Xanax is not an opioid — it’s a benzodiazepine — but it factors into the opioid epidemic because it’s often mixed with opioids, resulting in overdoses. Xanax is the most prescribed psychoactive drug in the United States and the second-most commonly prescribed medication resulting in emergency room visits for drug abuse.
While Xanax is an effective prescription medication for certain mental health disorders, its abuse potential is high and many Xanax prescriptions go on to be misused.
What Is Xanax?
Xanax is a brand name of alprazolam. The Xanax drug class is known as sedative-hypnotics and, as mentioned, Xanax is a benzodiazepine.
Xanax is an intermediate-acting benzodiazepine. Despite its effectiveness for certain clinical uses, it has dangerous withdrawal effects — especially after prolonged use — and can make opioids much more dangerous.
What is Xanax Used For?
Xanax has FDA approval for two clinical uses. The drug was approved to treat:
- Anxiety disorders, especially generalized anxiety disorder (GAD)
- Panic disorder
In addition to its approved uses, Xanax is often used off-label (i.e., without FDA approval) for other clinical purposes:
- Seizure treatment or prevention
- Sedation and inducing sleep
- Depression (although this use is not well supported)
- Alcohol withdrawal (due to seizure prevention and sedation)
Although Xanax is primarily an anti-anxiety medication, it is generally not meant to be the first option because there are more effective, non-addictive alternatives available.
Though benzodiazepines, like Xanax, have been around since the 1950s, their exact functioning is not entirely understood. However, they appear to work mainly by reducing the excitability of brain cells by binding to the gamma-Aminobutyric acid (GABA) receptor in the connections between brain cells. The binding has a calming effect on many brain functions. This result explains the effect of benzodiazepines in reducing brain hyper-excitability problems, such as anxiety and seizures.
Dosage and Administration
According to the FDA, Xanax dosage for treating anxiety should be started at between 0.25 mg to 0.5 mg, three times per day. The dose can be increased, if necessary, every three to four days to a total maximum daily dose of 4 mg.
The FDA guidelines suggest that higher doses of Xanax may be required to treat panic disorder. In that case, the starting dose should be 0.5 mg, three times per day. If needed, the dose can be increased every three to four days by adding no more than 1 mg per day. Doses of up to a total of 10 mg per day may be required for treating panic disorder.
Because of the risk of addiction and the other toxicities associated with Xanax, the FDA advises frequent re-evaluation of the dose and the need for the medication by medical professionals.
What Does Xanax Look Like?
The following are the available sizes and appearances of brand-name Xanax:
- 0.25 mg: white, oval, scored tablets with “XANAX 0.25” imprinted on one side
- 0.5 mg: peach, oval, scored tablets with “XANAX 0.5” imprinted on one side
- 1 mg: blue, oval, scored tablets with “XANAX 0.25” imprinted on one side
- 2 mg: white, oblong, scored with three lines with “XANAX” imprinted on one side and “2” on the reverse side. Often called a Xanax Bar.
What Does Generic Xanax Look Like?
Alprazolam is made by the pharmaceutical company Pharmacia and Upjohn (owned by Pfizer). There are currently 13 generic companies that also produce alprazolam, most of them produce the tablets in the same denominations as Xanax is.
Between them, these generic pharmaceutical companies produce a total of 44 different alprazolam tablets, all with different appearances. Additionally, fake Xanax is produced and has various appearances.
Street Names for Xanax
Because of its popularity as a drug of abuse, robust Xanax slang language has developed, resulting in some common Xanax street names, such as:
- Z-Bars/Zanbars/Xanbars (the 2 mg tablets)
- Footballs (due to the shape of the 0.25, 0.5 and 1 mg tablets)
- Blue footballs (the 1 mg tablets)
- School Bus
- Bicycle parts
- Totem Poles (the 2 mg tablets)
- Yellow/white boys
- White girls
- Upjohns (referring to the company name)
- Benzos (referring to Xanax’s classification as a benzodiazepine)
Side Effects of Xanax
What are the side effects of Xanax? The main Xanax side effects are mostly related to its sedative-hypnotic effects:
- Grogginess, drowsiness
- Rebound insomnia after the drug wears off
- Poor coordination and balance
- Impaired memory, short-term amnesia
- Possible birth defects in pregnancy
Because of its sedative-hypnotic effect, Xanax should not be used when driving or engaging in activities that are dangerous or that require concentration. Additionally, Xanax should not be used with other medications that can cause sedation, unless under the direction of a physician.
