Etizolam vs. Xanax: What You Need to Know
Etizolam (brand names: Etilaam, Etizest, Etizola, Sedekopan, and others) is a benzodiazepine analog drug that is technically a thienodiazepine. Drugs in this class are similar in their chemical structure to the benzodiazepines and have a similar mechanism of action.
Etizolam is available as a prescription medication in Japan and parts of Europe, but it is not used medicinally in the United States. The drug is not listed as a controlled substance by the United States Drug Enforcement Administration (DEA), but several states classify it as an illicit drug (Schedule I in Alabama, Arizona, Arkansas, Florida, Georgia, Mississippi, and Virginia at the time of this writing).
The DEA reports that in states where the drug is not illegal, etizolam appears to be available from specialty stores and on the Internet. At these vendors, the drug is often marketed as a drug that is used for research purposes.
Xanax (alprazolam) is a drug of the benzodiazepine class. Benzodiazepines are used medicinally throughout the United States, and they are potential drugs of abuse. Xanax is considered to have an intermediate onset of action and a brief half-life compared to other benzodiazepines, indicating that it acts rather quickly, has potent effects, and also wears off rather quickly.
Xanax was marketed as a replacement for the benzodiazepine Valium (diazepam), which at one time was one of the most prescribed drugs in the United States, and it was also a significant drug of abuse. Because Xanax has quick-acting, potent, and short-lived effects, it was believed that the drug would not be abused in the manner that Valium was; however, Xanax is also widely abused. Xanax is classified as a Schedule IV controlled substance by the DEA, indicating that it can be possessed with a prescription from a physician, but is tightly controlled and can only be prescribed for medicinal uses by a physician.
Medicinal Uses of Etizolam and Xanax
The medicinal uses of etizolam in countries where it is prescribed are similar to the medicinal uses of benzodiazepines like Xanax.
Taking these drugs results in:
- A significant decline in subjective feelings of anxiety
- Relaxation and sedation
- Overall down of physical and mental processes
Common medicinal uses for both drugs include:
- To reduce anxiety in individuals who have anxiety disorders
- To enhance or induce sleep
- To control seizures
Other medicinal uses for both drugs include capitalizing on their potential anesthetic effects, being used as skeletal muscle relaxants, and in the treatment of other issues with anxiety that occur in neurological and other psychiatric disorders aside from anxiety disorders (e.g., depression).
Mechanism of Action
The mechanism of action for benzodiazepines and for etizolam is also similar. Both drugs work to increase the actions and availability of the neurotransmitter GABA (gamma-aminobutyric acid). GABA is the major inhibitory neurotransmitter in the central nervous system, and it functions to modulate various actions by slowing down the firing rates of neurons. Both etizolam and Xanax are central nervous system depressant drugs.
Abuse of Etizolam and Xanax
There do not appear to be reliable statistics or data on the abuse of etizolam in the US: however, according to the World Health Organization (WHO), it is a drug of abuse in countries outside the United States where it is prescribed for medical uses. In addition, the drug has been listed as a drug of concern in the US due to rising numbers of reports from poison control centers and emergency departments of individuals being admitted for issues associated with the use and abuse of the drug.
Xanax is the most prescribed benzodiazepine according to data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). According to the data in 2016, about 4.3 million individuals reported misusing alprazolam products (Xanax) at least once. However, Xanax is not a primary drug of abuse. When the drug is abused, it is typically used in combination with other drugs of abuse, most often other benzodiazepines, alcohol, or prescription narcotic pain medications.
The signs of abuse for either drug are similar. They include:
- Having significant problems with controlling use of the drug in numerous contexts
- Significant impairment, distress, or dysfunction in more than one area of life associated with the drug
- Significant cravings to use the drug
- Continued use of the drug despite problems with functioning, physical health, or emotional health
- Developing signs of physical dependence on the drug
An individual who has developed a substance use disorder to either Xanax or etizolam would be diagnosed with a sedative, hypnotic, or anxiolytic use disorder according to the diagnostic criteria or by the American Psychiatric Association (APA).
