Addiction | 5 min read
Medically Reviewed By
On August 29, 2024
Written By
On November 2, 2021
Xanax (alprazolam) is a benzodiazepine medication that’s used to treat anxiety disorders. It can be effective and safe when used as directed, but Xanax is often abused for its relaxation effects. Misusing or abusing Xanax, especially at high doses, can cause a potentially life-threatening overdose.
Learn more about the risks of Xanax overdose, its symptoms and treatment, and what to do if an overdose occurs.
Xanax is a benzodiazepine medication that’s prescribed for the treatment of anxiety or panic disorders. It’s occasionally used off-label for conditions such as premenstrual dysphoric disorder (PMDD) and certain phobias.
Xanax works by decreasing the excitation levels in the brain to relieve the symptoms of extreme anxiety or panic disorders. However, these calming effects can lead people to abuse Xanax and develop an addiction.
Xanax can be safe when taken at recommended doses provided by a doctor. However, it’s possible to overdose on Xanax in high doses or if Xanax is mixed with other depressants like opioids or alcohol. Xanax may have greater toxicity and mortality risks than other types of benzos.[1]
The symptoms of a Xanax overdose can vary but often include:[2]
Depressants like Xanax can lead to respiratory arrest, decreased oxygen to the brain, and hypoxic brain injury or death. This doesn’t often occur with Xanax alone, but it’s more likely when Xanax or other benzodiazepines are taken in conjunction with alcohol, opioids, or other depressant drugs.
Fatal overdoses that involve benzos often include opioids, specifically fentanyl. In many cases, the person didn’t realize they were combining fentanyl with Xanax, as they purchased counterfeit Xanax on the illicit market.[3]
Xanax overdoses are a medical emergency and require immediate medical attention. If you think someone is experiencing a Xanax overdose – or any other type of overdose – call 911 immediately. A Xanax overdose can be treated with rapid medical intervention.
If you suspect that an opioid is involved, you can administer naloxone if you have it. This prescription medication can block opioids and reverse their effects. If they haven’t taken an opioid, it won’t help the overdose, but it doesn’t cause any harm.
If someone overdoses on Xanax or other benzos, medical professionals will provide the appropriate care based on their condition and history. Often, this includes supportive care like fluids, intubation to keep the airway open, and mechanical ventilation.[4]
In some cases, a drug called flumazenil may be used to reverse benzodiazepine sedation.[5] This drug works a little differently from naloxone, however, and must be used with caution. It can cause acute benzo withdrawal symptoms, including life-threatening seizures.
Xanax addiction and drug overdoses are on the rise. The Drug Enforcement Agency reports that Xanax is one of the most common benzodiazepines on the illicit market, increasing the risk of addiction and abuse.[6]
Illegal benzos have been involved in more overdoses in recent years, with a 519% increase in overdose deaths from 2019 to 2020.[7] In 2021, nearly 14% of overdose deaths involving opioids also involved benzos.[8] Research shows that people who use opioids and benzos concurrently are at a higher risk of visiting the emergency department, being admitted to a hospital for a drug-related emergency, and dying of a drug overdose.
Several risk factors increase the likelihood of a Xanax overdose, including:
It’s possible to recover from a Xanax overdose with medical intervention.During an overdose, the slowed or stopped breathing reduces the amount of oxygen that reaches the brain, causing a condition known as hypoxia. Like opioids, benzo overdoses can cause irregular breathing, followed by cyclic breathing and gasping.[9] Without reversal, the breathing stops entirely, causing hypoxia, brain injury, and problems with memory and concentration.
Hypoxic brain injury can occur with just one severe overdose, but multiple overdoses increase the injury over time and may produce long-lasting effects, especially if they occur close together.[10] In severe cases, hypoxic brain damage can leave someone in a vegetative state, but there can be milder lasting effects like:[11]
Overdoses can occur for a variety of reasons. Here are some ways to reduce the risk of Xanax overdose:
Xanax overdoses are more likely to occur if you misuse, abuse, or become addicted to Xanax. If you’ve experienced a Xanax overdose or struggle with Xanax abuse or addiction, it’s important to get help as soon as possible. The longer you abuse Xanax, the more likely you are to experience an overdose or other adverse effects.
