Are doctors still prescribing xanax

Are doctors still prescribing xanax DEFAULT

Xanax (the brand name for alprazolam) is one of the most popular anti-anxiety medications in the United States. It has many legitimate medical uses—doctors often prescribe Xanax to treat anxiety, depression, panic disorders, and phobia. Xanax is part of the benzodiazepine family, known as “benzos” for short.


Despite their legitimate uses, benzos like Xanax are still mind-altering substances. Unfortunately, people misuse Xanax for a number of reasons. Repeated misuse can lead to full-blown Xanax addiction that requires treatment, but quitting Xanax cold-turkey can cause seizures and other life-threatening side effects. It’s a catch-22 for many people who suffer from debilitating anxiety and other mental health issues.


Before you start taking Xanax, it’s important to fully understand how the drug works and the risks associated with it.


The Basics about Benzos


First, the scientific explanation: benzos are a class of anti-anxiety medications, or anxiolytics, that increase the activity of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter that helps brain cells (or neurons) communicate with each other and reduces anxiety by enhancing GABA inhibitory function. In layman’s terms, benzos slow a person’s brain activity, which brings feelings of relaxation and calmness.


In addition to Xanax, other drugs in the benzo family include diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan). 


Most benzos have similar effects, but they differ in strength (how long it takes them to work) and half-life (how long the drug stays in your system). Drugs with a shorter half-life are linked with higher potential for addiction and dependence because the effects wear off faster. That is one reason why doctors are typically hesitant to prescribe Xanax for long periods of time. After taking Xanax in pill form, peak levels are found in your blood just 1-2 hours later. The average half-life of Xanax in the blood is only 11 hours in healthy adults.


How Benzos are Used


Benzos are mainly used for a short period at the beginning of treatment for an anxiety disorder because it usually takes a few weeks for the main pharmacological treatment for anxiety—antidepressants—to kick in. If someone’s anxiety is severe or debilitating, benzos may be prescribed for temporary use.


Benzos are also prescribed for occasional situations of high anxiety – for example, a person with a fear of flying who rarely goes on airplanes may choose to take a Xanax before they fly to calm their nerves. Someone who flies several times a month should not use Xanax as a long-term solution for their anxiety.


Benzos may be used for other medical conditions as well, such as treatment of seizures or alcohol withdrawal. But the use of benzos should not be taken lightly, as the risks of dependence and ultimately addiction are very real.


Dependence vs. Addiction


Benzo dependence, which affects every person who consistently uses these drugs, is different from addiction. Essentially, when a person takes benzos for multiple days or weeks, the brain adapts to the presence of the drugs and begins to depend on them to function. As this dependence develops, the brain starts to require larger doses to feel the same effects.


When someone who is dependent on a benzo stops taking the drug, they are likely to experience withdrawal symptoms. Stopping benzos abruptly can cause restlessness, irritability, aggressive behavior, insomnia, muscle tension, and blurred vision—just to name a few. Withdrawal from high doses of benzos (especially ones like Xanax with a shorter half-life) can be very dangerous, causing seizures or worse.


If you become dependent on benzos and have to continue increasing your dose to feel the same effects, you are entering addiction territory. Some benzos, including Xanax, actually have street value because of the pleasant, relaxed feeling they give the person who takes them. Benzos are to anxiety what opioids are to pain—a temporary escape, not a cure, with a high potential for addiction.


Benzo overdose, especially when mixed with alcohol or opioids, can be life-threatening. In 2015, approximately 20% of people who died of an opioid overdose also had benzos in their system. 


The Lure of Xanax


A lot of people misuse Xanax and other benzos because they want relief from anxiety, and Xanax helps to calm them down. Others desire the relaxed, goofy feeling Xanax gives, which is often compared to how people feel when they get drunk. Like alcohol, Xanax is a depressant—in high doses, both substances make people feel carefree. Many people pass out after taking too much Xanax. Like alcohol abuse, Xanax abuse is dangerous.


Xanax can be a lifesaver for people with severe anxiety but if you take it recreationally or ignore your doctor’s guidelines, you are putting yourself at risk of developing an addiction.


