t’s a gross understatement to say that the pharmaceutical industry is a big business. Accounting for over $1 trillion in revenue per year, Big Pharma is only going to get bigger. But one prescription drug, since its commercial introduction in the early ’80s, has become recreationally common, increasingly abused, and somehow socially acceptable: Xanax.
Alprazolam, known by its commercial name of Xanax, is a benzodiazepine (commonly referred to as “benzos”) prescribed for relief from anxiety and panic disorders. Benzodiazepines are a class of drugs that target neurotransmitters in the brain, causing a calming, tranquilizing effect. This explains why over 40 million prescriptions of Xanax are written every year and, given the fact that anxiety disorders affect over 40 million adults in the United States alone, Xanax’s continued success is fairly secure.
On paper, prescribing benzodiazepines makes sense. “There is a receptor in the brain where benzodiazepines act and they increase GABA activity,” says Matthew Goldenberg, D.O., a mental health and addiction expert in Los Angeles, “which is what we call an inhibitory neurotransmitter. Basically, they slow down the sympathetic response (fight or flight response) of the nervous system.” But Xanax is not effective for long-term treatment and becomes dangerous when taken habitually. “Xanax and other benzodiazepines quickly build up tolerance in most people, meaning they lose their effectiveness and require higher doses even when taken as prescribed,” says Dr. Goldenberg. “They should be prescribed for short term anxiety and panic relief, while another long-term option is employed and until that long-term option begins to work.”
The problem is, according to Soroya Bacchus, M.D., a Los Angeles-based psychiatrist and author of How to Detox Yourself from Alcohol, addiction can rear its ugly head in as soon as five days. Dr. Bacchus stresses that benzodiazepines “only provide relief from anxiety symptoms for the moment. They do not treat anxiety.” Dr. Bacchus’ distinguishes between temporary relief and meaningful treatment because taking Xanax is in no way a cure for anxiety and other panic disorders. In fact, Xanax has proven to be habit-forming and ultimately dangerous when abused.
Most doctors are now cutting down on the use of opiates but over-prescribing Xanax for patients with untreated mental disorders.
“Xanax releases dopamine like all addictive drugs,” says Dr. Goldenberg. “Some people use it to escape or feel high. I think America has a fixation with finding a pill that makes us feel good. In many cases, heroin, pain medications, and Xanax are combined (sometimes intentionally and sometimes not) and this has contributed to overdose deaths.” What’s most alarming, however, is Xanax’s prevalence as a socially acceptable recreational drug that has been normalized by pop culture: if you’re feeling anxious or squirmy, just pop a Xanny. More recently, 22-year-old rapper Lil Xan took his name from the drug, and 2 Chainz rapped about it in 2016’s “Xanny.” This pursuit of good feelings and fast-acting relief has led many to claim that we’re currently in the midst of a Xanax epidemic (one that is unnoticed by the public at large) partly because the physical act of swallowing a pill raises few eyebrows. As such, a Xanax habit can remain unnoticed until it’s out of control.
“Early marketing, just like with opiates, promoted how rapidly effective they were with little side effects including addiction. Right now, the main culprit for the current epidemic are primary doctors over-prescribing these drugs,” says Dr. Bacchus. “Most doctors are now cutting down on the use of opiates but over-prescribing Xanax for patients with untreated mental disorders.” When a drug is over-prescribed, it’s common for it to become available on the streets and, more alarmingly, within reach from many medicine cabinets. The accessibility of benzos is partly what makes them so attractive and seemingly safe—how can it be dangerous if it’s in so many homes? But the long-term health risks involved in recreational Xanax definitely outweigh the short-term high.
“The biggest risk is death,” says Dr. Goldenberg, “usually from respiratory suppression. In other words, you can stop breathing if you take too much. You can also have a seizure if you abruptly stop taking high doses. But most commonly you have people who go through cycles of withdrawal. They are constantly ‘living’ to find more of the drug to just feel ‘normal.’” This type of junkie behavior is not commonly associated with Xanax abuse because it is a prescription drug. As Dr. Bacchus notes, effective marketing (a sort of drug in itself) has kept Xanax’s image squeaky clean, warding off any comparisons to illegal “street” drugs like heroin or cocaine. Despite Xanax’s lack of social stigma, treatment for benzo addiction can be as ugly as kicking the hard stuff.
Xanax addiction treatment requires “medical supervision with a doctor trained in addiction medicine, not your regular medical doctor,” says Dr. Bacchus. “Taper with supportive medications to prevent withdrawal seizures is the goal and can usually be done in a few weeks easily.”
Dr. Goldenberg breaks it down further. “First, you have to get safely ‘detoxed’ medically to avoid the seizure risk. Next, you have to treat the underlying issues. You basically have to learn to deal with life without the drug—and that is hard—but it is very much possible for those who are motivated to change their life.”
Dr. Bacchus shares a similar sentiment. “Most people don’t abuse these drugs. The majority of people who do have underlying mental disorders that should be diagnosed and treated by a mental health provider.”
When treating benzodiazepine addiction, both Dr. Bacchus and Dr. Goldenberg emphasize the necessity to identify and treat the underlying issues. For Dr. Goldenberg, he points out key culprits like grief, trauma, and sadness. Unfortunately, recreational Xanax users will often convince themselves they have things under control (even when they’re popping over twenty pills a day) or it’s not a big deal because it’s just Xanax. Bottom line? Just smoke a joint instead.
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