When the general public imagines the face of the prescription drug epidemic, they’re usually picturing opioids like Vicodin or OxyContin, not benzodiazepines such as Klonopin, Valium, or Xanax. And while the rate of overdose deaths are significantly lower, in 2015 there were less than 1,000 deaths from benzodiazepine overdose, that’s still a 4.3-fold increase from 2002.
More worrisome though is the statistic that 2015 also had roughly 8,000 overdose deaths due to benzodiazepines used in conjunction with opioids, otherwise known as “polysubstance abuse.”
In fact, in about 82 percent of treatment admissions related to benzodiazepines, it’s the secondary drug to opioids, alcohol, or other substances. Whether they are “less dangerous” than opioids, benzodiazepines are still highly addictive and tend to be restricted to short-term or as-needed prescriptions.
Xanax, the brand name for the benzodiazepine Alprazolam, works by increasing the levels of inhibitory brain signaling, which means that it depresses the central nervous system, resulting in feelings of sedation and relaxation.
The way that the medication works is by altering the brain chemistry in the patient. The brain possesses a wide variety of neurotransmitters or brain chemicals. In people with anxiety disorders or any other condition in which Xanax is prescribed, the brain has an internal chemical imbalance that needs to be rectified in order to increase the quality of life in the patient.
Xanax works by acting on the brain’s gamma-aminobutyric acid (GABA) neurotransmitters. GABA is a naturally occurring neurotransmitter that produces calming and sedative effects on the brain. Xanax may be very helpful to a person who may not produce enough GABA naturally. In order to combat the resulting anxiety or panic attacks, the person’s brain is able to substitute the Xanax in place of GABA and maintain homeostasis.
As such, it is typically prescribed as a sleep aid or anti-anxiety medication. It provides fast-acting, temporary relief from symptoms such as insomnia, panic attacks, or components of hyper or hypomanic episodes, which makes it a popular treatment for people with bipolar disorder. As of 2010, Xanax was the 12th most prescribed medicine in the United States, as well as one of the most misused benzodiazepines.
While still widely considered a relatively low-risk medication, the dangers of Xanax lie with issues of tolerance and overprescribing. When used as a long-term solution to the aforementioned symptoms, the nervous system adapts and begins to build up a resistance, requiring a consistently stronger dosage to overcome the tolerance.
This, in turn,n speeds up the process of psychological dependence and, eventually if left unchecked, abuse and addiction.
Through continuous use of Xanax, the individual’s brain will inevitably begin to produce less GABA. The liver will begin to improve its ability to process Xanax quicker, meaning it will exit the body faster. The culmination of these two physical reactions causes Xanax to lose its effectiveness and fast. The body begins to build up a tolerance and dependence at the same time, meaning a larger, more frequent dosage of Xanax will be required in order to achieve the same results as before.
Xanax and benzodiazepines, in general, are meant to be carefully restricted to avoid overuse and lower the chances of abuse and dependence. However, the standard indications for prescriptions can range anywhere from “mood disorders” to “unclassified” and can lead to unnecessary prescriptions. Furthermore, in the case of many primary care practices, some patients did not even receive a follow-up session or a monitoring of their usage.
As mentioned, once someone is addicted to Xanax, it is likely that they will seek out more fatally dangerous drugs, such as opioids, vastly increasing the odds of an overdose. Even alcohol, which can seem “safe” when compared to substances like heroin, can be deadly when mixed with Xanax, as it too is a central nervous system depressant. Interactions between the two can lead to over-sedation: dangerously slow breathing that can worsen to a coma or even death.
As with nearly every drug withdrawal, there are both physical and mental symptoms to contend with. The length and severity of these symptoms are dependent on factors such as:
These will determine the intensity of your withdrawal symptoms, including the common physical symptoms, which are (but not limited to):
While the physical symptoms of Xanax withdrawal are documented as fading fairly quickly, the mental symptoms are much more likely to linger, sometimes for as long as several months. These can include:
Again, due to the severity of these symptoms and the key role that careful monitoring of respiration levels, blood pressure, and heart rate plays during detox, it is best to undergo treatment under medical supervision that can meet your physical and mental needs.
