Benzodiazepines such as Xanax, Valium, and Klonopin have been described as the quiet killer at the heart of the prescription drug epidemic. Having been overshadowed by the ongoing opioid crisis, which is centered on the abuse of legal and illegal drugs such as oxycodone, fentanyl, and heroin, abuses of anti-anxiety meds and tranquilizers often go under-the-radar.

The Center for Disease Control and Prevention (CDC) reported that 30 percent of all prescription drug overdose deaths in 2013 involved benzodiazepines, and the number of benzodiazepine-linked deaths is growing per year. Prescriptions of benzodiazepines in the U.S. have tripled in the last 20 years, with overdoses quadrupling. Additionally, the quantities of the drugs in each prescription more than tripled from 1.1kg to 3.6kg lorazepam-equivalents per 100,000 adults between 1996 and 2013.

Xanax (generic name alprazolam) is the most popular psychiatric drug in the U.S. and was the country’s 11th most prescribed drug in 2010. Although things are beginning to change (more on that later), Xanax is still at the forefront of a very real prescription drug crisis. And the issue isn’t limited to the United States. Last month, the BBC reported that children in the UK as young as 11 are taking the anti-anxiety medication, with drugs charity Addaction claiming that 13-year-olds have been “dealing” the drug in UK schools.

In addition to the overprescription and popularity of the drug, Xanax’s glorification through pop culture adds to the problem and could require a whole industry to reevaluate its message regarding the drug.

So, what exactly is Xanax and how dangerous is it really? The press loves to demonize drugs of all types, which has hindered efforts to legalize relatively harmless drugs such as weed and generated controversies around various licensed medical treatments. Where does Xanax fall? Is it a misunderstood and necessary prescription drug or should we be more careful about how we use it? Read on to find out.

What is Xanax?

Alprazolam is a potent, minor tranquilizer that belongs to a class of medications called benzodiazepines, which are psychoactive drugs used to treat a range of anxiety disorders. It is better known by its trade name Xanax and is mostly used as an anti-anxiety medication in the United States. However, it can be highly addictive when misused or taken for recreational purposes.

Dr. Robyn Jordan, an assistant professor at the UNC School of Medicine, tells Highsnobiety that “Xanax is the most addictive of all benzodiazepines and the most likely to cause dependence.”

How does Xanax work?

Xanax affects your brain’s gamma-aminobutyric acid (GABA) receptors, stimulating the production of GABA, which acts as a kind of “nerve calmer” in the brain. If you imagine your body as a car and the brain as the engine, GABA is the brake. GABA is a natural chemical that creates a calming effect and reduces feelings of anxiety and fear.

Xanax has a short half-life, which means its effects wear off relatively quickly. Its effectiveness can lessen over time as the brain adapts to it, too. “It also has a quick onset compared with other benzodiazepines, giving you a quick rush and euphoric feeling,” says Dr. Jordan. “What happens is people get the nice high, feel good, and then begin to crash. As Xanax leaves their system, they feel anxious and agitated, so they take another Xanax. Very quickly people find themselves addicted.”

What is Xanax used for?

Like most benzodiazepines, Xanax is used to treat anxiety and panic disorders. It is, however, abused by some people to get high. Reddit users who’ve taken Xanax either for medical and leisure purposes describe its effects as relaxing and euphoric. One user says Xanax “hits you with zero anxiety, mentally you relax.”

Or as another user put it: “Imagine that you're walking somewhere. You've been walking for hours, days, or an eternity and you're absolutely exhausted and in pain. Then suddenly you're allowed to sit down, and you can finally relax. That's what taking Xanax is like.”

What are the side effects of Xanax?

According to WebMD, minor side effects can include drowsiness, dizziness, increased saliva production, or a change in sex drive or ability. If symptoms persist or worsen, it is recommended that you see a doctor or your pharmacist as soon as possible.

Dr. Helen Arntsen, a doctor in British Columbia, Canada, spoke to Highsnobiety about issues relating to Xanax and other benzodiazepines. According to Dr. Arntsen, in addition to the side effects listed above, “Benzodiazepines can cause confusion, disorientation, and memory impairment.” However, although dangerous when taken with other substances, Dr. Arntsen says “fatal benzodiazepine overdoses are less common when they are used on their own.”