There are safer treatments for anxiety, but they often require patience to work. Options such as psychotherapy and exposure therapy (where a person is gradually exposed to the feared situation under the guidance of a therapist) can teach you healthier ways to cope with the sources of your anxiety. Medications such as antidepressants, especially when combined with psychotherapy, can also be effective. Talk with your doctor to determine which option is best for you.


If you are already addicted to Xanax, it’s not too late. You can get effective treatment for Xanax or benzo addiction and learn how to live a sober life free from the chains of substance abuse. The Kimberly Center is here to help. After undergoing detox to heal your body from addiction, we offer a range of flexible outpatient programs to lead you back to a fulfilling, substance-free life. Call 855-452-3683 to get started today.


As an academic psychiatrist who treats people with anxiety and trauma, I often hear questions about a specific class of medications called benzodiazepines. I also often receive referrals for patients who are on these medications and reluctant to discontinue them.

There has been increasing attention into long-term risks of benzodiazepines, including potential for addiction, overdose and cognitive impairment. The overdose death rate among patients receiving both benzodiazepines and opioids is 10 times higher than those only receiving opioids, and benzo misuse is a serious concern.

What are benzodiazepines?

Benzodiazepines are a class of anti-anxiety medications, or anxiolytics, that increase the activity of the gamma-aminobutyric acid receptors in the brain. GABA is a neurotransmitter, a molecule that helps brain cells, or neurons, communicate with each other. GABA receptors are widely available across the brain, and benzodiazepines work to reduce anxiety by enhancing GABA inhibitory function.

The benzo family includes diazepam, or Valium; clonazepam, or Klonopin; lorazepam, or Ativan; chlordiazepoxide, or Librium; and the one most commonly known to the pop culture, alprazolan, or Xanax, among others.

Different benzos have similar effects, but they differ in strength, how long it takes for them to work and half-life, a measure of how long the drug stays in your system. For example, while diazepam has a half-life of up to 48 hours, the half-life of alprazolam can be as short as six hours. This is important, as a shorter half-life is linked with higher potential for addiction and dependence. That is one reason physicians typically are not excited about prescribing Xanax for long periods of time.

When are they used?

When benzos were introduced to the market in the 1950s, there was excitement as they were considered safer compared to barbiturates, which had been used to treat anxiety. By the 1970s, benzos made it to the list of the most highly prescribed medications.

Benzos are mainly used to treat anxiety disorders, such as phobias, panic disorder and generalized anxiety disorder. They are mostly used for a short period at the beginning of the treatment. That is because it may take a few weeks for the main pharmacological treatment for anxiety, antidepressants, to kick in. During that time, if anxiety is severe and debilitating, benzodiazepines may be prescribed for temporary use.

Benzos are also prescribed for occasional situations of high anxiety, such as that caused by phobias. The main treatment of phobias, such as excessive fear of animals, places and social interactions, is psychotherapy. Sometimes, however, phobias can interfere with one’s functioning just sporadically, and the person may not be interested in investing in therapy. For example, a person with fear of flying who may fly on a plane once or twice a year may choose to take a benzo before flying. However, for a businessman or woman who flies several times a months, psychotherapy is recommended.

Benzos may also be used for situations of short-term stress, such as a stressful job interview.

Benzos are also used for other medical conditions, such as treatment of seizures or alcohol withdrawal in the hospital. There is no good evidence for use of benzos in post-traumatic stress disorder.

So why the worry?

Now we get to the part about why I and other doctors are not eager to prescribe benzodiazepines for long-term use: We have a Hippocratic oath to “first do not harm.” I sometimes tell patients who insist on getting benzos: “I am not paid differently based on the medication I prescribe, and my life would be much easier not arguing with you about this medication. I do this because I care about you.”

A major risk of long-term use of benzos is addiction. That means you may become dependent on these meds and that you have to keep increasing the dose to get the same effect. Actually benzos, especially Xanax, have street value because of the pleasant feeling they induce. In 2017, there were more than 11,000 deaths involving benzos alone or with other drugs, and in 2015, a fifth of those who died of opioid overdose also had benzos in their blood.

Benzos to anxiety can be seen like opioids to pain. They both are mostly for short use, have a potential for addiction and are not a cure. Benzo overdose, especially when mixed with alcohol or opioids, may lead to slowing of breathing, and potentially death. Benzo misuse can also lead to lack of restraint of aggressive or impulsive behavior.

