Xanax: The Bad and The Beautiful

The trouble with Xanax is that it works too well.”

I have said this to my patients who are requesting prescriptions for this medication, generally people I am seeing for the first time who want to continue the medication they have been using over months or years. It works too well in the sense that it offers an instant solution to problems, by replacing a stress signal with a feel-good signal; but the downside is that you don’t learn how to solve problems. In fact, you tend to forget that there is a problem.

We have been learning more about the unique risks of this particular benzodiazepine (“benzo”= ben-zoe-dye-az-uh-peen) called Xanax (alprazolam=al-praz-oh-lam) which is becoming the most prescribed of all psychotropic medications, as well as the most common drug seen in emergency room visits involving drug misuse (usually in combination with other substances such as alcohol and opioids). Because of this newer information, I generally avoid starting this medication in people who have never used it. But Xanax is very difficult to reduce or stop, compared to most other drugs. It is both dangerously rewarding and particularly risky.

Xanax and other benzodiazepines have been in the news because of problems arising when they are combined with opioids and deaths from overdose.

Other issues involve:

• Memory problems (possibly long term)
• Geriatric risks
• Pregnancy
• State drug monitoring programs
• Risk evaluation and mitigation strategies
• And more

But again, there are some people taking Xanax who feel it is necessary for their quality of life, and who will find some way to continue this medication no matter what, even when a well meaning physician refuses to prescribe it.

In the next couple of blogs I will discuss these matters, including how physicians cope with this very difficult set of problems, especially Xanax side effects, withdrawal and discontinuation.