Xanax is a benzodiazepine medication. This is a prescription medicine designed for short-term treatment of anxiety disorders, panic attacks, anxiety associated with depression, and some other off-label treatments related to panic.
The drug can be prescribed in the form of immediate-release (IR) and extended-release (XR) tablets, a liquid, and disintegrating tablets. The brand name was developed by Pfizer and approved for prescription use by the Food and Drug Administration (FDA) in 1981. Now, this benzodiazepine is also available in its generic form, alprazolam.
Although Xanax is an important part of treating anxiety and panic disorders, the medication, like other benzodiazepines, should not be prescribed for more than two weeks of continuous use. Many people who take prescription benzodiazepines rapidly develop a tolerance to these substances, which means the original dose will no longer be as effective. At the same time, they may feel like they need the drug to be normal and not experience anxiety, so that they may develop a physical dependence on it. These conditions contribute to the compulsive behaviors associated with addiction, so doctors limit this risk by prescribing fast-acting medications like Xanax on an as-needed basis or for short-term use.
Unfortunately, many people still struggle with Xanax abuse. In the United States in the past few years, overdose deaths involving benzodiazepines, including Xanax, have soared. In 2013, about 30 percent of prescription drug overdose deaths involved benzodiazepines while 70 percent involved opioid drugs, leading the problem to be called a “shadow epidemic.” Although opioid abuse is a major problem in the nation, abuse of other prescription medications, especially Xanax and other benzodiazepines, is also a major, and deadly, problem.
To understand why these drugs are so harmful, even though they are prescription medications with specific guidelines, it is helpful to know how they work in the brain and what side effects can become problematic.
The History of Benzodiazepines and the Creation of Xanax
Benzodiazepines as a drug class were discovered in the 1930s, but the first prescription version of these substances was not introduced until 1957 when Librium was first approved to treat anxiety. These medications were created as a safer, less potentially addictive alternative to barbiturates, the main sedative at the time, which was widely abused.
When benzodiazepines were first introduced, however, they were prescribed for the long-term, which also led to high rates of drug abuse. Prescription misuse occurred when the dose was changed, or the prescription was mixed with other drugs, especially alcohol. Now, there are safer prescribing practices for benzodiazepines, but because they are still widely prescribed, they may be widely misused or abused.
There are more than 2,000 types of benzodiazepines, though few of the specific chemicals are approved for prescription use since they can cause quick intoxication and dangerous side effects. There are three general categories of benzodiazepines: ultra-short, short, and long-acting.
- Ultra-short acting benzodiazepines include Halcion (triazolam) and Versed (midazolam).
- Short-acting benzodiazepines include Xanax (alprazolam) and Ativan (lorazepam).
- Long-acting benzodiazepines include Valium (diazepam) and Librium (chlordiazepoxide).
Xanax is one of the most prescribed benzodiazepine medications in the U.S., alongside Valium, Klonopin, and Ativan. All benzodiazepine medications act on the gamma-aminobutyric acid (GABA) receptors, which regulate how much of the GABA neurotransmitter is active in the brain. By binding to these receptors, benzodiazepines allow the GABA neurotransmitter to remain effective for longer, which can induce a sense of calm, pleasant relaxation, and even sleepiness. This is because Xanax, like other benzodiazepines and related sedatives, is a central nervous system (CNS) depressant.
Standard dose sizes of Xanax are 0.25, 0.5, 1, or 2 milligrams (mg); to achieve this dose, the user may take one or two tablets, or cut a tablet in half. How a person takes Xanax involves a conversation between them and their prescribing physician.
Peak concentrations of Xanax in the body occur within one to two hours after the medication is taken. Effects begin to wear off after that, but some metabolites of the drug will remain active in the body. The elimination half-life for alprazolam, according to the FDA, is 11.2 hours in adults, so the drug is fully out of the body within a day.
The GABA receptors are a group of neurons associated with the brain’s reward system. By triggering these receptors artificially, other parts of the reward system may become activated, leading to the release of other neurotransmitters like dopamine and serotonin, which are associated with elevated mood. When a substance quickly stimulates the reward system, compulsive behaviors and cravings can develop, and the person may begin abusing the substance to feel good or normal. According to the FDA, compulsive behaviors and physical dependence occur, on average, in people treated with doses of 4 mg or more per day consistently for 12 weeks or longer.
Xanax and other benzodiazepines are widely abused for their similar effects to alcohol. Both substances impact the GABA receptors, leading to sedation, sleepiness, dizziness, and a high that can change reaction times and physical control. The pleasant feeling associated with both alcohol and Xanax can trigger compulsive behaviors in some people.