One thing that many users want to know is how long the Xanax withdrawal symptoms last. The answer: an average timeline of two weeks. Keeping in mind the factors mentioned above that affect duration and intensity of symptoms, the rough Xanax withdrawal timeline can be separated into four phases:
Withdrawal symptoms can start as soon as Xanax is no longer active in the blood, usually within six to 12 hours of the last dose. Insomnia and anxiety are most common during this period, but relatively mild compared to what’s to come.
Typically lasting one to four days, this is when both the physical and psychological symptoms are at their peak, with frequent nausea and vomiting and significantly increased anxiety and sleeplessness.
It is usually during this phase that the physical symptoms will have largely faded, and the mental ones should have at least lessened, though they will most likely still be felt from anywhere between five and 14 days.
The final stage of Xanax withdrawal is commonly reached around the two-week mark. At this point, all symptoms of withdrawal will have either mostly or completely faded. Although, in the case of insomnia and anxiety, if you were initially taking Xanax to treat these conditions, they will still be present, as you will no longer be medicating them.
Some of the factors that may contribute to a longer or shorter timeline than the one described above include:
The effects of Xanax withdrawal tend to kick in fast and hard, but are usually over fairly quickly, especially when compared to other benzodiazepines, such as Valium, which can last as long as three months. However, the psychological symptoms could persist in a protracted withdrawal that can last for weeks or months. If this is the case, it is imperative to seek out the help of a mental health professional.
Before discussing the typical withdrawal symptoms and process you can expect when detoxing from extended high-dosage Xanax abuse, it is vital to know that, unlike other substances, you should absolutely not abruptly stop taking Xanax or go “cold turkey.” The side effects of a sudden withdrawal include hallucinations, psychosis, and Grand mal seizures severe enough to prove fatal.
Though there have been very few documented cases of fatal benzodiazepine withdrawal, they still paint a haunting picture. One such incident, documented in the Journal of the Oklahoma State Medical Association, reported a woman who used 200 mg of Xanax in six days only to suddenly stop and consequently die four days later from seizures resulting from withdrawal.
Because of these dangers, it’s always a smarter, safer decision to detox in a professional, controlled environment, in the care of medical experts who can slowly taper down your Xanax use to ease the effects of withdrawal. Dealing with withdrawal symptoms is an ordeal even with qualified medical assistance and monitoring and is almost guaranteed to fail or have disastrous consequences when attempted on your own.
Detoxing from Xanax abuse is an intense and taxing process, both physically and psychologically. But there are many things you can do to ease the discomfort of the process, even if it’s in small ways. Staying hydrated is perhaps the most important thing to remember during your detox, as dehydration will cause many symptoms to worsen. Aspirin or ibuprofen can be taken for pain management, as well as medications like Dramamine for symptoms of nausea.
Knowing what to avoid can often be just as helpful as knowing what to take. Stay away from symptom agitators like caffeine, artificial sugar, MSG, and honey. And while it might be obvious that medications like antidepressants or mood stabilizers can have negative effects, you should also steer clear of vitamins D, B, and magnesium, as these can be just as detrimental.
Early on in the withdrawal process, it’s recommended to make your environment as dark and quiet as possible to keep from aggravating the symptoms of hypersensitivity to light and noise. Some mental health strategies that can be integral not just during the stages of withdrawal but well beyond them include:
Many people find that discussing the range of emotions they’re experiencing during detox to be helpful, and a counselor is a great source of further coping tips.
This form of mindfulness training has been shown to substantially reduce symptoms of depression and anxiety and avoided protracted withdrawal.
Though you may not feel like doing it, physical activity will help work against the sluggish feelings of withdrawal as well as cause the brain to release endorphins.
And of course, a positive mindset can make all the difference in getting through the four stages of withdrawal and avoiding relapse. It may not be easy, it might sometimes not even feel possible, but you just need to remember that withdrawal is a temporary state, and once you’re through it, you’ll be ready to take the next step on the road to living addiction-free.