Understanding Drug Dependence

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XANAX-THE DANGEROUS BENZODIAZEPINE

PREFACE
This article presents some basic information about benzodiazepines. However, everyone needs to keep in mind that all of us have different DNA and we will metabolize and use all drugs in different ways. Some of us may experience more effect from the same drug, less effect or, in some instances, little or no effect.

WHAT ARE BENZODIAZEPINES?
Benzodiazepines ("benzos") are drugs that were first marketed in the 1960's for the treatment of insomnia, anxiety, seizures, convulsions and as muscle relaxants. Today these drugs account for about one out of every five prescriptions for controlled substances.

Benzos like ProSom, Dalmane, Doral, Restoril and Halcion are often prescribed for insomnia. Klonopin is often prescribed for the treatment of seizure disorders. Ativan, Centrax, Librium, Paxipam, Serax, Valium, and Xanax are often prescribed for the treatment of anxiety. Xanax was introduced in 1969 and is the fifth most commonly prescribed drug in America, according to data from IMS Health, a health care information company. In 2006, 37.5 million prescriptions for it were dispensed, up from 29.9 million in 2002.

Xanax and other benzos are increasingly being used, mostly without prescription, by younger people seeking a high, according to the National Institute on Drug Abuse. A government survey in 2000 found that about 5 million Americans have abused Xanax or a similar anti-anxiety drug at some point.

HOW DO BENZOS WORK?
A benzodiazepine is a Central Nervous System (CNS) depressant. Anything that depresses the CNS will seem to relax a person. Our bodies manufacture a natural substance called gamma aminobutyric acid (GABA) that works to allow chloride ions to penetrate to a receptor on the cells and slow down the activity of the brain cells. GABA and chloride ions are the body's natural relaxing agent. A benzo will have a similar effect on your mind to that of alcohol. When GABA binds to a nerve cell receptor, it actually is like opening a door so that chloride ions are allowed to move into the nerve cell, contact a receptor in the cell, slow the activity of the cell, and as a result the person normally experiences a calming feeling.

Benzos increase the effect of GABA on the cell and this allows more than the usual number of chloride ions to reach the cell receptor and further reduce the activity of the cell. Again, the feeling created by this action of benzos is similar to the feeling most of us experience if we are drinking alcohol.

However, benzos are not a harmless drug. Government studies show that a large percentage of drug-related emergency room visits involve benzos. Like alcohol, using benzos impairs mental alertness and physical coordination and can dangerously compromise mechanical performance, such as automobile driving. Combining the use of benzos and alcohol can have fatal consequences. In addition, because of the effect created by benzos, a large percentage of people entering treatment for narcotic or cocaine addiction also report abusing benzos.

WHY IS XANAX DANGEROUS?
The half-life for Xanax is short... on the order of 6-12 hours. (Half-life: time taken for the blood concentration of the drug to fall to half its peak value after a single dose. Because of DNA and metabolism, this time may vary considerably between individuals but generally the shorter the half-life, the quicker the effect of the drug is felt.)

This means that it quickly is metabolized and transferred to the brain, where it increases the actions of GABA and thus more chloride ions reach the cells. Of course, this means that the calming effect of Xanax starts quickly and this is one of the reasons that it becomes so addictive so fast. (To feel the effect quickly is why people snort cocaine up their nose or inject heroin in their veins.) However, conversely, the effects lessen rapidly as well.

Initially, Xanax will be adding to the effect created by your own GABA. However, in anywhere from a few days to a few weeks, the use of Xanax will normally lead to a decrease in your production of GABA. To achieve the same initial effects, the Xanax dose will have to be increased to compensate for the lack of natural GABA-the person has developed a physical dependence on Xanax. (This is also what is meant when people are said to have developed a tolerance for benzos.)

While many people who are addicted to Xanax started taking it in small doses, like heroin or cocaine users, they often begin taking more and more and start craving the drug when the effects of the drug begin to lessen-in a relatively short time after taking drug. There have been reports that people taking larger doses of Xanax became physically dependent in as little as two days. As with most drugs, the larger the dose, the faster one becomes addicted to Xanax.

While there is nothing illegal about a doctor prescribing Xanax for long-term use, and many psychiatrists do, because of its extreme addictive qualities, Xanax is only approved by the FDA for up to eight weeks of use and is only approved for up to four weeks of use in Great Britain. If it is prescribed for more than eight weeks in the United States it is an "off-label" use, which means that it was not tested and approved for this use by the FDA.

Most of us are familiar with Valium, another benzo. What many of us do not know is that .5 milligrams of Xanax is equivalent to 10 milligrams of Valium. When you hear that someone is taking 5 milligrams of Xanax, you should realize that they are taking the equivalent of 100 milligrams of Valium. This is a very heavy dose and means that their tolerance to Xanax has increased markedly. Xanax is one of the two most frequently encountered benzodiazepines on the illicit market.

XANAX WITHDRAWAL
Often when someone learns that they need to take Xanax in larger doses and more frequently to receive the calming effect that they want, they will go to the doctor that prescribed it and the doctor may prescribe more, or the doctor may realize what is happening and refuse to prescribe more. Then the person is in the position of having to either go doctor shopping or purchase the Xanax on the street, or if neither of those options works they will experience Xanax withdrawal.

Although it may surprise you, doctor shopping is not as difficult as one might imagine. One of our Novus patients told me that there is an area of Houston, Texas where you can go to one pain clinic, complain of a pain in your neck, be examined, have an x-ray taken, pay $100 for a five minute meeting with the doctor and walk out in less than thirty minutes with a prescription for Xanax and OxyContin. Then he would go about a block to another pain clinic and repeat the process. He said that he would regularly go to at least four doctors and then would return home to Louisiana, and there he would sell enough of the pills to pay for the doctor visits and the cost of the pills and keep the rest for himself. Our patient was paying about $200 for 100 pills but was able to sell pills for up to $5 per pill on the street.

If the addicted person is either unwilling or unable to get additional Xanax, then withdrawal starts.

Remember, when you are taking Xanax your body is producing much less GABA-the body's natural calming substance. Again depending on your DNA and metabolism, it can take a week or more before your body starts producing enough GABA to begin calming the body. When the calming effects of the last Xanax dose wear off in a few hours, the withdrawal starts.

It is very unwise to try to withdraw from Xanax or any benzodiazepine on your own. Reports from people who have tried to just "stop taking" Xanax relate that they experience a very bad panic attack. Others withdrawing on their own from Xanax experience high blood pressure, a rapid heartbeat, uncontrollable tremors and sudden movements of their limbs, confusion, delirium, hallucinations and even seizures which can lead to death.

At Novus, we successfully help people withdraw from Xanax and other benzos. Our medical detox protocol does not guarantee that someone will have no symptoms, but that the person will safely and as comfortably as possible, complete their withdrawal.