Know A Xanax User? PLEASE Read This!

The official coroner's report states that my brother's death was caused by 'potentially lethal levels of Oxycontin'.  I don't believe the coroner's report.

I know what you're probably thinking - it's hard for anyone to believe their brother died of a drug overdose, but a coroner's report is almost always correct.  After all, they use science.

Well, I'm a scientist - specifically a neural engineer finishing my doctorate.  And I know full well the fallibility of those tests.  Moreover, I don't deny my brother died from drugs.  However, my brother's death wasn't caused by an oxycontin overdose… or at least not solely.  My brother was killed by a pill now prescribed more than any other.  My brother was killed by Xanax.

Again, I know what you're thinking.  You have friends who use Xanax; perhaps you even use Xanax yourself.  Xanax is just a harmless antidepressant, similar to valium, but more effective. If any of these statements are true, I'm begging you – please read further. If only to indulge the annoying little brother who had to watch the slow death of the older brother he hero worshipped his whole life.

I wish I could say I had conclusive evidence Xanax killed my brother.  If I did, it would have shown up on the coroner's report.  But I do have evidence; some of the evidence is based on scientific research, the rest is admittedly biased personal experience.  I will try to be as honest as possible, despite my bias.

First, a VERY brief history.  Xanax, also known as alprazolam, is an anti-anxiety drug manufactured by Upjohn (1-10).  Xanax was approved by the FDA for use as an anti-anxiety drug on the basis of an 8-week clinical study (3); only the first 4 weeks of the study was used in the application for FDA approval(4). 

Anxiety is often caused by neurons in the brain firing spontaneously, instead of in a deliberately driven fashion (1-11).  Xanax acts on the GABA receptors of neurons, making it harder for neurons to fire spontaneously, and therefore decreasing anxiety (1-11).  To be included in the 8-week Xanax clinical trial, patients were required to score at a given level on a test designed to measure anxiety objectively (3, 4, 7, 9).  Over the course of the first four weeks of the study, the Xanax patients' levels of anxiety decreased markedly (3, 7).  Based solely on these results, the FDA approved (and currently has only approved) Xanax for prescription use for periods not to exceed eight weeks (4).

What is not commonly known, are the results from the rest of the eight weeks of the study.  During the remaining four weeks, the anxiety scores of patients on Xanax approached pre-trial scores (3, 4, 7, 9).  When taken off Xanax, their scores on the anxiety tests were markedly WORSE than pre-trial scores (this is known as the Xanax rebound effect) (3, 4, 7, 9, 11).  In summation, after 4 weeks, the patients became addicted to Xanax, and needed the drug simply to get back to where they were prior to ever receiving Xanax. 

This is one of the problems with Xanax – over time you need more and more of it to get an effect.  If you fail to take more and more of it, you become worse than you ever were initially (1, 2, 4-10).  This has led to a group of what Xanax addiction specialists refer to as 'accidental addicts' (10).  People who have never exhibited addictive behavior start to need more and more Xanax to function (10).  When their doctors try to wean them off of it, they begin to purchase the drug illegally.  Eventually they lie, cheat, and steal to get Xanax… and these are people who never previously drank or used drugs.  In one study, fifty percent of the subjects were deemed 'addicted to Xanax' after only 6 months of low level Xanax use (2, 4, 5, 8, 10).  In another study, it was reported that Xanax can produce dependence in 100 percent… I repeat… 100 percent of the patients to which it is administered (5, 8).   

Despite these results, which are widely available, doctors continue to prescribe Xanax for periods well exceeding eight weeks.  I'm sure you know a few people who have such a prescription.

I wish I could say my brother was an accidental addict, but that wouldn't be entirely true.  My brother drank himself to sleep every night for twenty years.  He was, however, a functional alcoholic, holding a job as a chief scientist at a major engineering firm, producing 11 patents, and running two successful side businesses.  Typical of mid-stage alcoholics, my brother started developing problems with anxiety and insomnia.

My brother was first prescribed Xanax by his personal physician for his anxiety and insomnia.  The dosage was 0.25 mg per four hours, a typical Xanax prescription.  I admit, he did initially drink in conjunction with his prescription, a big no-no.  As a testament to the addictiveness of Xanax, my brother eventually stopped drinking alcohol almost entirely, preferring Xanax.

My brother's doctor prescribed Xanax for about a year, and eventually started rebuffing my brother's requests to increase the dosage.  My brother began simply taking more pills than were prescribed; his physician noticed, so tried to wean him off of Xanax.  My brother simply went to other doctors, who were more than happy to prescribe more Xanax.  In one case, our family doctor prescribed Chris Xanax literally two weeks after he finished a two-month stint in rehab for Xanax addiction (his rehab stint, along with his previous long-term prescription for xanax, were stated clearly in his medical history).  Eventually my brother got Xanax delivered to his doorstep without a prescription via next-day delivery from online sources (yes, that spam you receive on a daily basis can get you drugs).