In addition to appearing intoxicated, there are more signs of addiction to Xanax, which include:
- Obsessing over the drug
- Lying about how much is taken or denying that use is a problem
- Paraphernalia, such as empty Xanax prescription bottles
- Consistently running out of the prescription too soon
- Doctor shopping or going to multiple physicians for multiple prescriptions
- Increased tolerance to the drug
- Inability to quit taking the medication, especially if the person has tried several times
How Widely is Xanax Abused?
The Centers for Disease Control and Prevention (CDC) found that alprazolam was among the top five drugs found most often in overdose deaths between 2010 and 2014. Other drugs consistently found in the top five were opioids like methadone and oxycodone; cocaine also was widely associated with deadly overdoses. In many instances, these drugs were combined. During this four-year period, alprazolam was more widely abused in fatal situations than Valium, which may be because Xanax binds to the brain more rapidly than diazepam.
The 2014 National Survey on Drug Use and Health (NSDUH) found that, on average, 1.5 million Americans started using tranquilizers and sedatives, including Xanax, nonmedically every year. Physicians are not recommended to prescribe more than 4 mg per day of Xanax, and even that is excessive for most people. People who abuse Xanax may take anywhere from 8 mg to 20 mg per day, often combining this substance with other recreational substances–most often, alcohol, opioids, and cocaine.
A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that benzodiazepines like Xanax increase the intoxicating effects of other sedatives, especially opioids and alcohol. Between 2005 and 2011, according to the report, there were close to 1 million emergency room (ER) admissions involving benzodiazepines, either alone or in combination with other substances: 89,310 admissions were from benzodiazepines alone; 50,561 involved benzodiazepines and opioids; 27,452 admissions involved benzodiazepines and alcohol; and 8,229 admissions involved benzodiazepines, alcohol, and opioids together. Adding benzodiazepines to other forms of substance abuse radically increased the risk of long-term hospitalization and serious complications.
Short-Term and Long-Term Dangers
When abused on a short-term basis, Xanax can lead to side effects, such as:
- Fatigue and lethargy
- Impaired coordination as though drunk
- Impaired cognition
- Slurred speech
- Memory trouble
- Paradoxical insomnia
- Altered vision
- Shaking or tremors
- Respiratory depression
- Nausea, constipation, diarrhea, vomiting, or abdominal cramps
- Dry mouth
- Loss of appetite
High doses of any benzodiazepine, including Xanax, can cause an overdose. There are specific signs of a sedative overdose.
- Slow reflexes
- Mood swings
- Hostile or erratic behavior
- Euphoria or a high
- Changes to breathing and heart rate
If you notice someone exhibiting these symptoms, they may be overdosing on Xanax or another sedative. Call 911 immediately because they need emergency medical attention.
Long-term harm is associated with ongoing Xanax abuse. Not only can constant intoxication on these drugs cause problems at work, school, or with family and friends, but Xanax significantly increases cognitive impairment, leading to problems with memory and judgment. This may become a chronic issue.
The risk of motor vehicle crashes increases with ongoing addiction and abuse, which can lead to a physical injury that may not heal, such as a back injury or head injury, or damage to internal organs. Benzodiazepine abuse has also been associated with a 50 percent increased risk of hip fractures in older adults. A long-term study suggested that ongoing, high-dose abuse of Xanax or Valium can cause permanent brain damage.
Overcoming Addiction Through Medically Supervised Detox and Rehabilitation
Withdrawal from Xanax can range from uncomfortable to life-threatening. There are common withdrawal symptoms associated with the drug, including:
- Rebound anxiety and panic
- Suicidal thoughts or actions
- Difficulty sleeping, including insomnia
- Blurry vision
- Excessive sweating
For the most part, though, withdrawal mimics the symptoms that Xanax was developed to treat, especially insomnia and panic. Experiencing these symptoms again can be highly uncomfortable for someone trying to stop Xanax abuse, and it can lead to relapse very quickly. It is important to stop taking Xanax – either because it has been abused or because the prescription is ending – with oversight from a physician or addiction treatment specialist.
People who take Xanax consistently are not automatically going to develop an addiction to this drug, but many are at risk of developing physical dependence, which can cause withdrawal symptoms. When working closely with a prescribing physician, you will likely begin tapering off the drug, especially if you needed to take high doses at first or took Xanax for longer than two weeks. Studies have shown that people who took the drug regularly for three to six months did not have a problem stopping their prescription as long as a medical professional oversaw a tapering process to ease them off it.
Some people who abuse Xanax may receive Valium as part of their withdrawal process. This medication acts on the brain longer than Xanax does, relieving cravings for the drug. Valium doses can then be tapered on a personalized schedule until the body no longer relies on the medication to feel normal.
Once a medical detox has been completed, it is essential to enter a rehabilitation program with behavioral counseling, which can help you to recognize compulsive behaviors and develop better coping mechanisms. The best way to do this is through cognitive behavioral therapy (CBT) and related therapeutic approaches in both group and individual therapy.