Whitney Houston’s death draws attention to dangerous drug combos. Paying tribute to the extraordinary singer Whitney Houston, wouldn’t be quite right without a sober contemplation of what her death draws attention to—the growing dangers posed by lethal drug combinations in today’s hectic and quick-fix-crazed world.
While the exact cause of Houston’s death may not be known for a month or more until the official toxicology report is released, doctors suspect the cause of death was a deadly cocktail of the prescription anti-anxiety drug Xanax, other drugs and alcohol.
The 48-year-old singer, after all, had a history of alcohol and drug abuse and a prescription for Xanax, and had checked into rehab centers at least three times during her career.
But according to Fox News and TMZ.com, Los Angeles County Coroner officials told Houston’s relatives she had died from what appears to be a combination of Xanax and other common drugs mixed with alcohol. The TMZ story reported a poignantly common set of prescriptions: Xanax, Ibuprofin for pain, Midol for menstrual cramps and the antibiotic amoxicillin for an upper respiratory infection.
Whether it’s done deliberately or accidentally, it’s known that a combination of Xanax and alcohol can be deadly, Dr. Marvin Seppala tells Discovery News. Seppala is the chief medical officer at Hazelden, a preeminent treatment center for alcohol and other drug addiction.
Houston had been hoping to revive her career this year with a possible comeback album, the New York Times reported, and Xanax is often prescribed for stage fright and all other types of anxieties.
“However, it’s abused a great deal and has the potential for addiction,” Dr. Seppala says, especially if someone has a genetic predisposition for addiction. “Tolerance develops quickly if it’s used on a regular basis.”
In the days before her death, Houston’s behavior was indeed reported to be erratic: she was seen wearing mismatched clothes with wet hair and bursting on the set of a television interview with Clive Davis. Slurred speech and behavior often associated with being drunk are also typical of high doses of Xanax, notes Dr. Seppala.
Xanax-Alcohol Side Effects: It’s a Dangerous Drug Combo
Xanax, also known by its chemical name Alprazolam, is one of the most-prescribed drugs in the United States. To be precise, it was the eighth-most prescribed drug in the U.S. in 2010, according to the New York Times.
Classified as benzodiazepine, the anti-anxiety drug alprazolam works by binding to part of the brain’s natural tranquilizers—or gamma amino butyric acids (GABA)—to increase the body’s natural calming ability.
Enhancing these inhibitory effects in the body can cause sedation, muscle relaxation, sleep-induction, anti-anxiety and amnesic effects. Benzodiazepines work quickly, often in 15 minutes and the effects last just a few hours. For these fast-acting inhibitory and sedating effects, benzodiazepines are widely prescribed to treat a variety of conditions like anxiety disorders, convulsive disorders and insomnia. They’re also used for pre-surgical sedation.
Doctors say that when prescribed, used and monitored appropriately, these drugs have many benefits for patients. When used correctly and by themselves, benzodiazepines carry a low risk of acute toxicity, they point out.
But when mixed with alcohol—as people often do, despite warnings—the anti-anxiety drug’s effects on the central nervous system are intensified, resulting in greater intoxication.
This can cause enhanced psychomotor slowing, confusion, slurred speech, dizziness, memory impairment, depression, or increased irritability and aggression. Loss of consciousness and deadly overdoses can also occur.
Xanax-and-alcohol combos can cause your heart rate to slow and impair your breathing, putting those who overdose at risk of death. “They cause the control mechanism of the respiratory system to slow down and ultimately stop,” says Dr. Seppala.
Benzodiazepines are also addictive and have a high potential for abuse.
“Drugs such as Xanax are meant to be used as short-term solutions,” Dr. John Baudhuin tells the Palm Beach Post. Dr. Baudhuin is one of the directors of the Caron Renaissance addiction-treatment facility in Boca Raton, Palm Beach County, Florida.
“When people use them habitually and build up a tolerance, the margin between a therapeutic and fatal dose becomes just too small,” he warns.
Dr. Baudhuin says he’s seen a sharp rise in the number of people who become, he believes, “unintentionally” addicted to anxiety medications such as Xanax. And the more a person takes Xanax, the more they need to take to get the same effect.
Dr. Seppala echoes his sentiments, grouping most patients checking in for rehab from Xanax into two groups.
“One group never uses it addictively, but needs help getting off because they’ve built up tolerance,” he says. “The other group is mixing it with all kinds of other stuff: opiates, marijuana, alcohol, and that complicates the withdrawal and the whole picture.”
The longer Xanax and similar drugs are taken, he points out, the less effective they become. And withdrawal symptoms are unpleasant: headache, insomnia, depression—and worse, more of the nervousness that caused the person to turn to taking Xanax in the first place!
Xanax nation
Xanax, approved in 1980 for the then-brand-new diagnosis of “panic attack,” is America’s most prescribed psychiatric drug, outpacing even the antidepressants that made us “The Prozac Nation,” notes Walter Armstrong is the articles editor at The Fix, an online publication on addictions.
