If you know anyone who uses Xanax (Alprazolam), I'm BEGGING you to read this!

Information that is an absolute MUST to have if you use benzodiazapenes.

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

1.            Allen D, Curran HV, and Lader M. The effects of repeated doses of clomipramine and alprazolam on physiological, psychomotor and cognitive functions in normal subjects European Journal of Clinical Pharmacology 40: 355-362, 1991.

2.            Ashton H. Protracted withdrawal from benzodiazapenes:  The post-withdrawal syndrome. Psychiatry Annals 25: 174-179, 1995.

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.

5.            Clark HW and McClanahan TM. Comtemporary Issues in Dual Diagnosis. In: New Treatments for Chemical Addictions, edited by McCance EF, Katz and Kosten TR. Washington D.C.: American Psychiatric Press, 1998, p. 151-182.

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

668-672, 1989.

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.

Reviews

[Cubic_Zirconia]

I have read your article and if you don't mind, I have a few questions/comments about the content. I'd like to let you know that in no way whatsoever do I mean any disrespect to you or your late brother. If it comes across as so, then I sincerely apologize.

"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."

Actually, Xanax (alprazolam) is not categorized as an anti-depressant. It is an anti-convulsant, tranquilizer, and anxiolytic. It has never been approved for use as an anti-depressant. Valium has a milder onset and a much longer half-life, but the equivalent dose is tenfold.

"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."

To say with conviction that the coroner was incorrect in his conclusion is a bold statement and would require proof that it was Xanax alone that killed him. Xanax was the 9th most prescribed medication in 2008. The #1 prescribed medication was hydrocodone, an opiate-based analgesic. http://fanaticcook.blogspot.com/2009/10/50-most-prescribed-drugs-in-2008.html

"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."

To say that Xanax killed your brother & then admit that you don't have conclusive evidence of that conclusion doesn't work. As a scientist, I'm sure you know this. Also, after admitting your bias, I will keep that in mind for the rest of your article.

"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."

What is not given here is the method in which the patients were taken off of Xanax. I don't have the books referenced so I have to ask: Were they tapered down slowly, or were they completely stripped of the drug and forced to go cold-turkey? If anyone is on a benzo daily for more than 2 weeks, and they abruptly stop, then yes, their anxiety will indeed rebound much worse than it was before starting. Seizures can also occur. That is why the correct method of discontinuing a benzo is very gradual and slow tapering. Depending on the dose, it may take some people years to completely be off the drug, while others may be able to do it in a few weeks. I personally have tapered down .25mg per week before, and experienced no withdrawal symptoms or rebound effect.

" 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)."

The first sentence is a generalization, therefore it is not correct (YOU need more and more, speaking for everyone..). An example is myself. Over a year ago, my SSRI stopped working after 10 years and was causing severe side effects. I tried other SSRIs and anxiolytic agents to no avail. After talking to my psychiatrist about long-term benzo use, he said he has had success with it in his 27 years of practice when all other medications and cognitive behavioral therapy had failed. We started at 1.5mgs of Xanax XR. It worked, but I was still having a panic attack every 3 days or so. We raised it to 2mg XR. It did not produce a high, it merely took away the panic, and has continued to maintain the exact same efficacy 1 year later, with absolutely no need for an increase. As for the lying, cheating, and stealing to get Xanax just to function, I simply don't believe that. I will look into "The Accidental Addict", but the wording sounds extremely biased. Also notice: "Xanax CAN produce DEPENDENCE in 100 percent of the patients to which it is administered to." CAN is different from WILL, and dependence is different from addiction. If the administered dose is 1mg to someone with panic disorder, and it eliminates their panic, then that person has become dependent on it for a legitimate reason. If a person without anxiety is administered 1mg and likes the waves of relaxation and wants that again and again, then they can become addicted to it. How many patients in the study constituted 100%? Was it 4 or 4000? (I don't have access to the material. I assume you do since you used them as references.) Xanax and benzos can definitely produce dependence. I am dependent on mine, much like someone who is taking an anti-psychotic or a diabetic taking insulin is dependent on their medications. However, this does not directly imply that I or anyone else who depends on a benzo to eliminate panic is going to "lie, cheat, and steal" to get it if we are suddenly cut off, which should never happen in the 1st place if it is being taken as directed and for purely therapeutic purposes (the anxiolytic effect). The prescribing doctor should know that stopping a person's Xanax script suddenly will equal some serious problems. Also, who deemed the patients "addicted to Xanax"? Was it the patients themselves who deemed themselves that, or was that the diagnosis of a health professional?