As benzos are sedating medications, they also increase the risk of accidents and falls, especially in the elderly. This is worse when they are mixed with other central nervous system suppressants like alcohol or opioids.

Recently, we have been learning more about the potential cognitive, memory and psychomotor impairment in long-term use of benzodiazepines, especially in older adults. Cognitive functions impacted may include processing speed and learning among others. Such effects may persist even after discontinuation of long-term use of the benzos.

Stopping benzos abruptly, especially if high dose, can cause withdrawal symptoms, such as restlessness, irritability, insomnia, muscle tension, blurred vision and racing heart. Withdrawal from high doses of benzos, especially those that are shorter acting, may be dangerous, leading to seizure, and getting off of these medications should be done under supervision of a physician.

Safer options abound

There are safer effective treatments for anxiety, but they require patience to work. A first line treatment for anxiety disorders is psychotherapy, mainly cognitive behavioral therapy. During therapy, the person learns more adaptive coping skills, and corrects cognitive distortions to reduce stress.

Exposure therapy is an effective treatment for phobias, social phobia, obsessive compulsive disorder and PTSD. During exposure therapy, the person is gradually exposed to the feared situation under the guidance of the therapist, until the situation does not create anxiety anymore. Importantly, the skills earned during therapy can always be used, allowing better long-term outcome compared to medications.

Medications are also used for treatment of anxiety disorders. The main group of such medications is selective serotonin reuptake inhibitors, commonly known as antidepressants. Examples of such medications are fluoxetine, sertraline and citalopram. Especially when combined with psychotherapy, these medications are effective and are safer options than the benzos, and without a risk of addiction.

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The benzodiazepines (or “benzos”, for short) are a class of medicines that have been quite popular and widely used to treat anxiety and sleep problems for many years. Examples include Librium (chlordiazepoxide), first marketed in the U.S. in 1960, Valium (diazepam) in 1963, Klonopin (clonazepam) in 1975, Ativan (lorazepam) in 1977, and Xanax (alprazolam) in 1981. They work quickly and work well for many people, and tend to be pretty “clean” in terms of short term side effects compared to other psych meds- they typically don’t cause weight gain, for example.

Yet the medical profession has turned against these meds, and it’s getting more and more challenging for patients to find doctors who prescribe them- why?

As time has gone on, we have become increasingly concerned about the short and long term side effects of the benzos.

First and foremost, they carry abuse and dependence potential. Benzos affect the GABA (gamma-amino-butyric acid) receptors in the brain- the same receptors alcohol affects. I’ve heard benzos described as “freeze-dried alcohol.” Most people drink alcohol socially without problems, just like most people take benzos without issues- but a significant number of people have trouble restraining the use of both substances.

Just like alcohol, benzos can impair balance and coordination. Research definitively shows older patients on benzos are more likely to fall and have hip fractures. Benzos can impair alertness and memory. There is even some research suggesting that long term (more than 90 days) use of benzos can increase the risk of dementia.

In 2016 the FDA came out with a “black box” warning about combining opiate pain medicines with benzos- the combination increases the risk of overdose, respiratory suppression, and death. Many pain doctors will no longer prescribe opiates if a patient is on benzos.

In 2018, the state of Indiana passed a law requiring over the next couple of years that all physicians in the state run an “Inspect report” on controlled substance prescriptions on a patient before prescribing benzos. I predict that this additional hoop to jump through will lead many primary care docs to stop prescribing benzos entirely- just like the hoops put into place around opiate prescribing caused most PCP’s to stop prescribing opiate pain meds a few years ago.

What’s my take on benzos? I think they can be very useful meds when used judiciously and appropriately. Just like the opiates for pain, they tend to work better when used short-term and on an as needed basis for anxiety. Chronic daily benzo use is like chronic daily opiate use- usually the patient is left with their chronic anxiety (or pain) but now they have a drug addiction to deal with on top of it.

Pretty much every week, I see at least one new patient or more with some variation of the story, “I’ve been taking Xanax 1 mg three times a day for 20 years. My primary care doc retired, and my new doc said she won’t prescribe it for me on an ongoing basis. It works for me! Can I stay on it?”

In that situation, I will continue your Xanax- for a while, while discussing with you alternatives and trying to work the dose down. The older you are, the more dangerous the benzos are, and the quicker I’ll work to get you off of them. That’s the story on benzos.

