Xanax and the new generation of addiction

By AMANDA MARTINEZ

Arizona Sonora News

Xanax believed to have been brought over from Mexico. (Courtesy of Tucson Police Department)
Xanax believed to have been brought from Mexico. (Photo: Tucson Police Department)

Gilbert Martinez is a 20-year-old auto glass repair technician who lives in Arizona. His life is typical in many ways: He gets up, goes to work, hangs out with his friends and plays video games for hours, but his driving motivation in life is to buy and take Xanax.

“I basically do my work to obtain Xanax and other drugs,” Martinez said.

His says his addiction started the way it does for many people. Family members were prescribed the drug and he began to skim pills from them, selling the pills at school and. over the course of four years, increasing his dose.

But as his intake increased, so did his legal problems. 

Around 4 p.m. on Halloween 2014, he was stopped at a DUI checkpoint in Tempe. He said he was given a blood test and it came back positive for benzodiazepines, cocaine and marijuana. That benzodiazepine was Xanax.

Today, more Xanax, Alazopram and fake versions of these drugs are coming into Arizona through Mexico.

This was just the beginning of more legal troubles to come. In December of the same year he was arrested for shoplifting in Scottsdale.

Martinez still has an outstanding court balance of $2595.04 from his DUI.

These charges were verified by Arizona Sonora News.

“Every bad decision I have made is due to Xanax,” Martinez said.

While he denies being physically addicted to the pills, he says so with some trepidation.

“Yes and no because if someone places them in front of me when I am completely sober I can say no,” Martinez said. “But if I am drinking a little bit or already on Xanax I really want them. I black out and start taking more and more.”

He doesn’t take the pills every day, but on his days off he starts out by popping two Xanax bars, or about 4 mg. Between meals, smoking marijuana, drinking alcohol and playing video games for hours, he takes more. He is exhausted and ready for bed by 7 p.m.

“I try to think in the moment and try not to think ahead. And the Xanax is part of why I want to live in the moment. I don’t have to worry about tomorrow. I’m not worried about my debt or life itself,” Martinez said.

 

The numb feeling Martinez speaks of is the reason people take Xanax for severe panic attacks and panic disorders said Dr. Saira Kalia, a Behavioral Health Provider at Tucson’s Crisis Response Center and a psychiatrist at Counseling and Psychological Services at the University of Arizona.

Xanax, known generically as alprazolam, is almost synonymous with a group of medicines known as benzodiazepines and is the number one drug prescribed from this family of medicine.

“It gets prescribed, number one, for anxiety and that is a very catch-all label,” Kalia said. “I have anxiety, you have anxiety, everyone has it at some point or another.”

Kalia said all kinds of doctors prescribe it: Pain physicians, family physicians and psychiatrists.

The problem, Kalia said, is the drug is highly addictive.

It isn’t an everyday treatment and is meant to treat a specific population, but it is also prescribed as a muscle relaxant, headache relief and for pain. People use it for alcohol withdrawal

According to Pfizer’s official Xanax website, people can become addicted “even after relatively short term use.” Use as low as 0.75 to 4.0 mg per day for about 12 weeks carries the risk for dependence. 

At the Crisis Response Center, Kalia will send people to the ER if they ingest even 8-10 mg of the drug.

“You’re probably not going to die,” Kalia said. “If you want to make sure you are going to die, it is only about 25 mg.”

Some of the long-term effects are those affecting Gilbert Martinez’ life.

Kalia said studies show risk taking behavior increases 15 fold while taking Xanax recreationally. Risk for sexually transmitted diseases goes up and it isn’t uncommon for people to face legal trouble.

“The risk-taking behavior is quite serious,” Kalia said. “It will still impact your life on a daily basis. Maybe you get away with it once or twice.”

But it isn’t only the risk taking behavior people need to be concerned about, according to Kalia.

“Over time the worst thing is your cognitive ability,” Kalia said. “While you are intoxicated you act like a zombie. Your risk of Alzheimer’s goes up.”It isn’t a unique drug that people don’t know about. There have been documentaries on it, there is information on it on college campuses.”

It has been cited as potential cause of death in high-profile deaths like those of Heath Ledger, Whitney Houston and Michael Jackson.

For many people, taking Xanax seems innocuous enough. A friend or family gives them a pill from their own legally obtained prescription for stress or anxiety and they find it works so well, they head to a doctor, admit to trying the drug and ask for a prescription.

Kalia said students come into the Counseling and Psychological Services office at the University of Arizona and admit to having tried the drug, but she emphasizes it isn’t a treatment, but a Band-Aid.