"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."

Despite his obvious success, being an alcoholic is indicative of an addictive personality. I'm sure you know alcohol is a CNS depressant, and every bottle of Xanax that comes from a pharmacy clearly states "DO NOT TAKE THIS MEDICATION WITH ALCOHOL."
"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."

A few questions. Did he know he was not supposed to combine the 2, yet did it anyway? Did he inform the doctor that he had a drinking problem? Do you know for a fact that he stopped alcohol entirely? If so, how is stopping alcohol and sticking to a prescribed dose of a prescribed medicine a testament to it's addictiveness?

" 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."

The physician did the right thing. Was he taking more than prescribed (which is where a benzo user enters the danger zone) because the medication had lost it's therapeutic effect, or because, as with the alcohol, he was going beyond what was realistically needed or desired?

"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)."

So he finished a rehab program successfully, yet goes to the family doctor and immediately requests it again, and right before that doctor's very eyes is the fact that he just completed rehab from Xanax...yet he gladly prescribed it to him again? That may be true, it may not be. If so, that's a blatant violation of the Hippocratic Oath. Also, if your brother was free of Xanax and completed rehab, it is not the drug or it's addiction to it that is causing him to seek out scripts for it and buy it illegally. It was his own free will to start it again.

The following paragraph about Xanax ABUSE and withdrawal is correct. When someone is abusing the medication as opposed to using it as directed, they will eventually run out and the sudden discontinuation of the drug will most likely be hell. However, when a USER chooses to part ways with a benzo, there is a strict protocol involved that I mentioned earlier that their physician will guide them through. I know some people who have completed CBT and decided to try to part ways with Xanax. By tapering very slowly, some have claimed to come off of it with no withdrawal whatsoever, or very minimal discomfort.

"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."

If someone is "wasted" on a benzo, they are clearly abusing it and going far beyond the therapeutic intentions. It is meant for the elimination of panic and severe anxiety, nothing more.

"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."

This is also a generalization. I have not had a severe memory lapse since taking it, or a memory lapse at all. If anything, it has improved it because of the elimination of severe anxiety and panic. It clears my head, making it easier to focus and remember. To say "Xanax users often forget if they've taken their Xanax" is assigning a side effect to ALL Xanax users, implying that you have talked to everyone on the planet using Xanax and concluded that they have all forgotten if they've taken their dose at one point or another. I personally have never forgotten. I'm sure you see how this would be poor journalism/research reporting.

"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�""

By now it is clear that your brother was abusing Xanax, not simply using it. Doctors generally seek alternate forms of treatment if the dose rises above 6mg per day. I won't dispute the heroin comparison, simply because I have never used heroin or stopped it, therefore I don't know. But apparently the nurse has used both, so she can make that conclusion.

"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."

No disrespect intended, but when an organism ceases to function, it is extremely difficult for a drug to be eliminated because there are no body systems working to eliminate it.

"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."

An Opioid like Oxycontin should NEVER be taken with any amount of benzodiazepine. This increases the risk of respiratory failure, as they are both CNS depressants. Oxycontin is especially potent. I don't imagine it was prescribed, as no physician in their right mind would allow such a combination. Also, falling constantly while on Xanax is an obvious sign that the dose is way too high. He was not USING like millions do for a simple therapeutic effect. It appears as if he was far beyond that.

"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."

Respectfully, just because you did not find it does not mean he was not taking it. Even the smallest amount of such a potent opioid with the exorbitant amounts of Xanax can easily lead to death. I'm not sure what you mean by "derivatives" of Xanax. Was he taking other benzos as well? Also, even though you state earlier that you do not have conclusive evidence that it was Xanax alone that killed your brother, you state it here anyway. What reason would a coroner have to lie about his findings?

Again, I am very sorry about your loss, and I mean no disrespect. To me, and I'm sure you agree, it is obvious that had your brother stayed on his initial dose and used it for what it was to be used for, this tragedy would probably never have ensued. Millions take xanax and are able to keep it under control. There are many, many medications that can cause severe addiction. Not just Xanax. Amphetamines, opiate painkillers, and many more that are listed in the 2 classes above benzos for addiction potential. Many people, including myself, found Xanax to be a lifesaver from horrendous anxiety and panic disorder and use it with discipline and under a physician's supervision. We (meaning the large group who use benzodiazepines successfully for a better quality of life and elimination/reduction of panic) are aware of the possible interactions and avoid them. We use them to function properly and live a normal life, and our doses do not skyrocket by the week. And we also want to stop misinformation about a drug, especially when that misinformation is applied to regular, supervised therapeutic use. It is not Xanax that kills people. People kill themselves by the choices they make and how they exercise their own free will.

