What is Xanax?
Xanax is the most famous brand name for alprazolam, a benzodiazepine sedative prescribed to treat generalized anxiety disorder (GAD), panic disorder, and anxiety associated with depression. It is sometimes used as a treatment for depression, and more rarely, it is used to treat insomnia.
Originally, Xanax was produced by Pfizer. It was approved by the Food and Drug Administration (FDA) in 1981 for prescription use. There are now several generic versions of alprazolam available from other pharmaceutical companies.
Benzodiazepines like Xanax have important medical applications, but they can also be abused. According to the Drug Enforcement Administration (DEA), Xanax and several other benzodiazepine medications are Schedule IV, so they require a prescription, but they can be refilled several times, and they are not tightly regulated like opioid painkillers or prescription stimulants. While access to these drugs is important for people who need immediate treatment for a panic attack or intense anxiety, Xanax and similar benzodiazepines are widely prescribed, so they are widely available for people who may misuse or abuse them.
Abuse of any prescription drug, including Xanax, can cause an overdose, which may lead to death. In 2013, there were 23,000 overdoses from prescription drugs in the United States, and 31% of those overdoses involved benzodiazepines like Xanax. One report found that Xanax specifically was involved in about one-third of ER admissions for overdose.
If someone overdoses on a sedative like Xanax, call 911 immediately. The person must receive emergency medical attention.
Xanax Misuse and Abuse
It is important to take Xanax only as prescribed. This means taking a fast-acting drug like Xanax only as needed to treat specific instances of intense anxiety or a panic attack. In very rare cases, benzodiazepines are prescribed to be taken daily or regularly, but the drug will only be prescribed this way for a very short period of time.
Misusing prescription drugs, such as taking larger doses without consulting the prescribing physician or taking doses more often than prescribed, can lead to drug abuse and dependence. The FDA notes that it only takes two weeks of regular use of Xanax for the body and brain to become dependent on the presence of the drug, which can lead to taking more than prescribed, and that can cause an overdose.
Physical dependence on Xanax can happen rapidly, which can lead to misuse or abuse of the medication.
However, many people who take benzodiazepines like Xanax may misuse these drugs because they enjoy the relaxation and sense of calm that the medication causes. People who struggle with anxiety may also feel like they need to take Xanax regularly to control their panic even if their doctor did not prescribe Xanax this way. Sometimes, people mix Xanax with other substances to increase the potency, especially with other sedatives like alcohol, prescription painkillers, or heroin. They may also take Xanax to ease negative side effects from abusing stimulants, including cocaine, meth, and prescription stimulants like Ritalin and Adderall.
Additionally, many people who receive prescriptions for these as-needed sedatives also have prescriptions for other drugs like opioid painkillers, and it is unfortunately common for people to misuse prescription drugs by also drinking alcohol, which can be very dangerous. Mixing central nervous system (CNS) depressants like opioids, alcohol, and Xanax can quickly lead to an overdose and death.
While it is rare, it is also possible to take too much Xanax and overdose.
Why Does Xanax Lead to Overdose?
Xanax acts quickly, especially when it is in immediate-release form. The drug’s half-life is about 11 hours, but the medication’s effects begin within 30 minutes after it is taken orally. People who abuse Xanax by snorting or injecting it may get sedative effects faster, but they are more likely to suffer an overdose by abusing the drug this way.
General overdose symptoms include:
- Somnolence or extreme sleepiness
- Impaired physical coordination, leading to stumbling or falling as though drunk
- Diminished reflexes
- Extreme confusion
- Passing out and not waking up
- Breathing and heart rate changes
An overdose on Xanax occurs because there is too much of this sedative in the body, and the brain becomes overwhelmed. Benzodiazepines act on both the brain and body.
