Alprazolam, also known by the brand name Xanax, is a benzodiazepine drug. Benzodiazepines were developed to take the place of the barbiturates, as they were believed to have less abuse potential than barbiturates; however, benzodiazepines can be significant drugs of abuse themselves.
Use of Xanax
Xanax is primarily prescribed for the treatment of anxiety, and it was intended to replace the more addictive benzodiazepine Valium (diazepam). Xanax can also be used as a muscle relaxant, to assist in anesthesia, as a sleep aid, and even to assist in the prevention of seizures, but its primary use is for the prevention of clinically significant anxiety. This means that it is primarily used to treat anxiety that is associated with anxiety disorders and other psychiatric disorders were anxiety is a significant feature, such as, PTSD.
Xanax is the most frequently prescribed and used benzodiazepine in the United States, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Xanax and other benzodiazepines are considered to be controlled substances, according to the United States Drug Enforcement Administration (DEA), meaning that their use is only legal when they are prescribed by a physician.
According to SAMHSA and the National Institute on Drug Abuse (NIDA), Xanax and other benzodiazepines are not commonly primary drugs of abuse, meaning that they are not the major drug of abuse among individuals who abuse them. Instead, benzodiazepines like Xanax are more commonly used in conjunction with other drugs. The most common drugs that are used with Xanax and other benzodiazepines are narcotic pain medications (e.g., opiate drugs like Vicodin and illicit narcotic medications like heroin), alcohol, other benzodiazepines, and stimulant medications. Xanax may also be used in conjunction with cannabis products.
When Xanax is used in conjunction with these other drugs, the typical motivation is to enhance the effects of the other drug, enhance the effects of Xanax, or counteract the effects of the other drug (e.g., in the case of using Xanax and stimulants). There are several different possible effects that can occur when individuals abuse Xanax in conjunction with other drugs.
Potentiation and Other Effects
When a person uses two or more different drugs at the same time, they risk experiencing effects that are different than those experienced when taking the drugs singularly. When individuals abuse two or more different drugs, the risk is even higher.
These types of drug interactions are divided into four major groups.
- Antagonism occurs when one drug reduces or cuts down on the effects of another. For instance, taking Xanax with a stimulant like cocaine will reduce the effects of both the cocaine and the Xanax.
- Synergism occurs when two drugs work together to produce a therapeutic effect. Synergism is often considered to be an effect of medical interventions that attempt to produce effects that do not occur when the drug is used alone.
- Potentiation occurs when the effects of one drug enhance the effects of another. For example, taking Xanax with alcohol will result in enhancement of the depressant effects of both drugs.
- Interactions with metabolism occur in multiple areas of the body and can either facilitate or slow down the elimination of the drug from the system.
Potentiation and Abuse of Xanax
Prescription drug abuse has become a major concern in the United States with 20–25% of Americans over the age of 12 years old admitting to nonmedical use of prescription drugs at least once. Of the benzodiazepines, Xanax is the most commonly misused and abused.
The number of individuals needing medical attention as a result of Xanax abuse doubled between 2005 and 2011 compared to previous periods of record. Because of its short half-life and very potent effects, Xanax can be an easily abused drug.
The potentiation of Xanax occurs when an individual abuses Xanax with some other central nervous system depressant drug. These drugs include narcotic pain medications, alcohol, other benzodiazepines, sedatives, and cannabis products.
There are numerous anecdotal reports online that grapefruit juice can potentiate the effects of Xanax; however, research studies have suggested that these reports most likely are the result of placebo effects. However, it should be noted that numerous medications can have untoward reactions when taken with grapefruit juice even though it does not appear that Xanax is one of these. Individuals who abuse Xanax and other central nervous system depressants and also consume grapefruit juice in an attempt to potentiate the effects of Xanax may be placing themselves at risk for problematic interactions.
When using Xanax with other central nervous system depressants, there are different potentiating effects at different doses of each drug. At very low doses, there may be a rather mild stimulation effect, but at higher doses, significant issues with lethargy, sedation, and decreased reflexes will occur.
When taken alone, central nervous system depressants result in a reduction in blood pressure, heart rate, breathing rate, and reaction time, and lead to issues with poor coordination, poor balance, reduced reflex actions, and impaired judgment. Taking central nervous system depressants in conjunction with one another, such as Xanax and another central nervous system depressant, will potentiate these effects.
The amount of a drug that can produce an overdose is decreased when similar drugs are combined. When the effects of Xanax are potentiated by some other central nervous system depressant, the amount of both drugs that can produce an overdose or toxic effects is significantly reduced.
Dangers of Potentiating Xanax
Based on the above information, using other drugs to potentiate the effects of Xanax can produce significantly increased risks. There are several potential dangers associated with using other drugs to potentiate the effects of Xanax.
- The depressant effects of Xanax are significantly increased. This includes potential negative side effects.
- When abused, central nervous system depressants affect judgment. Using them in combination to potentiate the effects of one or the other leads to the potential for significantly decreased rational thinking.
- Emotional control is often severely hampered when central nervous system depressants are combined. Individuals may become very angry, aggressive, and even violent when taking Xanax in conjunction with some other central nervous system depressant.
- The normal process of the body eliminating a drug is hampered when an individual takes multiple drugs. This means that even though the person may no longer feel intoxicated, they may still have dangerously high levels of alcohol, Xanax, or narcotics in their bloodstream. This could lead to an increased potential for overdose if the person takes one of these drugs before they have been metabolized completely.
- Long-term effects of central nervous system depressant drugs often include issues with respiration, cardiac functioning, and even brain functioning. Regularly taking other central nervous system depressants with Xanax in order to potentiate the effects of these drugs enhances these possibilities.
- Individuals who abuse multiple drugs together are at an increased risk to develop other types of mental health disorders, including depression and anxiety.
- The development of physical dependence and a substance use disorder is accelerated when individuals habitually combine drugs with similar actions.
Given that Xanax is typically eliminated from the body rather quickly when taken alone, an individual using Xanax in conjunction with alcohol or narcotic pain medications would be at an increased risk for an overdose on alcohol or the narcotic rather than an overdose on Xanax. For instance, NIDA reports that over 30% of opiate overdoses also involve abuse of benzodiazepines like Xanax.
Any individual who habitually combines Xanax with some other central nervous system depressant to potentiate the effects of these drugs is misusing the drugs and moving toward a formal diagnosis of a substance use disorder.
There are several signs that a substance abuse issue may be present.
- Continued and compulsive use of these drugs for nonmedical reasons
- Combining drugs when not directed to do so by a physician
- Issues controlling use of the substances
- Continuing to use the drugs in spite of negative effects
Those who abuse benzodiazepines like Xanax and develop physical dependence on them may be at risk for life-threatening conditions if they undergo withdrawal from benzodiazepines when they are not under medical supervision. This is because withdrawal from benzodiazepines can include significant seizures, which can cause brain damage and even be fatal. While not everyone who withdraws from benzodiazepines will experience seizures, the risk is so significant that anyone who has abused any benzodiazepine for more than a few weeks should only discontinue use under the supervision of a physician.
Treatment for a polysubstance use disorder should include the use of medical management (medications and other medical procedures), substance use disorder therapy, support group participation, and a long-term commitment to abstinence.