Xanax - a rant!

[jagdkampf]

Ok, here I go. I am absolutely infuriated at the over prescription of xanax. In my practice, it seems that every other able bodied person is on xanax. Some of these people have been on xanax for 15 years or more. In of itself, I have nothing against xanax for what it was intended -- short term anxiety treatment but the rub is this. Chronic usage of benzodiazepines produces a very unique dependence requiring very controlled detox and follow up. Sudden withdrawal of benzodiazepines can cause life threatening problems. I recently had a patient who was on long term xanax who had to have anesthesia. The patient was so desensitized to benzodiazepines that it took 20 mg of Versed to get the patient to the OR and then twice the usual dose of propofol to get the patient asleep. Then post op, the patient was having hallucinations and delirium. Normally, I would chaulk this up to a one time emotional disturbance but I am beginning to see definite trends with xanax in particular and have had several patients with similar sorts of reactions. I am also beginning to wonder about delirium in some of the elderly patients I am seeing. Anyway, has any other health care providers been noticing similar sorts of problems with xanax. Rant off.
Jag

[tangent]

hmm... well there is the little problem of mixing it with alcohol and shedding inhibitions.

I'm curious if this has taken over the over-prescribed drug of choice slot from valium (mama's little helper) in the USA? In the UK it's rohypnol that's passed out like candy...

[Reasonable Rascal]

Jagd, 20 mg of Versed is astounding! Very serious resistance to the otherwise normal effects there, just based on my experience. I honestly did not know the human body could tolerate anywhere near that much and remain off a vent.

My experience with widespread use of Xanax is limited to what I have seen on geriatric patient med lists. Mostly the over 50-60 crowd period with the odd 20-50 y.o. pt. on it. Perhaps a regional difference. Otherwise I've seen widespread use in alcoholics undergoing rehab, but little elsewhere.

15 years though. Astonishing. Interesting tidbits like this can be useful. Thanks for the rant, it was educational.

RR

[deerwchr]

Seems to me that I read that it was like the #1 drug of abuse these days and brought big bucks on the street. I think it's the mix with alcohol that makes it so popular. That and the fact that 1 out of 3 doctors recommend it to their patients weather they need it or not!

[jagdkampf]

I just had to go off a bit. Still, I am seeing it used on a long term basis regularly. It causes big time trouble if used for long periods of time. The biggest problem I am seeing is withdrawal. If patients miss their doses by more than 12 hours they begin to exhibit tremors and agitation and if they go more than 24h, hallucinations and delirium occur. This is particularly problematic in the older population. Sudden withdrawal can also cause status epilepticus. This can be life threatening. The brain produces such a high neural discharge rate that it literally fries the brain cells. Damage can be permanent or fatal. Dependency on Xanax seems to develop fairly rapid. I've seen patients that seem to exhibit moderate withdrawal after 3 months of daily usage. I believe we need to reevaluate our usage of this drug, much like we did with oxycontin. Oxycontin was a great pain med but when used improperly produced tremendous dependence.
Anyway, user beware!
Jag

[RESQDOC]

I agree 100%. I do not RX Xanex for new patients. I have 3 elderly females that I have not been able to wean off but are on minimum dose. This medicine has a dependancy load at least that of Valium, with much faster onset, IMO. Nasty, and to say it is overused is the understatement of the century.

All Benzo's have side effects and addiction potential and need to be used with restraint. I pretty much only use them for acute alcohol/drug withdraws and rarely for severe acute emotional upset (rape, death of spouse, etc.) for just a few doses - if they are still having the same level of problems then other, long term medications + therapy are what is needed, not a magic happy pill. I use Librium or Serax for the most part, depending on the half-life I want.

Inpatient use of Benzo's in the ICU, etc., is of course a different topic.