The side effects of Xanax are magnified when the drug is used with alcohol, and such effects are often more prominent in the elderly.
Other common side effects of Xanax are:
- Physical and mental dependence (addiction)
- Dry mouth
- Low blood pressure
- Blurred vision
The side effects of Xanax use are short-term because the drug is eliminated from the body relatively quickly. The long-term side effects of Xanax are related to the withdrawal effects when the drug is used for longer than a few days. The main concern with the cessation of use or dose reduction is seizures. Discontinuation of Xanax after prolonged use can also cause:
- Muscle spasms
Because of this concern, Xanax should only be discontinued under the supervision of a doctor. The drug should be tapered down by no more than 0.5 mg every three days, or even less if the drug has been used for an extended period or at high doses.
How Long Does Xanax Stay in Your System?
Xanax reaches peak levels in the blood one to two hours after taking the drug and has an elimination half-life of 11.2 hours. A half-life is the time it takes the body to metabolize and excrete half of the drug.
The length of time that the drug can be detected in individuals’ system depends on how the testing is conducted. There are newer and better drug testing methods being continuously developed. The testing methods and the length of time that a drug can be detected after use varies between laboratories.
The rate at which people metabolize and eliminate Xanax from their body depends on many individual factors:
- Genetic and physiological make up
- General state of health
- The health of kidneys and liver
- How much Xanax was taken
- Age and gender
- Body weight and amount of body fat
- Amount of physical activity since Xanax was used
- Whether the individual is a smoker
The length of time Xanax remains in the body depends on many factors. However, here are some general guidelines as to how long Xanax can be detected:
- How long does Xanax stay in your blood?
Blood tests are not routinely used for the detection of Xanax. Usually this is done by urine or hair testing. However, it takes five to seven half-lives for 98% of a drug to be eliminated from the blood. Therefore, it would take about four days for Xanax to be eliminated from the blood.
- How long does Xanax stay in your urine?
Urine drug screens for intermediate-acting benzodiazepines (including alprazolam) can detect the drug for five days after the last dose.
- How long does Xanax stay in your hair?
Hair provides the longest-lasting method of detecting drug use, but is expensive and depends on the length of the individual’s hair. The drug becomes detectable in the hair two to three weeks after the drug was taken, and remains detectable nearly indefinitely. Therefore, the length of detection is related to the length of hair: the detection window is about one month per half-inch of hair — so a 1.5-inch hair sample allows for a 90-day detection window.
- How long does Xanax stay in your breast milk?
Detection of alprazolam in breast milk is done in experimental applications only; it is not a routine test. However, alprazolam and other benzodiazepines can be detected in breast milk. When consumed through breast milk, these drugs cause sedation, lethargy and weight loss in nursing infants.
Is Xanax Addictive?
Benzodiazepines are linked to the increased drug overdose death rate in America because, when taken with opioids, benzodiazepines lower the amount of opioid needed to overdose. Between 1996 and 2013 the number of drug overdose deaths involving benzodiazepines increased by more than 400%.
Xanax and other benzodiazepines are most often a secondary drug of abuse, meaning that they are used in conjunction with another drug, also known as polysubstance use. Most benzodiazepine misusers also abuse another drug. The most common primary drug used by people who end up abusing Xanax are:
If you or a loved one struggle with Xanax use, contact The Recovery Village Palm Beach at Baptist Health today to speak with a representative about how professional addiction treatment can address an addiction alongside any co-occurring mental health disorders. Call today to take the first step toward a healthier future.
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American Psychiatric Association. “Study finds increasing use, and misuse, of benzodiazepines.” December 17, 2018. Accessed July 9, 2019.
Bachhuber, Marcus; et al. “Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013.” American Journal of Public Health, April 2016. Accessed July 9, 2019.
Food and Drug Administration. “Xanax.” September 2016. Accessed July 9, 2019.
Harvard Medical School. “Benzodiazepines (and the alternatives).” March 15, 2019. Accessed July 9, 2019.
Mayo Clinic Laboratories. “Benzodiazepines.” 2019. Accessed July 9, 2019.
Schmitz, Allison. “Benzodiazepine use, misuse, and abuse: A review.” Mental Health Clinician, May 2016. Accessed July 9, 2019.
van Marwijk, Harm; et al. “Alprazolam for depression.” Cochrane Database of Systematic Reviews, 2012. Accessed July 9, 2019.
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