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Tolerance occurs rapidly to etizolam and Xanax with continued use. For this reason, Xanax or etizolam that is used for anxiety control or to initiate sleep should only be used as a short-term measure while other longer-term interventions (most often behavioral interventions) can be implemented. As most individuals who abuse these drugs take them in far higher amounts than the dosages that would normally be prescribed, those who abuse them on a consistent basis develop tolerance even more rapidly. The development of tolerance fosters the withdrawal syndrome that can occur as a result of chronic use and abuse of either of these drugs.
The withdrawal syndrome for Xanax and etizolam is very similar. It generally consists of two phases: acute and protracted withdrawal.
- Acute withdrawal: An acute phase of withdrawal typically begins within a few days after the person has discontinued the drug. For Xanax, withdrawal symptoms may occur rather rapidly due to its short half-life; for etizolam, the symptoms of withdrawal will often begin even more quickly due to its shorter half-life. The average half-life for Xanax is about 11-12 hours; for etizolam, it is estimated to be 4-5 hours.Symptoms in the acute phase are typically intense, uncomfortable, and may even be life-threatening. Depending on the individual’s level of abuse, the acute phase may last for several days up to several weeks. Symptoms will include at least some of the following:
- Feelings of anxiety (rebound anxiety)
- Insomnia, irritability, or restlessness
- Fever, perspiration, chills, nausea, vomiting, appetite loss, and/or stomach cramps
- Irregular heartbeat and/or hypertension
- Headaches, confusion, tremors, and potential seizures, which can produce brain damage or be fatal
- Significant depression, emotional lability, and strong cravings to use the drug
- Protracted withdrawal: The second phase is a protracted phase that will begin once the symptoms in the acute phase peak and start to subside. The peak of the acute symptoms will occur within 1-2 weeks after their onset, but for individuals with severe abuse, issues may last longer. The protracted phase consists of symptoms that occur in the acute phase and the onset of psychological symptoms, such as depression and cravings, if these were not experienced the acute phase. The protracted phase can run for several weeks in some individuals. Seizure potential is decreased during this phase but remains a possibility.
The standard treatment for withdrawal from either drug is to place the individual under the supervision of a psychiatrist or addiction medicine physician and prescribe them a long-acting benzodiazepine (e.g., Valium).
The benzodiazepine is administered on a tapering schedule, such that the initial dose controls any withdrawal symptoms the individual is experiencing. Over time, the physician slightly decreases the dose at specific intervals to wean the person off the drug. The medical detox program typically lasts longer than the withdrawal period from the drug would last, but it is a far safer method of discontinuation, reduces relapse potential, and results in far less distress than using a cold-turkey approach.
The treatment protocol for an individual recovering from abuse of either drug would be similar and include the effective components of overall treatment for substance abuse:
- A thorough assessment of the individual to identify all areas of concern
- Placement in a medical detox program (preferably an inpatient program)
- Initiation of therapy and peer support group participation
- Placement in a long-term aftercare program once the withdrawal management program is completed
- Continued abstinence and participation in treatment for years following initial abstinence
Because both Xanax and etizolam are central nervous system depressant drugs, there is a potential for overdose on either drug. Overdose on either drug can be potentially fatal.
Signs of overdose include:
- Significant lethargy, unconsciousness, or a comatose state
- Significantly decreased breathing rate
- Significant confusion, incoherence when speaking, and problems with motor coordination
- Depression, hostility, irritability, and loss of emotional control
Any individual who is suspected of overdosing on these drugs should receive emergency medical treatment. Individuals not trained in medical procedures should not administer any medications, food, or liquids to the person.
Etizolam is currently not available for medical reasons in the United States. As a result, it is probably abused at a lower rate than Xanax, which is a Schedule IV controlled substance. Both drugs have similar mechanisms of action, similar effects, and can produce physical dependence. Both drugs can be potential drugs of abuse. Any use or possession of etizolam is illegal in some states.
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