Xanax: Uses, Withdrawal, and Misconceptions

Xanax is a type of benzodiazepine that doctors prescribe to help people treat conditions such as anxiety, muscle spasms, or seizures. The generic name for Xanax is alprazolam.1 According to the U.S. Drug Enforcement Agency, Xanax is one of the most frequently sold benzodiazepines on the black market.

While Xanax is a medication that has medical uses, it also has the potential for misuse. Some people, especially young people, abuse the drug as a means to get high. Because the medication can cause severe and potentially deadly side effects from withdrawal, many doctors recommend seeking professional medical treatment to overcome a Xanax addiction.

History of Xanax

The benzodiazepine category of medications was first discovered in the late 1950s by research chemist Leo Sternbach.2 Once he discovered the class of compounds, he tested 40 different benzodiazepine variations, but could not find one that had effects on laboratory mice. However, in 1956, Sternbach added a colorless gas called methylamine to a compound. The results were a white powder that made mice appear sleepy and calmer when they used it. The compound was a benzodiazepine called Librium. The FDA approved this drug for use in the United States in the 1960s. Three years later, the FDA would approve another benzodiazepine called alprazolam (Valium).

The first patent for alprazolam was awarded in 1970 in Germany for a pharmaceutical company that is now a part of Pfizer.3 The U.S. Food and Drug Administration issued a patent for the drug in the United States in 1976, according to the American Chemical Society. Within two years, Xanax became a popularly prescribed drug.

Today, benzodiazepines represent a significant market for pharmaceutical manufacturers. According to CNBC.com, the U.S. market for benzodiazepines (including Xanax) is projected to be $3.8 billion in the year 2020.

How Does Xanax Work?

Doctors prescribe Xanax to treat anxiety and panic disorders. Some doctors may also prescribe it off-label in the treatment of depression. The medication is intended for short-term use, not as a long-term solution to anxiety.4 According to CNBC.com, an estimated 40 million Americans suffer from anxiety, making the condition a common struggle for many and the most common mental illness in the United States.

Benzodiazepines aren’t usually the first-line treatment for anxiety. Many doctors will initially prescribe anti-depressant medications to treat anxiety. These include Paxil, Prozac, and Zoloft.

However, after some time, tolerance to antidepressants can develop. In other cases the antidepressants may take time to work effectively resulting in a doctor prescribing Xanax to help relieve symptoms until the antidepressants take effect.

When Xanax is taken, the medication binds to specific receptors in the brain called gamma-aminobutyric acid (GABA) receptors. GABA is an inhibitory neurotransmitter that works to slow down functions in the brain. Essentially, GABA calms the brain down. Unfortunately, the brain can become dependent on the drug, and may result in the belief that the medication is required in order to remain calm or function. This is why most pharmaceutical companies don’t recommend taking benzodiazepines for longer than two to four weeks at a time.

Misuse and Abuse of Xanax

The U.S. Drug Enforcement Agency classifies Xanax as a Schedule IV substance. This means it has medical value and a mild potential for addiction. Drugs belonging to the Schedule I category are highly addictive with no known medical use. Schedule II drugs are those that have medical purposes and are highly addictive. Schedule III drugs are less addictive than schedule II drugs and have a medical purpose.

The effects of Xanax are similar to those using substances such as alcohol, barbiturates, GHB (Rohypnol), and sleeping pills.

Unfortunately, of all the benzodiazepines, Xanax has one of the highest potential for misuse. This is largely because the body rapidly absorbs the medication and the medicine isn’t as long-lasting as some other benzodiazepines.5 For example, diazepam (Valium) lasts about 22 to 72 hours in a person’s body while Xanax lasts about 8 to 16 hours. Xanax is also more potent than many other benzodiazepines. For example, one milligram of Xanax is as strong as 10 milligrams of Valium. As a result, when a person takes Xanax, they experience a faster and more potent high that unfortunately may wear off quickly. As a result, a person may try to take more to achieve the same effect.

Doctors have also found that Xanax in particular increases dopamine levels in the body. Dopamine is a feel-good chemical responsible for giving a person a euphoric feeling when they use them. This factor can increase the likelihood a person will experience an addiction to Xanax with continued use.

How Do People Abuse Xanax?

According to the U.S. Drug Enforcement Agency, many people who abuse Xanax take the medication in pill form or crush it up and snort it. The age groups who most frequently abuse Xanax are young adults and adolescents. Also, those who abuse heroin and cocaine are more likely to abuse Xanax as a means to enhance their high or come down from an intense stimulant episode.

Combining Xanax With Other Substances

People may also take Xanax in combination with opioids or alcohol. These combinations can prove deadly as both compounds are central nervous system depressants. If a person has a history of alcohol or opiate substance abuse, they are more likely to abuse Xanax than any other benzodiazepine.

Not as Prescribed

According to Science News, an estimated 5.6 million of the 30.6 million adults in the United States who take benzodiazepines admit to misusing benzodiazepines by taking them without a prescription or in taking the medications in a way that a doctor doesn’t recommend, such as increasing the dosages or frequency a person uses them.

Misconceptions About Xanax

It's a Prescription, so it's Safe

A common misconception about Xanax use is that because the medication is prescribed legally, a person cannot overdose from it. A person can overdose from Xanax use. Some of the symptoms a person may have overdosed on Xanax include clammy skin, coma, shallow or slow breathing, and a rapid or weak pulse.

In some instances, overdose from Xanax can cause death. According to CNBC.com, the number of overdose deaths from benzodiazepines such as Xanax has increased by 400 percent from 2002 to 2015. Part of the explanation for this increase is a 67 percent increase in benzodiazepine prescriptions in the United States.

