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Experts concerned over extended use of anti-panic drug

Chicago Tribune
October 21, 2002
by Ronald Kotulak
Tribune science reporter

At the age of 51, a family physician in a midsize southwestern city joined the ranks of an estimated 4 million Americans who are victims of prescription drug abuse.

"I took a Xanax pill that my wife had been prescribed to help her sleep, and I felt normal," said the doctor, who asked that his name not be used. "I didn't feel high, I just felt normal. My anxiety was gone. I was calm. It was a wonderful feeling."

The doctor's psychiatrist said "great" and prescribed Xanax for him. But it wasn't long before the doctor found he had to up the dose to retain that feeling of normalcy. When his Xanax supply ran low, he turned to alcohol to supplement its calming effect.

Xanax, a perfectly legal drug, is a member of the sedative-depressant family of pharmaceuticals known as benzodiazepines, and it is widely prescribed for anxiety and panic attacks.

The problem with Xanax is that it is too efficient, according to drug abuse therapists. It is the most potent and fastest-acting of the benzodiazepines, properties that can quickly make the brain become dependent on it.

"Xanax is one of the most problematic addictions that we treat," said Dr. Dan Angres, director of the Rush Behavioral Health treatment network.

"For one thing, it is really very highly addicting. It is short-acting so that you eventually need to be dosed rapidly throughout the day.

"The other problem with Xanax is that it is very effective," he said. "If people have a panic attack or suffer from anxiety, it will definitely help their symptoms. The problem is that if one is predisposed to addiction, it is a very addicting drug. It's the crack of benzodiazepines."

Most people who end up abusing prescription drugs become chemically dependent--the drug becomes entwined with the chemistry of their brain--and they suffer painful withdrawal symptoms when they try to stop. Addiction occurs when a person continually seeks to repeat the euphoric effects of a drug regardless of the cost to career, family, friends or life.

No one really knows how many people are addicted to prescription drugs. The estimated figure of 4 million is only an educated guess, but there is general agreement that the problem is increasing.

"Prescription drug abuse is a major health issue in this country," said psychologist Howard Heit, who treats addicted patients in northern Virginia. "It is a hidden epidemic."

Experts acknowledge the usefulness of psychoactive prescription drugs, but they say that there is little recognition among physicians or the public of their potential for abuse.

"We often see the same pattern with prescription drugs," said Dr. Martin Doot, chief of addiction medicine at Lutheran General Hospital in Park Ridge. "They come out, they are heavily marketed and the abuse liability is typically minimized. When Xanax came out, many doctors were sold on the idea that it was not addicting."

Xanax, like other members of the benzodiazepine family, is prescribed to produce sedation, induce sleep, subdue panic, relieve anxiety and muscle spasms, and prevent seizures.

In addition to Xanax, 14 other benzodiazepines are marketed under such names as Librium, Tranxene, Valium, Paxipam, Ativan, Serax and Centrax. The older, slower-acting benzodiazepines are far less likely to cause dependency or addiction.

An estimated 80 million prescriptions are written for Xanax annually. Some addicts refer to it as "alcohol in a pill" because of its ability to calm an overwrought brain. It also triggers the release of dopamine in the brain's reward center to produce euphoric feelings that are very similar to those produced by alcohol.

Manufacturer warns of risk

The manufacturer of Xanax, Pharmacia Corp., is aware of the problem and warns in the package insert that even after relatively short-term use at the prescribed doses, there is some risk of dependence.

The company referred calls about dependency to the federal government's National Institute on Drug Abuse and said that Xanax sales figures are considered proprietary.

The National Institute on Drug Abuse monitors visits to hospital emergency rooms by people who suffer overdoses, bad reactions, withdrawal or other threats to their health from illicit drugs or prescription drugs used for purposes other than medical reasons.

In 2001 there were 638,484 emergency room visits for bad reactions to illicit and prescription drugs. Of all the drugs that were abused, 43 percent were prescription medications. Cocaine, marijuana and heroin headed the list of illicit drugs, while narcotic painkillers (OxyContin, Darvon, Vicodin, Dilaudid, Demerol and Lomotil) and Xanax, along with other benzodiazepines were at the top of the prescription drug list.

Addiction experts say that taking Xanax for more than eight weeks carries a high risk of dependency.

"Xanax is one of the most dangerous drugs to come down from, even including heroin," said Kathy Vinson, director of nursing at Holy Family Substance Abuse Alcohol/Drug Treatment Center in Des Plaines. "It can have life-threatening withdrawal symptoms, like seizures."

Withdrawal symptoms from Xanax mimic those of anxiety and panic. Patients feel they have to take more of the depressant to quell their old disorder, but in fact they are trying to blunt the physical consequences of their new dependence.

"About 10 to 20 percent of our patients are addicted to benzodiazepines alone or in combination with other compounds, usually alcohol or illicit drugs," Doot said.

Although the street use of Xanax is increasing - especially among people who want to enhance the effect of other drugs, or to help them come down from heroin or cocaine--most abusers are patients who were legally prescribed the drug.

"We tend to get people who started taking it for insomnia or an anxiety disorder," said Greg Hayner, chief pharmacologist at San Francisco's Haight-Ashbury Free Clinic.

"We've had people come in who got it prescribed for stuff like agoraphobia.

"They've been given it for legitimate reasons, and the reason we're seeing them sometimes isn't so much because they've been abusing it outright, but they've had a hard time getting off of it," he said.

But many people who abuse Xanax and other prescription drugs are not seen in detox units or drug treatment programs.

They go from doctor to doctor to get new Xanax prescriptions, try to forge prescriptions or scheme with law-breaking doctors or pharmacists to get illegal supplies.

Florida Gov. Jeb Bush's daughter, Noelle, who is under treatment for drug abuse, was arrested in January after being accused of trying to obtain Xanax with a forged prescription.

Many taking drug improperly

When Express Scripts, Inc., a managed-care pharmacy, looked at more than 13,000 women 60 and older who were taking benzodiazepines, they found that more than half were taking the drugs improperly. Nearly 60 percent of these women were taking the drugs for four or more months, a length of time that significantly increases the risk of dependence or addiction.

For the 51-year-old physician reducing the dose of Xanax was physically painful. His anxiety clawed back, he couldn't sleep and a million butterflies seemed to churn in his stomach, disturbing sensations he now recognizes as withdrawal symptoms.

He became both chemically dependent on Xanax and psychologically addicted to it.

He chased the ever-fleeting "normal" feeling by taking more Xanax and drinking more alcohol. For four years his life descended deeper and deeper into addiction.

"That's when I really started doing some suicidal thinking," he said. "Not that I would ever carry it out, but I really began for the first time in my life to have some concrete plans for how I would end my life."

Several months ago his wife staged a confrontation in the office of his psychiatrist, who by this time knew his patient was out of control. Faced with a breakup of his marriage and the loss of his medical license, he agreed to go into treatment.

He consulted an addiction specialist. "He told me that I was an addict, that I'd become addicted to Xanax. Part of that whole thing was my addictive personality, but it was also misprescribing on the part of my psychiatrist."

The physician traveled to Des Plaines where he spent a week in Holy Family Hospital's detox unit to clear Xanax from his brain. He spent a week in detox.

Safely down from Xanax, he transferred to Rush-Presbyterian-St. Luke's Medical Center where he completed a 9-week program in August.

"My anxiety is under much better control," the doctor said. "I'm on no Xanax. I feel no desire to take Xanax ever again. It's a dangerous drug."

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