Again, I'm sorry for your loss and if I've offended, it was not intentional. Feel free to reply with any disagreements. I participate in civil conversations and productive debate.

[Kip]

Cubic/Dan,

No offense at all was taken here... don't worry about it. I'm always happy to participate in any reasonable discussion. And to take critiques. I'd be happy to discuss your points, point by point. I've offset my comments from yours with a '-'.

I have read your article and if you don't mind, I have a few questions/comments about the content. I'd like to let you know that in no way whatsoever do I mean any disrespect to you or your late brother. If it comes across as so, then I sincerely apologize.

"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."

Actually, Xanax (alprazolam) is not categorized as an anti-depressant. It is an anti-convulsant, tranquilizer, and anxiolytic. It has never been approved for use as an anti-depressant. Valium has a milder onset and a much longer half-life, but the equivalent dose is tenfold.

- I'm well aware it's an anti-anxiety drug, and I'm well aware of the equivalency and half-life of Valium. I'm also aware it's not indicated for depression or sleep disorder, however, that's what it was prescribed to my brother for. A doctor can always prescribe a drug for an off-label use, and unfortunately, prescribing xanax for depression and or sleep disorder off label isn't unusual. I'd also point out that some of this isn't intended to be in the same vein as any scientific article I've written, it's a personal story, meant to relate to the reader and convey a tale. Consequently, some specific set-ups (depression) are done for dramatic effect or simply to make the story more relatable based off of common misconceptions.

"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."

To say with conviction that the coroner was incorrect in his conclusion is a bold statement and would require proof that it was Xanax alone that killed him. Xanax was the 9th most prescribed medication in 2008. The #1 prescribed medication was hydrocodone, an opiate-based analgesic. http://fanaticcook.blogspot.com/2009/10/50-most-prescribed-drugs-in-2008.html

- there is a subtle semantic difference here. Over-prescribed is based off of being prescribed more than necessary, which involves a value judgement. There is of course more prescribed drugs. Here, over-prescribed is based off of the fact that the FDA did not approve the drug for use for more than 4 weeks. Consequently, any use of the drug for periods longer than 4 weeks is 'off-label' use. Xanax is the number one for off-label prescribed use.

"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."

To say that Xanax killed your brother & then admit that you don't have conclusive evidence of that conclusion doesn't work. As a scientist, I'm sure you know this. Also, after admitting your bias, I will keep that in mind for the rest of your article.

- I openly admit, this is my opinion. However, I would say that opinion is based off a combination of personal experience, and alot of reading on the subject and talking to experts. I'm telling this tale, as unbiased as I can, admitting my bias where I see it as best as I can, to allow people to draw their own conclusions.

"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."

What is not given here is the method in which the patients were taken off of Xanax. I don't have the books referenced so I have to ask: Were they tapered down slowly, or were they completely stripped of the drug and forced to go cold-turkey? If anyone is on a benzo daily for more than 2 weeks, and they abruptly stop, then yes, their anxiety will indeed rebound much worse than it was before starting. Seizures can also occur. That is why the correct method of discontinuing a benzo is very gradual and slow tapering. Depending on the dose, it may take some people years to completely be off the drug, while others may be able to do it in a few weeks. I personally have tapered down .25mg per week before, and experienced no withdrawal symptoms or rebound effect.

- The rebound effect actually occurred while they were continuing with the same dosages they started with. No tapering was done by the 8 week mark. I'm well aware of what happens when you discontinue xanax suddenly. I would suggest you read the article here, as it was the basis for FDA approval, and not being familiar with this article while supporting supervised Xanax use is a definite oversight. I should, however, have not used the terms 'patients' here as it implies all of them experienced a rebound. On average, there was a rebound. Some patients had a bad rebound, some did not.

" 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)."

