Are prescription Xanax bars becoming just as dangerous as opioid pain pills?
According to the Substance Abuse and Mental Health Services Administration, the number of emergency room visits in America involving the nonmedical use of Xanax MORE THAN DOUBLED between 2005 and 2011, increasing from 57,419 to 123,744.
“Even the label for Xanax warns against prescribing it to people who are addiction-prone…”
~Dr. Peter R. Breggin, M.D., Medication Madness: The Tole of Psychiatric Drugs in Cases of Violence, Suicide, and Crime
Even more troubling, the National Institute on Drug Abuse reports that overdose deaths involving Xanax bars and other benzodiazepine-class drugs skyrocketed to well over 8000—an all-time high! From 2002 to 2015, the number of “benzo”-related deaths rose by more than FOURFOLD.
For comparison purposes, the number of prescription painkiller deaths due to the “opioid epidemic” increased 1.9-fold between 2002 and 2011.
All told, 30% of fatal overdoses involve benzodiazepines.
What Are Xanax Bars?
Xanax is the brand name for alprazolam, a benzodiazepine medication used to treat a number of mental disorders:
- Panic disorder
- Generalized anxiety disorder (GAD)
- Social anxiety disorder (SAD)
- Separation anxiety disorder (SepAD)
- Specific phobias
“Xanax bar” refers to the shape of the medication, which comes in several formulations. Depending upon the manufacturer, alprazolam medications can range in strength from .25 mg to 2 mg. Colors and shapes include white, orange, pink, peach, yellow, and green Xanax bars, tablets, and pills.
“Patients who are prescribed benzodiazepines only to be taken when needed had higher markers of misuse. Clinicians may falsely assume that someone prescribed the medication on a schedule basis would be at higher risk of misuse.”
~Dr. Amy Swift, MD, from Mount Sinai Beth Israel, New York City
The medication may be brand-name Xanax or as generic alprazolam. For example, there is no difference between a white or a green Xanax bar (2mg) besides the manufacturer of origin.
The dosage is determined by the doctor, based upon the severity of the disorder. Higher-dosage Xanax bars come pre-scored, so patients can break off the prescribed amount.
Because at 2 mg they are the strongest prescribed dosage, Xanax bars are popular drugs of misuse, and abusers will often disguise their habit by talking/messaging in code. Here are some of the most common street names of Xanax:
- Christmas Trees
Xanax Bars Are Dangerously Addictive
Xanax increases levels of Gamma-Amino Butyric Acid (GABA), a neurotransmitter that has a calming effect on the central nervous system and brain.
When the brain becomes desensitized to the presence of the drug, a tolerance develops, and the regular Xanax bar dosage becomes less effective. Anxiety symptoms return and increasing amounts of the medication are needed to realize the same results.
“When used as directed, alprazolam is safe and effective, but misuse can result in serious health consequences.”
~SAMSHA Administrator Pamela S. Hyde
Furthermore, because of the artificial Xanax-triggered increase in GABA levels, the brain attempts to compensate by reducing the number of GABA receptors. This makes it much harder to stay calm enough to function normally without the presence of the drug.
Xanax is a fast-acting, powerful medication that delivers 90% of its effects within the first hour. It is so potent that it can create a physical dependency in as little as four weeks or less. In other words, one 30-day supply can be enough to get a person hooked.
Perhaps this is why the United States Drug Enforcement Administration reports that alprazolam is one of the “Top 3” diverted prescription medications.
- London’s Royal College of Psychiatrists estimates that approximately 4 out of every 10 people who take Xanax longer than six weeks will develop an addiction.
- Stanford University’s School of Medicine makes the recommendation that Xanax should be prescribed for eight weeks or less, and further advises that it should not be used to treat everyday stress and tension.
- Of special relevance, people who have a personal history of or a vulnerability to substance abuse are at greater risk of abusing Xanax bars.
In fact, benzo drugs are so addictive that even taking them “as needed” can promote misuse.
Anxiety Drives Xanax Bar Misuse
Another reason Xanax bars are misused so often is because of the prevalence of need.
Xanax is typically prescribed for any of the various anxiety disorders, accounting for 44% of all anti-anxiety drugs dispensed. Per the National Institute of Mental Health, 18.1% of US adults—nearly 1 in 5—have struggled with symptoms of clinical anxiety within the past year. That works out to approximately 45 MILLION people.
What’s more, nearly 29% of American adults will have a diagnosable anxiety disorder at some point in their lifetime.
“Anxiety essentially consists of too much attention to a problem or a fear. Benzodiazepines treat anxiety by preventing the brain from attending, attaching and remembering.”