%

Increase in Overdose Deaths from 2002 to 2005

%

Increase in Benzodiazepine Prescriptions in the US

Medications Means You Know What it Is

Another misconception is that because benzodiazepines like Xanax are made in pharmacies, that all medications that look like benzodiazepines must be real. Unfortunately, illegal drug manufacturers may attempt to recreate Xanax in a laboratory or even create fake Xanax pills from other materials and sell them on the streets. This means that a person who purchases Xanax on the street may not know what they’re truly taking.

What are Xanax Side Effects?

The immediate side effects of Xanax include:

  • Depression
  • Dizziness
  • Drowsiness
  • Fatigue
  • Headache
  • Memory Loss

Although doctors do not usually recommend Xanax for long-term use, people still take it on a regular and long-term basis. A person can quickly develop a tolerance for Xanax and may find they need to take more and more to achieve the same effects.

Because benzodiazepines aren’t intended to be taken on a long-term basis, there isn’t much data on their long-term effects. However, there are some known effects, which include:6

Cognitive Impairment:

According to the American Academy of Family Physicians, chronic benzodiazepine use can affect a person’s memory, affect their reaction times, and result in clumsiness and poor coordination. These effects can also increase the risks for accidents, such as falls.

Hip Fractures:

Benzodiazepines can increase the risks for hip fracture in older people by as much as 50 percent. This could be due to affected coordination that makes a person more likely to fall.

Benzodiazepines Increase Risk of Hip Fracture in Older People
50%

Motor Vehicle Accidents:

Taking benzodiazepines can make a person have judgement impairments that are similar to drinking alcohol. Driving while taking benzodiazepines can have the same effect as a person with a blood alcohol level of 0.050 and 0.079 percent

In addition, tolerance to Xanax can be built up with time and continued use, the risks of overdose increases with the continued use of the medication.

Xanax Withdrawal

Withdrawing from Xanax can be dangerous and potentially life-threatening. This is because Xanax makes it less likely a person will experience a seizure. If a person suddenly stops taking them after continued abuse, the brain can go into overdrive, and seizure can be a result.

Other potential symptoms associated with Xanax withdrawals include:

Anxiety
Depression
Insomnia
Irritability
Muscle jerking or muscle spasms

Unfortunately, Xanax withdrawal symptoms are some of the most severe. This is because the drug is a short-acting benzodiazepine and has fast-on and fast-off effects. Benzodiazepines that are longer acting are usually associated with causing fewer severe withdrawal symptoms. Examples of these include the drugs Librium and Valium.

According to an article in the Journal of Addiction Medicine, a laboratory study found that mice experience withdrawal symptoms even after one week of taking Xanax. They also reported that patients addicted to Xanax were more likely to experience more significant rebound anxiety as a result of withdrawals as compared to other benzodiazepines. Some people may report this anxiety is greater than the anxiety they had before they started taking Xanax.

In rare instances, a person withdrawing from Xanax may experience severe withdrawal symptoms that include delirium and psychosis.

What is Treatment for Xanax Addiction Like?

Rehabilitation centers typically first treat Xanax addiction by helping a person evaluate how much Xanax is used on a daily basis. Treatment professionals will consider the amount and frequency of use to create a tapering plan. This involves slowly decreasing the dosages of Xanax until Xanax is no longer being taken. These tapering plans may vary. Some people may prefer more aggressive methods while others may adopt a tapering plan that takes a few months.

In addition to tapering plans, it is important that a person address the underlying behaviors they were using Xanax to treat. For example, some people use Xanax as a means to overcome their anxiety. As a result, a person may choose to participate in therapy options as a means to learn how to better deal with their anxiety. In some instances, doctors may recommend a person take a longer-acting benzodiazepine instead of Xanax because the withdrawal symptoms and rebound anxiety are usually less severe as with Xanax. Examples of these medications include clonazepam.

Examples of the therapeutic options a person may use to treat their anxiety may include the following:

Cognitive Behavioral Therapy:

Also known as CBT, this therapeutic approach usually involves participating in about 12 to 16 therapy sessions. In these sessions, a person learns how to recognize their anxious thoughts. They then learn how to modify their behavior to reduce feelings of anxiety.

Acceptance and Commitment Therapy:

This therapeutic approach involves practicing mindfulness as a means to try to reduce anxiety by focusing on living in the moment and reducing their exposure to situations that fill them with needless anxiety.

In addition to these therapies, a doctor may recommend other lifestyle changes to promote anxiety reduction. Examples include getting plenty of sleep, meditating, and engaging in regular exercise. If a person cannot control their anxiety through these methods, a doctor may recommend anti-depressants as they are less habit-forming.

Recovery from Xanax Addiction

When used as prescribed and for a short duration, Xanax can be a safe medication. However, when used not as prescribed, it has greater potential for substance abuse and misuse. Some of the pharmacological components of Xanax mean that it is more difficult to withdraw from as well as more addictive than other similar medication types. Because it can cause more significant withdrawal symptoms, it’s important to seek medical attention to determine a safe tapering plan as well as alternate methods to manage recovery. Through professional help, a person can recover from Xanax use disorder and emerge a healthier, safer individual.

Resources

  1. https://www.dea.gov/sites/default/files/2018-06/drug_of_abuse.pdf 2. https://www.aafp.org/afp/2013/0815/p224.html 3. https://www.sciencenews.org/article/overdose-deaths-tied-antianxiety-drugs-xanax-continue-rise
  2. https://www.cnbc.com/2018/08/02/antianxiety-drugs-fuel-the-next-deadly-drug-crisis-in-us.html
  3. https://www.acs.org/content/acs/en/molecule-of-the-week/archive/a/alprazolam.html
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/
  5. https://mosaicscience.com/story/mothers-little-helper-brief-history-benzodiazepines/