- Brain: Xanax and other benzodiazepines work on the gamma-aminobutyric acid (GABA) receptors in the brain. GABA is a neurotransmitter that inhibits “spasms” or rapid firing of neurons. Some benzodiazepines suppress seizures, but most induce a sense of calm, relaxation, and even sleepiness because they reduce how intensely and quickly neurons communicate. Many sedatives, including alcohol and barbiturates, create similar effects because they bind to GABA receptors; however, benzodiazepines like Xanax bind specifically to the GABA-A receptors, so the effect of these medications is more targeted.Xanax creates effects that are similar to those created by alcohol and sedative drugs, which means that many people get high from taking larger doses of these drugs. In many instances, people combine sedatives like Xanax with other sedatives like alcohol to increase the overall effects, which is extremely dangerous.
- Body: Xanax’s main action is on the brain, but when too much of the drug is consumed, changes to the body from an overdose can lead to lasting physical harm or death. The riskiest symptom of overdose is a change to breathing rate; slowed, irregular, or shallow breathing can all lead to oxygen deprivation, which may cause the brain to start shutting down. Stopped breathing will lead to suffocation and death. Slowed heart rate can also prevent enough oxygen from reaching the brain because circulation changes. Low blood pressure and body temperature can lead to organ damage.
To understand the progression of side effects to overdose, it is important to know how Xanax can affect the body. Long-term harm can occur if benzodiazepine abuse continues after the person suffers an overdose.
What are the Short Term Effects of Xanax?
There are several common side effects associated with Xanax, which can be managed with the help of a doctor. If these side effects are not treated by adjusting the dose, then they may get worse. People who abuse Xanax are more likely to experience these effects, and more likely to experience serious versions of these effects, because they compulsively take too much of the drug.
- Drowsiness or fatigue
- Impaired physical coordination
- Slurred speech as though drunk
- Paradoxical insomnia and anxiety
- Memory problems
- Trouble thinking
- Poor judgment
What are the Long-Term Effects ?
Abusing Xanax for a long time can lead to dependence and tolerance, which can both eventually lead to overdose, addiction, or both.
There are other long-term effects, including:
- Impulsive behavior
- Compulsive behaviors around other drugs
- Psychotic experiences
- Increased anxiety or insomnia
It is rare, but Xanax and other benzodiazepines have sometimes been associated with liver damage and failure. However, this is more likely when the drug is taken in combination with alcohol because alcohol is closely associated with liver damage.
Methods of Abusing Xanax
When prescribed, Xanax is available as a liquid or tablet, as both extended-release tablets and disintegrating immediate-release tablets. Tablets come in doses ranging from 0.25 mg to 2 mg. These are scored in the middle, so they can be split in half, as directed by a doctor. Oral liquid solutions should be mixed with water, another liquid, or a semisolid food and consumed. Extended-release Xanax has a dose up to 3 mg.
People who struggle with Xanax misuse or abuse may crush the tablets and snort them, or mix them with water or alcohol to inject them. The liquid version of Xanax may also be injected intravenously. These methods of drug abuse force the substance to enter the bloodstream and bind to receptors in the brain faster, so the high occurs faster and is more intense. However, this increases the risk of overdose because the drug’s potency changes when it is abused this way instead of moving through the digestive system.
Mixing Xanax and Other Substances
There are several substances, including other prescription drugs that interact poorly with Xanax. Prescription drugs that interact with Xanax include antifungals, antipsychotics, some antibiotics, antiseizure medications, antidepressants, antihistamines, and many other sedatives. These may be less effective, or they may increase the potency of Xanax. More often, however, Xanax increases the potency of sedative drugs, which can lead to an overdose. Alcohol and opioids are the two most common substances mixed with benzodiazepines like Xanax, and these combinations often lead to overdose.
While benzodiazepines like Xanax are widely misused and abused, they are not often the main substance of abuse. People who abuse benzodiazepines are more likely to use these drugs to either enhance the effects of the main drug of abuse or to manage the negative side effects from that drug.