Xanax abuse is especially problematic for two reasons:

First, Xanax only lasts in the bloodstream for a very short time, approximately 9 hours (1-10).  What this means is that a Xanax abuser had to constantly take Xanax to prevent the dreaded 'rebound' effects.  When a Xanax abusers blood levels dips beneath a certain threshold, the neurons in their brain start firing like crazy.  They experience severe insomnia, anxiety, mood swings, dyskinesia (impaired motor movement), hallucinations, and in some cases, seizures (1-10).  Unlike most addictive substances, where withdrawal symptoms last for 72 hours to a week, Xanax abusers suffer protracted withdrawl syndrome (PAW) (2, 4, 6-8, 10).  Withdrawal symptoms last for six months or longer, with symptoms reported out to a year and a half (2, 4, 6-8, 10).  Many researchers believe the withdrawal symptoms may last longer than a year and a half, but the current studies don't go out that far (2, 4, 8, 10).  Over the last two years of his life, my brother was either wasted on Xanax or going through withdrawal 24 hours a day– often both in the same day.   

Second, Xanax causes severe memory lapses (some doctors have gone so far as to call it the 'Great Mind Eraser') (1, 2, 8, 10).  To put it bluntly, Xanax users often forget if they've taken their Xanax.  I can't tell you how many times my brother would take Xanax, only to come back 30 minutes later and take more Xanax… and this was before he was intentionally abusing.  I'd have to continually remind him he'd just taken it.  (After one hospital stay due to Xanax overdose, my brother had lost 8 months of his memory, which he never regained.)

I remember the addiction specialist who talked to me when my brother went into a coma after his second overdose.    When I told her he was using Xanax at high dosages, she immediately exclaimed "I wish it was heroin.  That would have been easier habit for him to kick…"

Despite the eyewitness accounts of Chris abusing Xanax that same week, and the empty bottles of Xanax found on top of him (coinciding with Xanax purchases we traced online earlier that week and tried to intercept), no drug was found in his system, and he was eventually released from the hospital.  Oxycontin, or any other drug with a longer half-life, would have appeared on his blood tests. 

I should also note that my brother was also found only two days AFTER his death by overdose; as demonstrated by his previous similar overdose, any trace of Xanax would have worked his way out of his system.     

After his second overdose, we tried desperately to get my brother into rehab.  We had a family member stay with him at all times, and we policed his internet accounts.  We knew what he had purchased, when he had purchased it, but couldn't stop him from getting his hands on it.  And in almost every case, it was Xanax – 25 grand of Xanax over the course of one year.  I know the exact amount because as executor of the estate I got the receipts from his tax attorney; he had attempted to claim his online Xanax purchases as a business expense.

Oxycontin only came into the picture later as a painkiller when his Xanax abuse got particularly severe.  He kept on falling and hurting himself while on Xanax - multiple cracked ribs and broken bones were found posthumously from his autopsy, all remnants of his many Xanax related falls. I remember one incident in particular where he had fallen down the stairs.  He was bleeding severely and couldn't walk, yet was desperately pawing at the encyclopedia shelf on his hands and knees.  When he died and we cleaned out the house, we found a stash of Xanax (and only Xanax) on that encyclopedia shelf behind the 'D's'.  One of twenty or so stashes we found, all with mostly empty containers of Xanax. 

In the months I spent with my brother trying to prevent his death, I almost never found oxycontin, only Xanax, and it's derivatives.  Oxycontin is on the death certificate, but Xanax killed my brother.  Even the coroner's wording, 'potentially lethal levels of oxycontin' instead of 'lethal' is suspicious to me.  But even if Oxycontin was the bullet that killed my brother, Xanax pulled the trigger. 

This was very difficult for me to write, and forcing myself to do the painstaking research to document these facts was even more difficult.  I am putting myself through this for one reason - I need some good to come of my brother's death.  PLEASE, if you know anyone using Xanax, pass this story on to them.  E-mail this story to anyone you think is appropriate.  Help my brother's story to help others.  My brother started at 0.25 mg per four hours, and it spiraled out of control… and his Xanax story is hardly unique.  This is the only way I can stomach my brother's death – if it helps someone else.     

If you are currently taking  Xanax, talk to your doctor.  Discontinuing without tapering off slowly under a doctor's supervision can lead to seizures, or even death.  This caveat should also underscore the severity of taking Xanax. 

References

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3.            Ballenger JC, Burrows GD, DuPont RL, Jr., Lesser IM, Noyes R, Jr., Pecknold JC, Rifkin A, and Swinson RP. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Arch Gen Psychiatry 45: 413-422, 1988.

4.            Breggin P. Toxic Psychiatry. New York: St. Martin's Press, 1994.

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6.            Marks I. Alprazolam and exposure alone and combined in panic disorder with agoraphobia. British Journal of Psychiatry 162: 790-794, 1993.

7.            Marks I, Albuquerque A, Cottraux J, and Gentil V. The 'efficacy of alprazolam in panic disorder an agoraphobia: A critique of recent reports. Arch Gen Psychiatry 46

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8.            McClanahan TM and Antonuccio DO. Cognitive-Behavioral Treatment of Panic Attacks. Clinical Case Studies 1: 211-223, 2002.

9.            Pecknold JC, Swinson RP, Kuch K, and Lewis CP. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. III. Discontinuation effects. Arch Gen Psychiatry 45: 429-436, 1988.

10.          Porritt D and Russell D. The Accidental Addict. Sydney: Pan Books, 1994.


11.          Rastogi R, Lapierre Y, and Singhal R. Evidence for the role of brain norepinephrine and dopamine in 'rebound' pohenomenon af ter repeated exposure to benzodiazapenes. Journal of Psychiatric Research 13: 65-75, 1976.