Published by Mark R. Ogle, M.D., Psychiatrist in Indianapolis, Indiana

Dr. Ogle graduated from Wabash College in 1983, from Indiana University School of Medicine in 1987, and completed his residency training in psychiatry at Indiana University Hospitals in 1991. He was lifetime board-certified in general psychiatry in 1993, and was subspecialty board-certified in geriatric in 1995 with recertifications in 2005 and 2015. He has maintained a private outpatient practice in psychiatry since 1991 and has had extensive experience in hospital work, serving in the past as medical directors for the geriatric inpatient units at St. Vincent and Community Hospitals in Indianapolis. In November 2018 he decided to devote himself full-time to his outpatient private practice. View all posts by Mark R. Ogle, M.D., Psychiatrist in Indianapolis, Indiana

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This article was co-authored by Kirsten Thompson, MD. Dr. Kirsten Thompson is a Board Certified Psychiatrist, Clinical Instructor at UCLA, and the Founder of Remedy Psychiatry. She specializes in helping patients with mental health conditions such as major depressive disorder, anxiety, ADHD, bipolar disorder, OCD, PTSD, and postpartum depression. Dr. Thompson holds a BS in Operations Research Industrial Engineering from Cornell University and an MD from The State University of New York, Downstate College of Medicine. This article has been viewed 1,426,731 times.

Co-authors: 40

Updated: October 8, 2021

Views: 1,426,731

Categories: Sedatives

Medical Disclaimer

The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.


Xanax prescribing doctors are still

The Other Prescription Drug Problem: ‘Benzos’ Like Valium and Xanax

While the nation has focused on opioid addiction, experts tell Healthline that benzodiazepines such as Ativan can also be addictive and dangerous.

When Janis* separated from her husband, she took Ativan in the morning and at night for two years, while she tried out different antidepressants.

“If you pop an Ativan, the anxiety goes away in 10 minutes,” she told Healthline. “It’s enormously addicting.”

We’ve heard plenty about the opioid epidemic.

But there’s another less recognized prescription drug problem: benzodiazepines like Ativan, Xanax, Valium, and Klonopin.

While doctors are prescribing fewer painkillers, prescriptions for these anti-anxiety drugs are still going up.

Like painkillers, “benzos” should be a temporary solution.

Yet, doctors allow their patients to stay on them for years.

Many Americans don’t realize that their prescription is an addictive drug that, over time, is likely to aggravate their original problem.

Sound familiar? That was true of opioids prescribed for chronic pain, too.

People who use benzos regularly over months or years risk “dependence, addiction, cognitive damage, more falls, and death,” according to Stanford University psychiatrist Anna Lembke.

“Doctors also tend to overestimate the benefits. Long-term use can make insomnia, mood, and anxiety worse,” she told Healthline.

“They’re grossly overprescribed,” added Yale psychiatrist Swapnil Gupta. “Very often, I’ll see a patient who is managing their issues and they’ll say my family doctor gave me this to sleep and I’ll see 2 mg Xanax.”

Gupta told Heathline she often helps patients taper off from prescriptions from other doctors, a process that can take more than a year.

Meanwhile, teenagers are buying “Z-bars” — a 2-milligram (mg) dose of Xanax — on the street.

Super potent variations of benzos, such as clonazolam, are sold online as a “research chemical” to anyone.

“Just as overprescribing opioids contributed to the use of heroin and illicit fentanyl and related deaths, overprescribing benzodiazepines may herald the dawn of a new era of illicit and deadly benzodiazepines,” Lembke warned.

The dangers of benzos

Besides anxiety, the Food and Drug Administration (FDA) has approved benzodiazepines for insomnia and other uses. They’re often prescribed alongside antidepressants.

The quantity Americans consume has since the mid-1990s.

Benzos are involved in of all deaths from prescription drug overdoses, typically combined with a painkiller.

Both drugs may have been prescribed, since of Americans with an opioid prescription also used a benzodiazepine in 2013.

People also die when they take a benzo along with alcohol.

And even prescribed use can lead to a cycle of dependency.

Take a benzo nightly to sleep, for example, and you’ll typically get “rebound insomnia,” Lembke said.