~ J.T. Junig, MD
Every year, approximately 50 MILLION alprazolam prescriptions are written, more than any other benzodiazepine-class medication. Because Xanax is habit-forming, more users naturally means more people at-risk for dependence and diversion.
Within the past two decades, the number of American adults with a prescription for Xanax or another benzodiazepine ballooned from 1 million to 13.5 million. Since 1983, Xanax, has been the most-prescribed psychotherapeutic medication available.
Every second, at least one Xanax prescription is written.
At the same time, the amount of medication in those prescriptions increased by an average of 40%.
Other relevant statistics about anxiety include:
- The average age that anxiety symptoms first manifest is 11.
- Women have a 60% greater likelihood of anxiety than men.
- People with anxiety disorders are 6X more likely to be hospitalized for a psychiatric illness than people without anxiety.
How Widespread Is the Abuse of Xanax Bars and Other Benzodiazepines?
The American Journal of Public Health recently published an article saying:
- Since 1996, benzodiazepine overdose deaths have risen more than fourfold.
- Roughly 1 out of every 20 Americans received a prescription benzodiazepine within the past year.
- This represents a 67% increase from 20 years before.
- Also since 1996, the average quantity of medication received has more than doubled.
- The rate of fatal benzodiazepine deaths for African-Americans, Hispanics, and senior citizens continues to rise.
- Every year, there are almost 200,000 new benzodiazepine abusers.
Celebrities and Xanax Bars: The Drug of Choice
One way you can gauge a society’s drug use is to look at its celebrities. Xanax is a common drug of use – and misuse – among the rich and famous:
- In 2008, actress Winona Ryder collapsed after a suspected overdose of Xanax bars.
- Also in 2008, actor Heath ledger died due to multiple drug intoxication – several opioids and benzodiazepines, including Xanax.
- Comedienne Sarah Silverman took up to 16 Xanax a day as a teenager.
- Singer Michael Jackson took 10 Xanax bars a night, obtaining multiple prescriptions in staffers’ names.
- Model Anna Nicole Smith needed to be weaned off Xanax.
- Singer Whitney Houston was popping Xanax pills the day before she died.
- Actor Philip Seymour Hoffman fatally overdosed from a mixture of heroin and benzodiazepines, possibly Xanax.
- Singer Gerald Levert died from a 6-drug cocktail that included opioids, antihistamines, and Xanax.
- Golf legend Tiger Woods was arrested for a DUI after he was found passed out in his car. He admitted that he was having an unexpected reaction to his prescription medicines, which include Vicodin and Xanax.
Xanax Bars, Alcohol, and Opioids – The Risk of Overdose Is Real
“It is nothing short of a public health crisis when you see a substantial increase of avoidable overdose and death related to two widely-used drug classes being taken together.”
~Dr. Robert Califf, FDA commissioner
Most, if not all, of the celebrities listed above had dangerous – or even fatal – reactions when they took Xanax in combination with other substances. That’s not surprising, because roughly 75% of overdoses—and 98% of those that are fatal —involve multiple substances.
Opioids, alcohol, and benzodiazepines are each depressants. This means their effects multiply when used in combination. Both benzos and opioids slow breathing. When used together, this affect manifests sooner and lasts longer. Death due to respiratory failure can and does occur.
Among polydrug abusers, using benzodiazepines such as Xanax along with other drugs prolongs the high. And, for the past 20 years, the most popular combination involving benzodiazepines has included opioids. In 2001, just 9% of opioid patients were concurrent benzodiazepine users. However, by 2013, that percentage had nearly doubled, to 17%.
SAMSHA reports that in 2011, opioid/benzo mixtures comprised the majority of ER visits involving the non-medical use of prescription drugs.
- Heroin addicts realize longer and stronger effects when they also inject benzos.
- Nearly three-quarters of heroin users have used benzos within the past year.
- One-quarter does so daily.
- A third of heroin users obtained a benzo prescription within the past 30 days.
- 4 out of every 10 people in opioid maintenance programs (suboxone or methadone) have used a benzo prescription within the past year.
- This is 8X the general population’s rate.
- Up to 70% of patients in methadone maintenance test positive for benzos.
- 50% of new admissions to maintenance programs need benzo detox.
- More than 45% of methadone patients who use benzos report doing so to enhance their high.
- 94% of methadone patients use prescription sedatives during their lifetimes.
- 40%-60% of people in chronic pain are regular benzo users.
- 1 out of every 6 patients prescribed opioid pain medication also uses benzos.
- 80% of deaths involving buprenorphine, methadone, or heroin also involve benzodiazepines.
