treatment Is Available
To manage benzodiazepine withdrawal, get help from medically supervised detox programs. Withdrawal symptoms typically begin within one or two days of the final dose, and if they are serious enough, detox specialists may use diazepam, which is a longer-acting benzodiazepine, to slowly taper your body’s physical dependence on Xanax. You will spend up to a week stabilizing on a dose of diazepam, and then tapering will begin. If your symptoms are not too serious, then over-the-counter medicines can be used to manage physical discomfort, but medical supervision will still help you manage anything that comes up.
After detox, rehabilitation helps you understand and change your behaviors around drugs of abuse like Xanax. Treatment professionals will also help you create an aftercare plan, so you can stay away from intoxicating substances and avoid relapse.
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