Xanax is the well-known brand name for alprazolam. This medication belongs to a class of sedative and anxiolytic (anti-anxiety) drugs called benzodiazepines.
History of Xanax
Xanaxis most commonly prescribed to treat:
- Panic disorders.
Dr. Leo Sternbach created the first benzodiazepine, chlordiazepoxide (Librium), in 1956 in an attempt to create safer, less addictive alternatives to traditional tranquilizer drugs such as alcohol, barbiturates, and meprobamate.
First introduced in the US market in 1981, alprazolam is distinguished by:
- Intermediate onset of action.
- Shorter half-life, or quicker elimination from the body than other commonly prescribed benzodiazepines such as Valium or Librium.
Xanax became widely used in anxiety disorders because it provides rapid symptom relief for these disorders (within a week of beginning treatment) and shows no decrease in its effectiveness over time, even when used for several years.
Like many other anxiolytic and sedative drugs, alprazolam works by binding ?-aminobutyric acid A (GABAA) receptors in the brain, which decreases the overall level of brain activity. By activating GABAA receptors, Xanax reduces feelings of anxiety and panic in patients, but it can also produce euphoria when taken in larger doses, leading some people to abuse this medication.
Abuse, Dependence, and Withdrawal Among Xanax Users
Although benzodiazepines were initially thought to have little potential for abuse , dependence and withdrawal symptoms are now well known for many of these drugs—including alprazolam.
In fact, severe withdrawal symptoms can be observed when individuals stop taking alprazolam suddenly—even in patients who take this drug exactly as directed. For this reason, doctors gradually reduce a patient’s dose over time before directing them to stop taking it altogether.
In users who become dependent outside of a doctor’s care, withdrawal symptoms are often pronounced and include:
Despite problems with abuse and withdrawal, Xanax is still commonly prescribed because it remains a very effective treatment for anxiety, and laboratory studies have suggested its abuse potential is lower than older alternatives. However, this does not suggest it has no potential for abuse or addiction. Non-medical use or inappropriate doses can quickly lead to a problem. Xanax dependency can lead to users to seek it out illegitimately for non-medical use.
The high number of legal prescriptions for alprazolam being issued has increased the availability of this drug on the street. The Drug Enforcement Agency (DEA) has identified “doctor shopping” and prescription forging as major sources of alprazolam on the black market.
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Who’s Abusing Xanax?
Since 2006, there has been a rapid increase in the number of people admitted to drug treatment centers in the US for sedative or tranquilizer use in general—as well as for Xanax, in particular.
This increase tracks closely with the increase in legal prescriptions written for Xanax and other forms of alprazolam over the same time period, suggesting that the increase in legal availability of these medications may be indirectly fueling their abuse.
It is a hopeful sign that treatment admissions for alprazolam abuse have leveled off and the number of people reporting recent non-medical use of Xanax or related drugs has declined in recent years.
Such figures may indicate that the peak of alprazolam abuse has passed, but whether these trends will continue remains unknown.
The following statistics further illustrate the current picture of alprazolam and benzodiazepine abuse:
- The 2013 National Survey on Drug Use and Health showed that young adults were the most likely to have ever used alprazolam or the closely related drug lorazepam for non-medical purposes. The rate of abuse for those aged 18-25 (10.3%) was nearly double that for people aged 26 or over (5.7%).
- Alprazolam and other benzodiazepines are frequently combined with other drugs by abusers. According to the Substance Abuse and Mental Health Services Administration, more than 50% of the nearly 176,000 emergency room visits for benzodiazepines in 2011 also involved alcohol or other drugs.
- A 2011 study in the journal Drug and Alcohol Dependence reported that men and women and all racial groups were equally represented among young adults abusing benzodiazepines in nightclubs.
Online Interest in Xanax
Additionally, Google Trends shows that monthly numbers of Internet searches including the term “Xanax” have nearly doubled since 2004, with the highest increases concentrated in the southern and eastern regions of the country.
The Xanax Market
Over 49 million prescriptions for alprazolam were written in 2012, making this drug the second-most prescribed psychoactive drug that year after the narcotic painkiller hydrocodone.
According to figures from the DEA, alprazolam is one of the top 3 prescription drugs being diverted to the black market.
Because alprazolam is available as a generic, costs for legal prescriptions are very low, ranging from $17-$27 for 30 2mg tablets, or between $0.56 and $0.90 per pill.
The street cost of alprazolam varies significantly, but has been estimated at $5 per 2mg tablet. This high profit margin likely explains why such a large amount of this drug is diverted to illicit use.
Xanax and the Law
In the US, alprazolam is available by prescription only. Furthermore, this drug is classified as a Schedule IV controlled substance by the DEA, reflecting the consensus that this drug has a relatively low, but real, potential for abuse or dependence.
The increase in abuse that has been reported in the last 10 years has led to efforts to further restrict its use. Tennessee has enacted rules requiring doctors to:
- Check patients’ drug histories in a statewide database before prescribing drugs such as Xanax.
- Dispense no more than a 30-day supply at one time.
In the United Kingdom, alprazolam is no longer made available through the public National Health Service.
Legal Penalties of Using Xanax
Doctors and pharmacists are required to keep detailed records when prescribing or dispensing alprazolam. Users found to be in possession of the drug without a prescription can be subject to:
- Up to 5 years in prison for a 1st offense.
- 10 years for a 2nd offense under federal drug laws.
These penalties apply for any quantity of Xanax, even a single pill.
Additionally, states can apply their own penalties to cases involving controlled substances. In Florida, for example, anyone convicted of illegal possession of Xanax:
- Must have their driver’s license revoked for a minimum of 2 years.
- Are subject to other penalties.
How Dangerous Is Xanax?
The motivation behind the development of alprazolam and other benzodiazepines, as stated earlier, was to find safe and effective alternatives to older sedative and anxiolytic drugs. However, the dangers of abuse and dependence associated with alprazolam is greater than initially thought.
Overdose with alprazolam can cause symptoms of sedation including drowsiness or confusion, but life-threatening symptoms are rare when this drug is taken alone. However, abusers frequently combine Xanax with other drugs—such as alcohol or cocaine—to enhance the drugs’ effects; such combinations can indeed be deadly if large doses are taken.
Multiple studies have reported that drinkers and former drug abusers experience significantly greater mental impairment when taking alprazolam than other people. This suggests that such groups are at greater risk of abusing alprazolam and may experience more severe adverse reactions if they do.
Increases in emergency room visits due to alprazolam have increased in parallel with the increase in abuse observed in the last 10 years.
The fact that approximately 50% of Xanax-related emergency room visits do not involve any other drugs demonstrates that there is still a real danger to health, even to those who do not combine alprazolam with other drugs.
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- US National Library of Medicine. (2016). Alprazolam.
- Google Trends – Web Search interest: Xanax – United States, 2004-present
- Drug Enforcement Administration. (2013). Benzodiazepines.
- Substance Abuse and Mental Health Services Administration. (2013). National Survey on Drug Use and Health (NSDUH) 2012 and 2013.
- QuintilesIMS. (n.d.). Top 25 Medicines by Dispensed Prescriptions (U.S.).
- Substance Abuse and Mental Health Services Administration. (2014). The DAWN Report: Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes.
- Kurtz SP, Surratt HL, Levi-Minzi MA, Mooss A. Benzodiazepine dependence among multidrug users in the club scene. Drug Alcohol Depend. 2011 Dec 1;119(1-2):99-105.
- Verster JC, Volkerts ER. Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature. CNS Drug Rev. 2004 Spring;10(1):45-76.