The first step is getting an evaluation from an addiction treatment professional to determine the extent of your substance use disorder. This may include details about your substance use history, medical history, and treatment goals to determine the best treatment for your current circumstances and goals.
Often, the first step in benzo addiction treatment is detox to manage Xanax withdrawal. Benzo withdrawal can have potentially life-threatening symptoms like seizures, but detox offers medical support and supervision to reduce the likelihood of complications and alleviate your symptoms.
Detox can form a strong foundation for addiction recovery, but it’s not enough on its own. You may need a complete addiction treatment program to address the underlying causes of addiction, which may include counseling sessions, behavioral therapies, and support groups.
Xanax overdoses aren’t as common as opioid overdoses or other types of overdoses, but they’re no less concerning. Xanax can have a greater risk of toxicity and mortality than other benzos, particularly when mixed with other drugs. If you misuse Xanax or feel you struggle with Xanax abuse or addiction, it’s important to seek help as soon as possible to reduce the risk of Xanax overdose and other adverse effects.
The prescription dose for Xanax ranges from 0.25 to 0.5 mg per day, which may be split into three doses.[12] Your doctor may increase the dose gradually until the symptoms have improved. The highest dose is usually 10 mg per day.
Some Xanax overdoses are caused by using the drug with other drugs. Medications that inhibit CYP3A4, such as antifungals and some antibiotics, make it harder for the body to break down Xanax, increasing the risk of overdose.[13] Other medications can interact with Xanax, such as sedatives, opioids, muscle relaxants, cimetidine, and alcohol.
Here at Ascendant New York, we understand the importance of having access to accurate medical information you can trust, especially when you or a loved one is suffering from addiction. Find out more on our policy.
[1] Brett, J., & Murnion, B. (2015, October). Management of benzodiazepine misuse and dependence. Australian prescriber. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657308/ on 2024, July 26.
[2][12] Xanax: Uses, dosage, side effects & warnings. Drugs.com. (n.d.-c). Retrieved from https://www.drugs.com/xanax.html#warnings on 2024, July 26.
[3] [7]Centers for Disease Control and Prevention. (2021, August 26). Trends in nonfatal and fatal overdoses involving benzodiazepines – 38 states and the District of Columbia, 2019–2020. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/mmwr/volumes/70/wr/mm7034a2.htm on 2024, July 26.
[4] Kang, M. (2023, June 26). Benzodiazepine toxicity. StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482238/#_NBK482238_pubdet on 2024, July 26.
[5] Shoar, N. S. (2024, February 29). Flumazenil. StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470180 on 2024, July 26.
[6] Counterfeit pills. (n.d.). Retrieved from https://www.dea.gov/sites/default/files/2021-05/Counterfeit%20Pills%20fact%20SHEET-5-13-21-FINAL.pdf on 2024, July 26.
[8,9] U.S. Department of Health and Human Services. (2024a, May 17). Benzodiazepines and opioids. National Institutes of Health. Retrieved from https://nida.nih.gov/research-topics/opioids/benzodiazepines-opioids on 2024, July 26.
[10] Sussex Publishers. (n.d.). Fentanyl overdoses may cause brain injury. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/addiction-outlook/202406/fentanyl-overdoses-may-cause-brain-injury on 2024, July 26.
[11] Anoxic brain injury and hypoxic brain injury. Anoxic Brain Injury: Causes, Symptoms, and Treatment | Shepherd Center. (n.d.). Retrieved from https://www.shepherd.org/programs/brain-injury/about/anoxic-hypoxic-brain-injury on 2024, July 26.
[13] K;, O. (n.d.). [cytochrome P450 3A4 and benzodiazepines]. Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12875231/ on 2024, July 26.