Figures from the American Psychiatric Association (APA) are shockers: Every year, doctors write more than 50 million prescriptions of benzodiazepines—more than one per second.
Only one percent of Americans are daily users of benzodiazepines—which is supposed to be the indication that these drugs are being abused. But the sheer ubiquity of benzodiazepines is cause for concern. From 11 to 15 percent of all American adult have a bottle of these tranquilizers in their medicine cabinet.
Looking at their sales, no one can doubt that Xanax and similar drugs are popular:
• Xanax is ranked number nine on the list of the nation’s top-earning drugs
• Klonopin, no. 32
• Ativan, no. 33
• Valium no. 51
Paradoxically, in addiction centers, benzodiazepines are commonly given to alcoholics and opiate addicts to quell withdrawal symptoms during detox.
About 41 percent of alcoholics say they’ve abusing sedatives. Drug dependents themselves will tell you that benzodiazepines have become a mainstay of many styles of drugging—they’re use to coming off a crystal meth high or to boost the euphoric effect of smack or Oxy. One study found that 80 percent of benzodiazepine abuse is associated with other drug abuse, mostly alcohol or opiates such as hydrocodone, oxycodone and heroin, The Fix reports.
In the last decade, sedative abuse has been on the rise. From 1998-2008, the number of those seeking treatment for benzodiazepine-related abuse rose from an estimated 22,400 per year to 60,200 per year, according to The Fix. The Fix, a website about addiction and recovery established in March 2011, has been since been cited as an expert source by mainstream news agencies like the New York Times, Washington Post and many others.
Drug-related deaths
For the first time, too, since the 1970s, drug-related accidental deaths have officially outnumbered those caused by car accidents, according an analysis by the Los Angeles Times.
Despite an increase in the numbers of drivers and in total driving time, the figures for drug-related deaths in 2009 for Americans surpassed vehicular accidents.
In 2009 alone, some 37,500 Americans succumbed to drug overdoses, fueled by either prescription drug abuse or a combination of mixing medications with each other, alcohol or recreational drugs.
This is compared to approximately 33,800 deaths from car accidents that same year, as reported by the National Highway Traffic Safety Administration.
Indeed, Whitney Houston’s death is only one of commonplace tragedies in the lives of celebrities. Her death is only the last in a long list of drug-related celebrity deaths: The toxicology report on Judy Garland, who died in 1969, revealed that her blood contained the equivalent of 10 capsules of the barbiturate Seconal.
Seconal, Nembutal and other barbiturates also claimed the lives of Marilyn Monroe, Jimi Hendrix and Tennessee Williams. Xanax has claimed the lives of Michael Jackson and Heath Ledger. Then there are those who overdosed on stronger cocktails: Anna Nicole Smith OD’d on nine such drugs, including four different sedatives.
If their deaths draw attention to the growing problem of drug-related deaths from prescription drugs, whether done on purpose or accidentally—then their deaths wouldn’t have been in vain.
That said, Xanax is a drug that has benefits when used as intended. For those who’ve been prescribed Xanax, here are some dos and don’ts:
Xanax Dos and Don’ts
DON’T use Xanax if:
• you’re pregnant. It could harm the unborn baby.
• you’re allergic to alprazolam or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).
• narrow-angle glaucoma;
• if you are also taking itraconazole (Sporanox) or ketoconazole (Nizoral)
Before taking Xanax
DO tell your doctor if you have any of these other conditions:
• asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;
• glaucoma,
• kidney or liver disease (especially alcoholic liver disease);
• a history of depression, suicidal thoughts
• a history of drug or alcohol addiction.
Do tell your doctor if regularly use the following medications:
• other medicines that make you sleepy like cold or allergy medicine
• other sedatives
• narcotic pain medicine
• sleeping pills
• muscle relaxers
• medicine for seizures, depression, or anxiety
These medications can add to sleepiness caused by Xanax.
DON’T buy from the Internet
DON’T buy Xanax on the Internet or from vendors outside the United States.
DO know that medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy.
DO know that samples of Xanax purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects.
Pregnancy
DO know that the FDA has categorized the medication as pregnancy category D.
DON’T use Xanax if you are pregnant. If you’re a mom and you’ve been taking Xanax during pregnancy, it may cause addiction or withdrawal symptoms in your newborn.
DO use effective birth control if you’re a woman.
DO tell your doctor if you become pregnant during treatment.
DON’T breastfeed when taking Xanax. Alprazolam can pass into breast milk and may harm a nursing baby.
Elderly and children
If you are a senior citizen, DO be cautious about avoiding falls or accidental injury when taking Xanax.
DO know that the sedative effects of Xanax may last longer in older adults.
DO know that accidental falls are common in elderly patients who take benzodiazepines.
DON’T give alprazolam to under-18s
Addiction
DO know that Xanax may be habit forming.
DON’T share Xanax with another person, especially those with a history of drug abuse or addiction.
DO keep the medication in a secure place where others cannot get to it.
DO keep track of the amount of medicine used from each new bottle. Xanax is a drug of abuse.