The first sentence is a generalization, therefore it is not correct (YOU need more and more, speaking for everyone..). An example is myself. Over a year ago, my SSRI stopped working after 10 years and was causing severe side effects. I tried other SSRIs and anxiolytic agents to no avail. After talking to my psychiatrist about long-term benzo use, he said he has had success with it in his 27 years of practice when all other medications and cognitive behavioral therapy had failed. We started at 1.5mgs of Xanax XR. It worked, but I was still having a panic attack every 3 days or so. We raised it to 2mg XR. It did not produce a high, it merely took away the panic, and has continued to maintain the exact same efficacy 1 year later, with absolutely no need for an increase. As for the lying, cheating, and stealing to get Xanax just to function, I simply don't believe that. I will look into "The Accidental Addict", but the wording sounds extremely biased. Also notice: "Xanax CAN produce DEPENDENCE in 100 percent of the patients to which it is administered to." CAN is different from WILL, and dependence is different from addiction. If the administered dose is 1mg to someone with panic disorder, and it eliminates their panic, then that person has become dependent on it for a legitimate reason. If a person without anxiety is administered 1mg and likes the waves of relaxation and wants that again and again, then they can become addicted to it. How many patients in the study constituted 100%? Was it 4 or 4000? (I don't have access to the material. I assume you do since you used them as references.) Xanax and benzos can definitely produce dependence. I am dependent on mine, much like someone who is taking an anti-psychotic or a diabetic taking insulin is dependent on their medications. However, this does not directly imply that I or anyone else who depends on a benzo to eliminate panic is going to "lie, cheat, and steal" to get it if we are suddenly cut off, which should never happen in the 1st place if it is being taken as directed and for purely therapeutic purposes (the anxiolytic effect). The prescribing doctor should know that stopping a person's Xanax script suddenly will equal some serious problems. Also, who deemed the patients "addicted to Xanax"? Was it the patients themselves who deemed themselves that, or was that the diagnosis of a health professional?

- it's an interesting point you make about generalization. The generalization was not intentional, what is meant is that from these studies, on average, this is what occurs. In some patients it does, in some it doesn't - and these studies were done at recommended therapeutic dosages. Similarly, some people can smoke for 50 years and not develop cancer - it is just a strong trend evident in meta-analyses done on the subject population. I should also point out, extrapolating your own experience to the general use of Xanax is in itself a gross generalization.

- it's also an interesting point you make about dependence versus addiction. My brother made the same argument about Xanax before he overdosed on xanax and wound up in a coma (he had multiple xanax related overdoses prior to the final death). Again, this time we know it was Xanax, as it correlates to a) the 90 pill bottle he had gotten delivered off the internet that was emptied the next day and b) the blood report, where I told them to look for Xanax after the usual suspects came up negative, and they were able to find abnormally high levels. There are certainly people who are dependent upon heart medications, not addicted. My personal definition is that if the drug is no longer 'preventing the original symptoms' but instead primarily preventing withdraw symptoms, it's an addiction, not a treatment. This is again a personal judgement, admittedly.

"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."

Despite his obvious success, being an alcoholic is indicative of an addictive personality. I'm sure you know alcohol is a CNS depressant, and every bottle of Xanax that comes from a pharmacy clearly states "DO NOT TAKE THIS MEDICATION WITH ALCOHOL."

- yep, well aware. And this is why my brother's story, despite being a personal tale that made me read up on xanax, does not extrapolate well to the entire patient population. However, my brother was an alcoholic who was prescribed Xanax because he experienced insomnia and depression consistent with alcoholism. In his case, the medicine was misprescribed, as the root cause was not a natural over-excitability of his neurons. Simply put, my brother was at fault because he didn't let the doctor know he was an alcholic, and this was the root cause of his symptoms. The doctor was at fault, as this his symptoms are commonly a result of mid-stage to late stage alcholism, and the doctor missed this.

"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."

A few questions. Did he know he was not supposed to combine the 2, yet did it anyway? Did he inform the doctor that he had a drinking problem? Do you know for a fact that he stopped alcohol entirely? If so, how is stopping alcohol and sticking to a prescribed dose of a prescribed medicine a testament to it's addictiveness?

- I'm pretty sure my brother was well aware he wasn't supposed to mix the two. I'm also pretty danged certain he stopped drinking entirely - this is based off of living with him near the end, being privy to all of his expenses as executor, and his own statements that he simply liked the Xanax 'calming effect' better. It is possible he still stole a drink now and then, however, if he did, it was minimal He often referred to it as the perfect drug - an interestingly, it acts similarly to alcohol in that one of alchol's effects is hyperpolarizing neurons to make it more difficult for these neurons to fire spontaneously. I personally found the fact that an alcholic who drank 6+ drinks very night for 30 years stop drinking and instead starting taking Xanax to be stunning. But this is a personal interpretation of this change in behavior, you are of course, free to interpret it differently.