 

Although it is possible to overdose on benzodiazepines like Xanax, death is more likely to occur when the drugs are used in combination with alcohol, opioids and other substances that cause respiratory suppression.

 Closer to home, University of Arizona football player Zach Hemilla’s death was attributed to the “combined toxic effects of oxymorphone and alprazolam” according to the autopsy report from the Pima County Medical Examiner’s office

Alexander Sandweiss is a MD-PhD student at the University of Arizona College of Medicine who researches opioids and how to prevent addiction.

Sandweiss said the mix of opioids and benzodiazepines can cause respiratory failure together or on their own.

In all mammals, the brain will send neural impulses to the diaphragm to make it contract and take air into the lungs.

“If we stop thinking about it we aren’t going to die,” Sandweiss said.

But this is where mixing the two drugs can become deadly.

“Benzodiazepines and opioids will decrease the respiratory rate by acting on their respective receptors [in the brain,]” Sandweiss said. “If you overdose and take too much, other regions [of the brain] are unable to compensate and you will stop breathing.”

A 2014 report from the Substance Abuse and Mental Health Services Administration, SAMHSA, says between 2005-2011 943,032 people visited the emergency department for benzodiazepines alone or in combination with opioid pain relievers or alcohol and no other substances.”

Although the combination carries a higher risk, in 2011 the number of visits for benzodiazepines outnumbered the combination benzodiazepines and opioids by about 39,000.

These statistics are not easy to find. Many agencies do not track specific drug use, if the pills were obtained legally or illegally or the outcome for the patient.

This is the case at Tucson Crisis Response Center.

Margie Balfour is the chief clinical officer at the CRC. She said about 13 percent of people who come into the center have some sort of benzodiazepine in their systems but there is no way to track how the pills were obtained or if they are being used in psychological treatment, and that information about addiction and drug use is self reported.

The situation is similar for the Arizona Poison and Drug Information Center. The 24/7 hotline fields calls from all over Arizona, except Maricopa County, but they don’t track pills’ origins, legality, what substances the pills are mixed with, medical comorbidities or patient outcome because they often only receive the information the person on the phone discloses.

Keith Boesen is the director of the center.

“Benzodiazepines are a very common drug involved in our phone calls,” Boesen said, adding that it’s hard to provide specific numbers.

In 2015, the center received 1705 calls (or about 4.6 per day) asking questions about benzodiazepines or opioids.

But Boesen is quick to point out that while poison control and drug centers track exposure, they do not necessarily track abuse.

It is also difficult to track arrests and possession for the Tucson Police Department.

The Public Information Officer, Sgt. Pete Dugan, said it is difficult to pinpoint cases where multiple drugs are involved.

“We may arrest someone for a bank robbery, but we do not clear it as a narcotic call,” Dugan said. “But they also have marijuana in their pocket so we don’t clear it as a narcotic possession case.”

He said TPD uses FBI clearance codes and whatever crime has a higher clearance for the FBI is used.

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            David, 40, who asked that his last name be withheld, said he first started using the drug when he was 23 and didn’t have a prescription. Before he legally obtained a prescription, he and his friends got his pills through other means.

“One time were even went down to Mexico,” David said.

James Scott is the deputy commander of the Counter Narcotics Alliance for the Tucson  Police Department. He said many of the Xanax or alazopram pills being sold in Tucson today are still coming up through Mexico.

“We buy a large amount of Xanax pills on the street…some of them being imported from Mexico,” Scott said. “We actually have a case where an individual was bringing up hundreds of them from Mexico and selling them and we bought three or four hundred of these pills.”

He said the pills are readily available in Mexico.

But when a person buys Xanax pills illegally, they cannot be exactly sure of what they are getting.

Twenty-one Xanax pills seized in Tucson last year contained TFMP, Trifluoromethylphenylpiperazine, a hallucinogen, Scott said.

Between March 9 of this year and September 27, the Counter Narcotics Alliance has seized 926 Xanax or Alazopram pills from street dealers.

“The obvious danger of this is individuals purchasing what they think is Xanax, then getting something else with unknown effects,” Scott said

            A story reported in the Tampa Bay Times said that nine people died in the state this year due to counterfeit Xanax pills laced with fentanyl.

            Scott said various pills laced with that powerful deadly drug are showing up in Tucson.

            “The biggest problem we are having right now is pills disguised as oxycontin, but are actually fentanyl,” Scott said.

            He said the department has had about four or five cases involving fentanyl and some of these pills are being manufactured in Mexico.

            “A couple of micrograms is enough to cause death and that is a couple of grains of salt,” Scott said. “The fear we have is only the beginning.”

Part Two of this report will focus on the rise of fentanyl coming into the United States through Mexico and China.

Download high resolution images here.

 

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