By Dr. Arnab Datta
Posted on June 7, 2021
Xanax (alprazolam) is a short-acting benzo (benzodiazepine) medication most frequently prescribed to reduce anxiety, but that’s not all it does. Have you ever gone to the emergency room, urgent care clinic, or your primary care physician and reported having some anxiety – and they prescribe you Xanax?
Such anxiety treatment is done very commonly by psychiatrists and medical doctors in NYC. Xanax and Ativan (lorazepam) are short-acting benzos which reduce anxiety but also cause dependence, especially the former. As a result, people who take Xanax find the need to take more and more rather quickly – their tolerance increases. By raising their tolerance and dependence, Xanax can very easily lead to abuse and addiction. The problem is that one can overdose on Xanax and die, and even withdrawal symptoms from Xanax alone can be so severe that it causes seizures.
One way in which Xanax can be fatal is through respiratory depression following an overdose. This means that someone can stop breathing while they’re asleep during an overdose. Mixing Xanax and common opiate pain medications (such as percocet, vicodin, oxycodone, Suboxone and methadone) increases the chance for respiratory depression. These patients must be revived by multiple doses of narcan (naloxone). Narcan is a mu-opiate receptor antagonist, which means it works by knocking off opiates from the opioid receptors in the brain. This terminates lethal respiratory depression, but throws the patient into immediate opiate withdrawal symptoms. Sure, this speaks more to overdosing on opiates than Xanax, but the point is, the combination of mixing Xanax and opiates is a dangerous trend right now.
Unfortunately, dependence and tolerance can build up without an obvious indication that it’s happening. There are many people unaware of a dependence to their prescription medication. This can happen with any benzodiazepine anxiolytic (for anxiety treatment) medication, but it happens most frequently with Xanax. Klonopin (clonazepam) and Valium (diazepam) are longer acting benzodiazepines that also cause dependence with high doses and chronic use. However, it doesn’t occur as easily with Klonopin and Valium, and these drugs are often used to help wean Xanax addicts off their dependence.
Xanax is FDA approved for the treatment of panic disorders with or without agoraphobia, and sometimes in combination with other medications for chemotherapy induced nausea and vomiting. It’s provided when the patient has no history of tolerance or dependence, but it isn’t at all a long-term solution. If Xanax is prescribed, it may be so that the patient can get back to work. For example, if they need to operate heavy machinery, Xanax is able to quell their anxiety and clear their system before the patient gets behind the wheel. Even if the patient doesn’t have a history of tolerance or dependence, this doesn’t mean they aren’t susceptible to Xanax addiction. Ativan (lorazepam) is less addictive in this situation – when the patient must have the benzo to relieve their anxiety and then have the medication leave their body.
Xanax works by agonizing, or stimulating, GABA-A receptors in the brain. This is the same receptor that alcohol and other benzos act on. Xanax is more addictive than other benzos, even ativan, because it increases extracellular dopamine d1 and d2 concentrations in the stratum of the brain. Dopamine is a feel-good neurotransmitter, it plays a central role in reward and pleasure, and generates the feeling of euphoria Xanax provides. That’s why it’s a street drug. It’s even tested for in generic urine toxicology lab tests.
Overdose from benzodiazepines can result in:
Aspiration pneumonitis: When a patient is so sedated that they vomit into their own lungs. This causes a type of pneumonia called aspiration pneumonitis.
Rhabdomyolysis: A breakdown in muscle tissue that releases toxic proteins into the blood that can lead to kidney failure. This can happen at any age.
Respiratory arrest and death: This is the most common outcome of overdose from benzodiazepines. This is the most morbid and happens from mixing Xanax and opiates together, but can also occur when taking too much Xanax by itself. Unfortunately this can happen even if a person doesn’t over-consume their Xanax or opiate.
Just like a person can drink themselves into severe alcohol intoxication, a person can over-consume Xanax or a benzo. Both alcohol and benzos both agonize or stimulate the Gaba-A receptor. It’s most dangerous when benzos are mixed with opiates, as mentioned above.
There are a number of ways to combat a Xanax overdose. If a person is found in an unresponsive state by EMT, an intravenous line of fluids is started and narcan is given. They may need to provide oxygen, dextrose and thiamine (vitamin B1 deficiency is caused with alcohol addiction) as well. In the addiction treatment emergency room, the patient is given activated charcoal to absorb the Xanax in the stomach (aspiration pneumonitis can still happen after activated charcoal is given), and the stomach can be pumped. Flumanzanil is a GABA-A receptor antagonist that treats intoxication and drowsiness from benzos. These are all emergency measures for benzodiazepine overdose.
Don’t let the above happen to you or a loved one. Prevention is the best treatment. The following include some helpful ways to do so: Patients can go to a traditional inpatient detox program for a duration of 5-7 Days depending on how much insurance will cover. Patients can also go to a traditional inpatient rehab, which can last anywhere between 7-28 days. When patients can’t go away like this, they may benefit from a customized outpatient detox plan, but this isn’t for everyone. It depends on how stable they are, how much substance they are using and how well they can stick to a scheduled tapering-down regimen. If the patient doesn’t match these criteria then they’re better off going to a traditional detox rehab center or setting. You are welcome to call my office if you’re curious about how this office-based outpatient detox program works.