The greatest danger is when benzodiazepines are mixed with opioids. “Xanax and other benzodiazepines are often prescribed along with opioids, which is particularly dangerous, as both drugs suppress breathing and can result in coma and death,” Dr. Artnsen explains. In fact, although benzodiazepine-related deaths are on the rise in the United States, most of those deaths have come as a consequence of mixing them with other substances, usually opioids.

Withdrawal symptoms or rebound symptoms might also occur if you stop taking the drug abruptly after regular use. It’s generally recommended that people reduce their dose gradually if they wish to stop using the drug.

Dr. Arntsen adds, “Long-term use results in dose escalation, increased risk of accidents, cognitive impairment, and possible drug-seeking behavior.” According to Dr. Arntsen, withdrawal can be just as serious as mixing benzodiazepines with other drugs, as it “can be severe, including seizures, and is potentially life-threatening.”

What does Xanax look like?

Not including generic alprazolam variants, fake Xanax pills have made their way into circulation and are being sold as authentic medication, which is why it’s important to obtain the drug via prescription and legitimate pharmacists only. Xanax pills come in doses ranging from 0.25mg to 2mg and usually bear the name “Xanax” and the dosage on them. The 2mg tablet is typically a rectangular shape, while the others are oval and can be either white, red, or blue in color.

It’s impossible to know what is in Xanax bought from disreputable sources online, so we strongly recommend following your doctor’s advice and only obtaining the drug with a proper prescription and through proper channels.

Why is Xanax so popular?

“One reason [Xanax] is so overprescribed,” says Dr. Jordan, “is that in the ’80s and ’90s – when it became popular and more widely available – patients liked the effect it had on them and they would go to their doctor to request it. Back then, physicians didn’t realize how dangerous it could be, so they kept prescribing it.”

And while doctors today understand the risks better, the drug’s popularity persists. And because Xanax can be so addictive, it’s hard to wean people off it once they do start taking it.

Another, darker side of the story is Xanax’s glorification through pop culture. Drugs have been part of the creative industries since there were drugs, so hip-hop latching onto Xanax shouldn’t come as any kind of surprise. Artists can influence their fans when they rap about their addictions or how they feel when they “pop some Xan’.” And while it’s not really possible to quantify the influence of Xanax’s emergence in pop culture with increased abuses of the drug elsewhere, there does seem to be a correlation.

Hip-hop’s love/hate relationship with Xanax

That’s not to say things won’t get better. Plenty of rappers have denounced the drug and are actively trying to quit it. Lil Pump and Smokepurpp both announced they were quitting Xanax at the start of the year, while Lil Xan has emerged as the unlikely inspiration for getting kids off the anti-anxiety medication.

Lil Xan earned his nickname before he started making music due to his fondness for hip-hop’s drug of the moment, but he quit Xanax and wrote “Betrayed,” in which he makes his position quite clear: “Xans don’t make you / Xans gon’ take you / Xans gon’ fake you / And Xans gon’ betray you.”

Xan’s decision to quit taking the drug that gave him his nickname was inspired in part by Lil Peep’s death. He saw the impact that the tragedy had on the rap community and decided to take action. But while these are promising steps in the right direction, there needs to be a more concerted effort from the world of hip-hop to influence people away from abusing benzodiazepines such as Xanax.

What can be done to combat the dangers of Xanax and other benzodiazepines?

When talking about the fight against the prescription drug epidemic in the United States, and Xanax in particular, Dr. Jordan is clear: “There is not enough being done to combat the dangers of the drug, in my opinion. There is a focus on opioids, deservedly so, but there needs to be more done on benzodiazepines being mixed with opioids.”

An important factor is educating doctors. “A lot of doctors don’t know or dismiss the dangers and need to be educated on them,” says Dr. Jordan. “A lot of patients are still on [benzodiazepines] and we need to change that.”

Many physicians, Dr. Jordan being one of them, are inheriting patients that have been prescribed Xanax, but figuring out how to get them off the drug safely is a big challenge. “There are a couple of options, such as a detox center where they can safely be detoxed, or other outpatient options,” she says.

When asked about the likes of Lil Xan and Lil Pump, Dr. Jordan agrees that while celebrities can be great role models for people struggling to kick the drug, “it, of course, depends on their success. If they get off of Xanax, it can set a good example for others. Any celebrity who is in that position — if they are going to take a stand on this and advocate quitting — that is a good thing.”

If you or someone you know is struggling with Xanax or other drugs, there are organizations that can help right now. Talk to Frank is available for British residents; while U.S. readers can contact Crisis Text Line.

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