" 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."

The physician did the right thing. Was he taking more than prescribed (which is where a benzo user enters the danger zone) because the medication had lost it's therapeutic effect, or because, as with the alcohol, he was going beyond what was realistically needed or desired?

- actually, the doctor stopped giving to him because he believed that Xanax is very addictive, and should only be used as a short term solution until a less addictive, longer acting drug is built up in the patients system (this was relayed from my brother). The fact that my brother kept on asking for higher dosages clued the doctor that he was of the subset of people who get decreasing therapeutic value from xanax overtime, and instead develop addictive behaviors in regards to the drug. My brother felt it was stupid for the doctor to taper him off something that he believed helped him.

"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)."

So he finished a rehab program successfully, yet goes to the family doctor and immediately requests it again, and right before that doctor's very eyes is the fact that he just completed rehab from Xanax...yet he gladly prescribed it to him again? That may be true, it may not be. If so, that's a blatant violation of the Hippocratic Oath. Also, if your brother was free of Xanax and completed rehab, it is not the drug or it's addiction to it that is causing him to seek out scripts for it and buy it illegally. It was his own free will to start it again.

- it certainly was my brother's own free will to start it again. It also was the reason he went to our family doctor before the internet, as he had fostered a relationship with the doctor that he felt he could talk him into anything. Interestingly, my brother's internet sources at first were all 'web-pharmacy online' where they would have you fill out a brief form, like a doctor's consultation, to justify puchasing the xanax. It's still totally illegal to sell it online without meeting the patient, but my brother still felt at that point he needed the validation that he wasn't abusing. Later, he said to heck with it, and started ordering online from places like 'Brazillian pharmacy on-line'.

The following paragraph about Xanax ABUSE and withdrawal is correct. When someone is abusing the medication as opposed to using it as directed, they will eventually run out and the sudden discontinuation of the drug will most likely be hell. However, when a USER chooses to part ways with a benzo, there is a strict protocol involved that I mentioned earlier that their physician will guide them through. I know some people who have completed CBT and decided to try to part ways with Xanax. By tapering very slowly, some have claimed to come off of it with no withdrawal whatsoever, or very minimal discomfort.

- agreed, it has to be tapered. However, some find it very difficult to get off of, even with the tapering. Again, people are variable, and studies are not absolute rules, but general trends.

"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."

If someone is "wasted" on a benzo, they are clearly abusing it and going far beyond the therapeutic intentions. It is meant for the elimination of panic and severe anxiety, nothing more.

- completely agreed, he was abusing heavily. The 'accidental addicts' reference is because there are people who develop abusive behaviors when prescribed xanax with no prior history. My brother had an extensive history, and therefore was really susceptible and never should have been prescribed the drug. In the doctors' defense, they werent' working with a full history. However, many doctors turned him down for Xanax, so there were signs that the other doctors should have noticed.

"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."

This is also a generalization. I have not had a severe memory lapse since taking it, or a memory lapse at all. If anything, it has improved it because of the elimination of severe anxiety and panic. It clears my head, making it easier to focus and remember. To say "Xanax users often forget if they've taken their Xanax" is assigning a side effect to ALL Xanax users, implying that you have talked to everyone on the planet using Xanax and concluded that they have all forgotten if they've taken their dose at one point or another. I personally have never forgotten. I'm sure you see how this would be poor journalism/research reporting.

- I appreciate your point, but I don't see how this is poor reporting, as again, the point wasn't to go to the extreme of applying it to every xanax case. I took it as a given this is a general trend, and assumed the reader would also. Admittedly, it could probably be worded such that 'some, but not all individuals' have this problem. I find this to be a very nit-picky argument, and missing the point. The point of the piece was to have dramatic impact, and when considering the likely audience, equivocations and qualifiers of that nature ruin the flow, and the implact. I appreciate your preference for exactness, but believe the point remains the same whether 10 percent of 30 percent of all xanax users experience memory lapses. The point being, many of those using xanax aren't aware that this is a relatively common side-effect.

"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�""

By now it is clear that your brother was abusing Xanax, not simply using it. Doctors generally seek alternate forms of treatment if the dose rises above 6mg per day. I won't dispute the heroin comparison, simply because I have never used heroin or stopped it, therefore I don't know. But apparently the nurse has used both, so she can make that conclusion.

