From teen dealers selling counterfeit Xanax bars on social media to addicted college kids using the benzos to help with panic attacks or comedowns, VICE UK is investigating the rise of Britain's counterfeit Xanax use. Read more features in this series here and watch our new film about mental health and fake Xanax, 'Xanxiety in the UK', here.
The effects kick in after around 20 minutes. You'll start to feel relaxed, maybe a bit sleepy. Depending on how much you've taken, you might notice changes in your perception. A bit of visual fuzziness, maybe. The effects peak around an hour later. With higher doses, you might have problems with coordination. If you’ve taken a lot, you may well blackout. While you'll still be able to function, your memory will be completely blank.
If you've ever taken Xanax, you know this already. But what's actually going on inside your brain while all this is happening?
Xanax is a brand name for alprazolam, one of a group of drugs known as benzodiazepines, or benzos, which are typically prescribed for anxiety. Like all drugs taken orally, it's absorbed into the body through the stomach, passing through the mucous membrane and entering the liver. From there, it enters the bloodstream and works its way towards your brain. The drug then passes through the blood-brain barrier, a membrane which filters out dangerous substances. Benzodiazepines, like other drugs, are able to pass through this barrier.
It’s in the brain where things get interesting. Benzodiazepines work on parts of the brain known as GABA-A receptors. Think of receptors like switches – with different switches responsible for producing different effects. GABA-A receptors are responsible for producing sedative effects. These receptors have to be switched on by neurotransmitters, which are chemicals used to carry messages around the brain. GABA-A receptors are switched on by the GABA neurotransmitter. Val Curran, professor of psychopharmacology at UCL, describes the GABA neurotransmitter as "sort of like the brakes on the brain. It calms everything down."
Benzodiazepines are agonists, meaning they amplify the GABA-A receptors' effects. Other drugs, such as alcohol and sleeping pills, work in the same way, albeit with different effects. They do this by attaching themselves to the GABA-A receptors and increasing the effectiveness of the GABA neurotransmitter. So, when you take a drug like Xanax, the switch (or receptor) is flicked on to full power. GABA-A receptors are concentrated in an area of the brain known as the hippocampus, which is important for memory, and is believed to be the reason why these drugs can cause blackouts.
When prescribed by a doctor, Xanax is typically intended to treat anxiety, which can be caused by an imbalance of chemicals in the brain. In those cases, Xanax is used to correct the imbalance. That experience can be very different from that of a recreational user.
Dr Cathy Montgomery, reader in psychopharmacology at Liverpool John Moores University, says: "If somebody's experiencing high levels of anxiety they have an increase in chemicals like adrenaline, which would normally make you feel more alert and awake, and a deficiency in GABA. High levels of adrenaline and low levels of GABA have a double impact of increased excitation in the brain, which people experience as anxiety. When they take Xanax, they won’t necessarily get the same type of heavy sedative effect."
Of course, if you’re taking Xanax recreationally, a heavy sedative effect might be just what you’re after. And because you don’t have a chemical imbalance to start with, that’s just what you’ll get. Effectively, you’re creating an imbalance in the brain – the same kind of imbalance Xanax is prescribed to correct – just in the other direction. (All this without considering the fact that in the UK Xanax is not prescribed, except privately, and black market Xanax can contain whatever active ingredients the person making it wants, as Pfizer pointed out in their statement to VICE.)
Broadly speaking, your body will try its best to maintain equilibrium in the brain. "Whatever you take, your brain will try to regulate it. It may release adrenaline to try and combat this," says Montgomery. While you're on Xanax, this won’t be noticeable, because the drug is powerful enough to overcome your brain's efforts to rebalance things. "When you’re taking the substance, you have enough GABA being released to prevent you experiencing anxiety," says Montgomery.
Xanax takes several days to leave the body completely. But the noticeable effects will wear off after a few hours. The drug first detaches itself from the GABA-A receptors in your brain and is broken down by enzymes and the liver, then eventually excreted from the body.
It's the point at which the drug detaches from your brain's receptors that potential problems start to arise. The sedative effects will start to wear off, but your brain is still trying to maintain equilibrium. That can lead to a fairly horrible comedown. "It’s really the flip side of why you’re taking it," says Montgomery. "You get a sudden increase in brain activity, which could make you feel quite anxious. You can start to feel quite agitated, insomnia – some people experience fearfulness."
Those feelings are part of the reason why Xanax users can build up a dependency on the drug quite quickly – and if they didn't have problems with anxiety before, they may well do now. Montgomery says: "For regular recreational users, the reason they might keep taking it is for withdrawal symptoms that would be characterised as dysphoria. That then perpetuates use. You are then taking it to self-medicate."
Tolerance to the anti-anxiety effects of Xanax tends to build up quite slowly, but users chasing its sedative effects can start to need higher doses within just a few days. Dr Tony O'Neill, clinical senior lecturer in psychiatry at Queen’s University Belfast, says: "Benzodiazepines are supposed to be prescribed for a short time. The problem is you need to use larger and larger doses to have the same effect." Recreational users, who may take the drug in large doses for sustained periods of time, can store up significant withdrawal symptoms. "Those can be horrendous," says O’Neill. Potential symptoms include insomnia, anxiety, panic attacks and nausea. Stopping suddenly has been known to cause seizures.
If you are going to take a drug such as Xanax, it’s important to know that repeated use can lead to withdrawal symptoms in a very short space of time. Curran says: "I would always recommend people not to take a benzodiazepine more than three days running, whether it’s prescribed or not." However, as with all drugs, the only way to avoid the risks is to not take it at all. One of the most significant dangers of Xanax is that studies have tended to focus on use in prescribed doses. As for recreational use, as Montgomery says: "A lot of the answers, we don’t really know."