- Co-abuse of opioids and benzos triples the risk of psychiatric hospitalization.
- It also doubles the likelihood of needing a prescription to deal with suicidal thoughts.
- Between 2005 and 2011, there were almost 250,000 emergency room trips involving both opioids and benzodiazepines.
- In addition, there were nearly 164,000 ER visits involving benzodiazepines and alcohol.
- Finally, more than 43,000 emergency visits resulted when all three substances were used.
- Approximately 40% of those emergencies had a “serious outcome”.
One follow-up study suggests that benzodiazepine use is a more accurate predictor of future opioid abuse than chronic pain.
Benzodiazepines during Opioid Recovery
Part of the reason for this may be because people who abuse both opioids and benzodiazepines tend to have a longer individual history of opioid misuse/abuse, take higher doses, and are at greater risk of poly-substance abuse than those who abuse opioids alone.
As evidence, regular benzo users participating in an opioid replacement program generally need higher-than-normal daily doses of methadone. Additionally, they are more likely to abuse alcohol than individuals who aren’t dependent on benzodiazepines. Up to 83% of concurrent benzo/heroin abusers are also alcohol-dependent.
Polydrug Abuse and Dual Diagnosis
Mental disorders associated with substance use and abuse are much more common in benzodiazepine/opioid abusers. People who co-abuse both are three times as likely to have been hospitalized for a psychiatric emergency during the previous year, and twice as likely to need a prescription for an emotional disorder.
Xanax Bars and the Newest Drug Trends
The threat from Xanax abuse spreads beyond misuse of one’s own prescription when you take into account the myriad ways that the drug is illicitly available, especially among adolescents:
- Pharm parties –Teens will bring whatever medications they can obtain, bring them to a party, mix them with what others have brought, and wash it all down with alcohol. Also known as “Skittles parties”, because of the brightly-colored pills.
Half of teens surveyed say that they get their prescription drugs from their home medicine cabinets.
- Xanie Tarts—Reports have surfaced of popular Sweet Tart candies that have been laced with liquid Xanax. Because they look nearly exactly the same as the unadulterated candies, police are worried about accidental overdoses.
Withdrawal from Xanax Bars Can Be Dangerous
Benzodiazepines have such a profound effect on the brain that when the Xanax bar dosage is significantly reduced or abruptly discontinued after long-time or heavy use, serious withdrawal symptoms may result. Xanax withdrawal symptoms can manifest in as little as 24 hours after the last dosage, and include:
- Extreme anxiety and restlessness, up to the point of panic
- Impaired memory
- Concentration/Focus problems
- Depersonalization/Feelings of unreality
- Suicidal ideation
- Symptoms of OCD
- Mood swings
- Muscle aches and cramps
- Flu-like symptoms
- Blurred/Double vision
- Elevated blood pressure
- Increased heart rate
- Pronounced sensitivity to light, sound, or touch
- Nausea, vomiting, and diarrhea
- Loss of appetite/Abnormal weight loss
As unpleasant as all of that sounds, quitting Xanax “cold turkey” can trigger even more dangerous symptoms, including convulsions and catatonia severe enough to be fatal.
In a 2011 article, “Benzodiazepine Withdrawal Seizures and Management”, published in the Journal of the Oklahoma State Medical Association, the authors made the following recommendations:
- If Xanax bars are discontinued abruptly, seizures can occur. This can happen to ANYONE taking ANY benzo drug in ANY half-life formulation.
- The greatest risk of seizure is among those patients taking high Xanax bar dosages over a long period of time.
- However, instances of seizures among patients who have properly taken the medication at the prescribed dosage for less than 15 days have been reported.
- Seizures can happen just once, or can increase in severity and frequency, resulting in coma or even DEATH.
- The ONLY way to quit benzodiazepines safely is to taper the dosage— rapidly in a controlled, monitored setting, or gradually via an outpatient detox program.
For this reason, Xanax detox and withdrawal should ALWAYS be under the supervision of qualified addiction specialists and medical personnel.
So What’s the Final Word on Xanax Bars?
There is no doubt that there are millions of people in America who struggle with an anxiety disorder. And there is little doubt that alprazolam-based medications can help. The problem arises when the drugs are looked upon as the only solution and prescribed for a long period of time.
That leads to tolerance, dependence, and, ultimately, addiction.
There are two things that we can take away all of the scary statistics about Xanax and other benzodiazepines.
FIRST, if you are at increased risk of addiction because of your family or personal history, share that information with your doctor. Discuss with him alternatives to potentially-dangerous benzodiazepines.
SECOND, if you are already dependent or addicted to your Xanax medications, you need specialized professional help TODAY.