Your “sleep effectively gets worse because of the benzodiazepine and the brain adapts to the benzodiazepine such that sleep becomes impossible without it,” she said.

When Gupta sees a patient experiencing panic attacks, she might prescribe Klonopin to use only during attacks. She’ll also limit the dose.

When patients show up with a prescription for insomnia, she can’t take them off it immediately because they’re addicted, she said.

“I tell them to try cutting the tablet in half,” she said. “It’s so hard to get off. You can get seizures, delirium, shakes. You can get suicidal. Sometimes the rebound anxiety can be much worse.”

“I’ve had people stop it completely over four to five months and have people who go back and forth over a year and a half,” she added. “At the same time, we’re working on other solutions: group therapy, acupuncture, and SSRIs. I make sure that every time they come in we spend 5 to 10 minutes on problems with benzos.”

Trying to withdraw

Janis gave up Ativan but later saw a new psychiatrist who put her on a cocktail of drugs that included 6 mg of Klonopin — 2 mg tablets that she was instructed to take three times a day.

“He never mentioned that it was addictive,” she told Heathline. “Every psychiatrist since then has said that’s a ridiculous amount [for a 130-pound woman].”

Over time, Janis lost her job, was sleeping 14 hours at a stretch, had bouts of slurred speech, and dropped down to a size 0 dress.

“People said I looked ‘drug addicted,’” she said, so she decided to quit Klonopin.

Working with a primary care doctor, she cut back her dose in steps over three years.

“Every time I reduced, I would be shaking, have headaches, my skin crawled, I’d be jittery and nauseated for days,” she said.

Janis was down to 1.5 mg when she decided to stop completely on her own. That was a mistake.

The shakes were “horrible,” and she was thinking about suicide, so she went to an emergency room and asked to be checked into a hospital.

Klonopin withdrawal can lead to seizures, so a psychiatrist at her hospital put her back on 3 mg, then cut back her dose over five days to zero. She spent those days on the floor, shaking and crying.

Benzos for a bad time

Antidepressants can take weeks to help and may increase insomnia and anxiety in the first month.

Psychiatrists sometimes prescribe a benzo just for that period, Gupta noted.

Nancy* took Ativan when she had reached a low. Her panic attacks had made her “unable to work or socialize or even leave my bed at times.” Her doctor prescribed Zoloft, and Ativan “as needed.”

“For me, it was a miracle drug, soaking up my anxiety like a sponge. It got me through that time,” Nancy told Healthline.

The Zoloft began working in a month, and after that, “just having Ativan in my pocket prevented countless anxiety attacks. I was able to give a talk and to date. Eventually, I did not need it at all,” she said.

But Nancy is now dependent on Ativan.

After the panic attacks subsided, she developed insomnia and resumed the Ativan at night.

“It helped me sleep, but I did need more and more to sleep as my body developed a tolerance and I discovered Ativan’s two bad side effects: amnesia and vomiting with alcohol. Now I take it with Ambien to sleep. Without them, I find I’m awake all night,” she said.

“For social and work purposes, I rarely need Ativan. I just keep it in my pocket and feel safe,” she added.

Weaning America from benzos

In 2015, the Veterans Administration kicked off a drive to cut back benzo use among veterans ages 75 and older, who often received a prescription years ago.

“It’s time for the medical community to take note that benzodiazepines prescribed long term are dangerous for patients,” Lembke said.

To manage insomnia, she told Healthline, skip the benzo and instead change your habits.

Rise early to enjoy morning sunlight, get daily exercise, limit caffeine after noon, stay on a regular schedule, and keep electronic screens away from the bed.

The standard antidepressants are the better medications for anxiety, she said.

Lembke analyzed the opioid problem in “Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop,” published in 2016.

In a recent New England Journal of Medicine opinion piece, she and two co-authors urged that the fight against opioids include benzos.

Some states require doctors to check a database for prescription history before prescribing opioids, benzodiazepines, or both. The database could reveal whether a patient is “doctor shopping,” they noted.

More states could institute that rule for benzos.

Health insurers could also review practices that allow overprescribing benzos, they said.

More could be done to shut down “illegal online pharmacies” and fight the proliferation of street versions.

Otherwise, they warned, the battle against opioids may simply push users to move “from one class of life-threatening drugs to another.”

*Names have been changed to protect the privacy of the individuals.



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