- lol - funny my friend, but I do believe that the nurse was going off of experience dealing with addicts of both times. My brother certainly was an abuser, not just a user. The journal articles here, however, indicate that many 'users' - but not all - become abusers over time. I'm honestly happy it's working for you, and would just urge you to pay attention and be cautious, which you are already doing.

"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."

No disrespect intended, but when an organism ceases to function, it is extremely difficult for a drug to be eliminated because there are no body systems working to eliminate it.

- Again, no disrespect taken. It's a legitament point. Sadly, he passed out from his overdose and was in a semi-coma 2 days before he was found according to the doctor. Consequently, he was still metabolizing the drug.

"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."

An Opioid like Oxycontin should NEVER be taken with any amount of benzodiazepine. This increases the risk of respiratory failure, as they are both CNS depressants. Oxycontin is especially potent. I don't imagine it was prescribed, as no physician in their right mind would allow such a combination. Also, falling constantly while on Xanax is an obvious sign that the dose is way too high. He was not USING like millions do for a simple therapeutic effect. It appears as if he was far beyond that.

- again, certainly agree here. This is a horror story, and a worst case scenario, of an definite abuser. The point is that some of the normal Xanax users become abusers, with no history of abuse. Consequently, be careful.

"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."

Respectfully, just because you did not find it does not mean he was not taking it. Even the smallest amount of such a potent opioid with the exorbitant amounts of Xanax can easily lead to death. I'm not sure what you mean by "derivatives" of Xanax. Was he taking other benzos as well? Also, even though you state earlier that you do not have conclusive evidence that it was Xanax alone that killed your brother, you state it here anyway. What reason would a coroner have to lie about his findings?

- I don't believe a corojner lied, just was mistaken, as he wasn't considering the 2 day lapse between overdose and death. And certainly, the opiod contributed to his death at the end. I believe - and this is a personal belief based off of first hand observation - that my brother started off as an alcoholic, and once he started with Xanax, it accelerated his downward spiral to it's unfortunate conclusion, overdose by opiod in conjunction with Xanax. When I refer to other benzo's here, this is intended for those who aren't aware of the equivalency scale and believe alprazolam and Xanax are different things, or that lorazepam at an equivalency dose is greatly differnet than alpraxolam.

Again, I am very sorry about your loss, and I mean no disrespect. To me, and I'm sure you agree, it is obvious that had your brother stayed on his initial dose and used it for what it was to be used for, this tragedy would probably never have ensued. Millions take xanax and are able to keep it under control. There are many, many medications that can cause severe addiction. Not just Xanax. Amphetamines, opiate painkillers, and many more that are listed in the 2 classes above benzos for addiction potential. Many people, including myself, found Xanax to be a lifesaver from horrendous anxiety and panic disorder and use it with discipline and under a physician's supervision. We (meaning the large group who use benzodiazepines successfully for a better quality of life and elimination/reduction of panic) are aware of the possible interactions and avoid them. We use them to function properly and live a normal life, and our doses do not skyrocket by the week. And we also want to stop misinformation about a drug, especially when that misinformation is applied to regular, supervised therapeutic use. It is not Xanax that kills people. People kill themselves by the choices they make and how they exercise their own free will.

- it's an interesting point you make here, and certainly there are other drugs to abuse. I'd say back it up your Xanax data with sources, as you haven't provided any (not saying you don't have them). 'Millions of people use xanax and are able to keep it under control' is a very vague metric and a generalization which does not mean there isn't a subset of this group that can't keep it under control. Moreover, I'd love to see the study backing this claim up. The frightening thing is that in some cases, the PAW and increased tolerance, make 'free will' to be moot... according to a number of the sources I have provided. This does not mean everyone who takes Xanax will become addicted. It worries me, that given all the available sources, you seem to believe that anyone taking Xanax as prescribed won't run into a problem. Xanax works for you, and I'm honestly gratefuly for that... but I caution you not to extrapolate a personal experience, coupled with a few stories you have heard, with a meta-analysis of data.

Again, I'm sorry for your loss and if I've offended, it was not intentional. Feel free to reply with any disagreements. I participate in civil conversations and productive debate.

[Yvonne Heidt]

I will write another review for this amazing piece later. I wanted to let you know that this was winning the Addictions contest before we were blasted into space.