DO be aware if anyone is using your medicine improperly or without a prescription.
DON’T drink alcohol while taking Xanax. The medication can increase the effects of alcohol.
When taking Xanax
DO take Xanax exactly as your doctor prescribed.
DON’T take in larger or smaller amounts or for longer than recommended.
DO follow the directions on your prescription label to the dot.
DO know that your doctor may occasionally change your dose to make sure you get the best results.
DON’T crush, chew, or break a Xanax extended-release tablet. Breaking the tablet would cause too much of the drug to be released at one time.
DO swallow the tablet whole. It’s specially made to release medicine slowly in the body.
DO contact your doctor if this medicine seems to stop working as well in treating your panic or anxiety symptoms.
Seizures
DO know that you may have seizures or withdrawal symptoms when you stop using Xanax. Ask your doctor how to avoid withdrawal symptoms when you stop using Xanax.
When you miss a dose
DO take the missed dose as soon as you remember.
DO skip the missed dose if it’s almost time for your next scheduled dose.
DON’T take extra medicine to make up the missed dose.
What happens if I overdose?
DO seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
DO know that an overdose of Xanax can be fatal.
Symptoms of overdose:
• extreme drowsiness
• confusion
• muscle weakness
• loss of balance or coordination
• feeling light-headed
• fainting
What to avoid while taking Xanax
DON’T drink alcohol while taking Xanax.
DO know this medication can increase the effects of alcohol.
DO know that Xanax may impair your thinking or reactions.
DO be careful if you drive or do anything that requires you to be alert.
DON’T take grapefruit and grapefruit juice; it may interact with Xanax and lead to potentially dangerous effects.
DO discuss the use of grapefruit products with your doctor.
Xanax side effects
Get emergency medical help if you have any of these signs of a serious allergic reaction to Xanax:
• hives
• difficult breathing
• swelling of your face, lips, tongue, or throat
DO stop using Xanax and call your doctor at once if you have a serious side effect such as:
• depressed mood, thoughts of suicide or hurting yourself, unusual risk-taking behavior, decreased inhibitions, no fear of danger;
• confusion, hyperactivity, agitation, hostility, hallucinations;
• feeling like you might pass out;
• urinating less than usual or not at all;
• chest pain, pounding heartbeats or fluttering in your chest;
• uncontrolled muscle movements, tremor, seizure (convulsions); or
• jaundice (yellowing of the skin or eyes).
Less serious Xanax side effects may include:
• drowsiness, dizziness, feeling tired or irritable
• blurred vision, headache, memory problems, trouble concentrating
• sleep problems (insomnia)
• swelling in your hands or feet
• muscle weakness, lack of balance or coordination, slurred speech
• upset stomach, nausea, vomiting, constipation, diarrhea
• increased sweating, dry mouth, stuffy nose or
• appetite or weight changes, loss of interest in sex.
DO know that this isn’t a complete list of side effects and others may occur.
DO call your doctor for medical advice about side effects.
DO report side effects to FDA at 1-800-FDA-1088, if you wish.
Drug interactions
DO know that these drugs will affect Xanax:
• birth control pills;
• immunosuppressants cyclosporine (Gengraf, Neoral, Sandimmune) or dexamethasone (Cortastat, Dexasone, Solurex, DexPak)
• migraine medication ergotamine (Cafergot, Ergomar, Migergot)
• anti-cancer drug imatinib (Gleevec)
• anti-tuberculosis drug isoniazid
• an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), rifabutin (Mycobutin), rifampin (Rifadin, Rifater, Rifamate), rifapentine (Priftin), or telithromycin (Ketek)
• antifungal medication such as miconazole (Oravig) or voriconazole (Vfend)
• an antidepressant such as fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), desipramine (Norpramin), imipramine (Janimine, Tofranil), or nefazodone
• antidepressant herb St. John’s wort
• a barbiturate such as butabarbital (Butisol), secobarbital (Seconal), pentobarbital (Nembutal), or phenobarbital (Solfoton)
• heart or blood pressure medication such as amiodarone (Cordarone, Pacerone), diltiazem (Tiazac, Cartia, Cardizem), nicardipine (Cardene), nifedipine (Nifedical, Procardia), or quinidine (Quin-G)
• HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva, Atripla), etravirine (Intelence), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), saquinavir (Invirase), or ritonavir (Norvir, Kaletra)
• seizure medication such as carbamazepine (Carbatrol, Equetro, Tegretol), felbamate (Felbatol), oxcarbazepine (Trileptal), phenytoin (Dilantin), or primidone (Mysoline)
Do know that drugs that make you sleepy can add to the sleepiness caused by Xanax.
• cold or allergy medicine
• other sedatives
• narcotic pain medicine
• sleeping pills
• muscle relaxers
• medicine for seizures, depression, or anxiety
This list isn’t complete and other drugs may interact with Xanax.
DO tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products.
DON’T start a new medication without telling your doctor.
DO ask your pharmacist for more information about Xanax.