- Opioids: On average, the opioid addiction epidemic takes the lives of 115 people per day in the United States, according to the Centers for Disease Control and Prevention (CDC). Benzodiazepines like Xanax have contributed to 30% of opioid overdoses in the US. The percentage of people who received prescriptions for benzodiazepines has gone up as opioid painkiller prescriptions have gone up, leading to an increase in the number of people who receive both medications to treat various conditions.Although the CDC has issued new guidelines on opioid prescribing practices, and is clear that prescribing both opioids and benzodiazepines at the same time is dangerous, this practice continues. Many people who struggle with addiction to either drug are at risk.
- Alcohol: Alcohol and benzodiazepines both work directly on the GABA receptors in the brain, so many people who struggle with alcohol use disorder (AUD) take these drugs to increase alcohol’s effects as they develop a tolerance to drinking. Mixing these two substances increases the risk of alcohol poisoning, cardiac arrest, or respiratory failure.
- Stimulants: Both prescription and illicit stimulants can have side effects like anxiety, shaking, paranoia, increased restlessness or nervousness, and insomnia. Many people who abuse stimulant drugs, especially cocaine, take benzodiazepines, including Xanax, to ease these effects so they can get the high from stimulants without the negative effects. However, mixing these drugs can lead to physical harm like seizures or heart attacks.
- Fentanyl: Although few people abuse fentanyl and Xanax purposefully at the same time, there are reports that fentanyl is being mixed into black market benzodiazepines or sold in place of these illicit benzos. This is extremely dangerous because fentanyl is a very potent opioid that rapidly causes overdose in people who do not know what they are taking and are not supervised by a medical professional while taking fentanyl. Unfortunately, illicit versions of fentanyl have flooded the illegal drug market in the U.S., causing several overdoses in people who did not know they were taking the drug.
Treatment for Xanax Overdose
Call 911 to get emergency medical treatment for any drug overdose, including an overdose on Xanax.
In their drug information, the FDA states that hospital admission is the key to surviving a Xanax overdose. Vital signs like breathing, blood pressure, and heart rate must be monitored; dangerous changes to vital signs must be treated. Intravenous fluids help to stabilize the body, and a stomach pump will remove any excess drug to prevent it from being digested further and continuing the overdose.
Because benzodiazepines are often mixed with other drugs like cocaine, alcohol, opioids, or meth, the person must be tested for other substances and treated for an overdose of those if needed.
In cases where a combination of benzodiazepines has been ingested, administering flumazenil can be effective in slowing or temporarily stopping the overdose. Flumazenil is used to revive people after surgery when a benzodiazepine was used in combination with other sedatives. Because this drug reverses the effects of benzodiazepines, it is also used to treat benzodiazepine overdoses.
Help Overcoming Xanax Abuse
Abusing Xanax is dangerous, but suddenly quitting the drug can be risky, too. It is important to get professional medical help to safely detox from drugs like Xanax because withdrawal symptoms can be life-threatening.
Typical withdrawal symptoms include rebound anxiety and insomnia, depression, intrusive thoughts or memories, panic attacks, muscle twinges or twitching, body aches and pains, digestive trouble, and nightmares. However, if the person develops benzodiazepine withdrawal syndrome (BWS), then they are at risk of heart palpitations, delusions, hallucinations, and even seizures. Working with a medical professional to safely detox means that the risk of developing BWS is much lower because a doctor will create a safe tapering schedule.
When benzodiazepines like Xanax are prescribed and the person wants to stop taking them, their doctor will help them slowly reduce the dose over several weeks until physical withdrawal symptoms are gone. Detox is similar, although a short-acting drug like Xanax may be replaced with a longer-acting benzodiazepine like Valium. The dose of this replacement drug will be gradually lowered until withdrawal symptoms have dissipated. Tapering the dose of a replacement medication helps to reduce cravings, compulsive behaviors, and uncomfortable physical symptoms that may lead to relapse.
Working with a replacement medication like Valium also allows the person to physically stabilize and focus on changing their behaviors. The most common and evidence-supported approach to changing behaviors is cognitive behavioral therapy. Many rehabilitation programs use this approach in group and individual treatment.