Even a cursory glance at benzodiazepines reveals a number of differences between the different brands. Some “benzos” are designed to deliver fast-acting effects, while others are meant to stay in the body for longer periods of time before dissipating. Very little research has gone into determining which benzodiazepine is the most toxic, however, if any. After reviewing national hospitalization records, a group of Australian researchers feel they have isolated the most dangerous benzodiazepine of them all – Xanax.
The study, Alprazolam is Relatively More Toxic Than Other Benzodiazepines, examines an Australian toxicology database for all cases of deliberate overdoses from 1987 to 2002 using benzodiazepines. Out of a total of 1,932 instances, only 131 overdoses were from Xanax. However, despite the low number of hospitalizations from Xanax, the study finds that Xanax users were more than three times likely to be rushed to an Intensive Care Unit upon admission.
Of the Xanax overdoses, 14 percent were severe enough to place under Flumazenil (a medication used to combat the dangerous effects of benzodiazepine withdrawal). This is compared to 8 percent of overdoses on other benzodiazepines, which is nearly double the difference. In addition, more Xanax victims required ventilation (16 percent) when compared to other benzodiazepine overdoses (11 percent).
Perhaps most telling of all, however, was the fact that patients admitted for Xanax overdoses stayed in the hospital on average for 19 hours. This was approximately 1.27 times longer than all other benzodiazepine admissions.
According to the results, Australian victims of Xanax overdoses stayed in the hospital for longer, were admitted into the Intensive Care Unit more often, and had more instances of mechanical ventilation with Flumazenil. The Australian researchers attribute Xanax with “relatively” enhanced toxicity levels, but do not offer theories as to why.
A study from this year, however, describes Xanax as an “intermediate to short-acting benzodiazepine with elimination half-life between 9 and 16 hours”. This expands upon a 1991 study that found Xanax to be “rapidly absorbed and enter the brain tissue rapidly”, contributing to “more withdrawal symptoms than diazepam [Valium]”. The same study notes that each benzodiazepine “causes a withdrawal syndrome, but alprazolam [Xanax] withdrawal may be more severe and may occur after a shorter period of use.” Could the shorter half-life be to blame?
In this light, the 2004 Australian study seems to be a continuation of what researchers have suspected for quite some time – that Xanax causes more severe withdrawal symptoms than most other benzodiazepines. However, this is the first study which proposes Xanax is more “toxic” than the other benzodiazepines.
Either way, Xanax withdrawal is notoriously hard to overcome. The most common symptoms of withdrawal include anxiety, headaches, an inability to sleep, blurry vision, depression, agitation, noise and light sensitivity, muscle cramps, and sweating. The more serious side effects include vomiting and seizures. It is not uncommon for a user to feel completely over their symptoms, only to have them return again. This is called “protracted withdrawal”, and it can last for years as the brain readjusts to its baseline chemistry.
A review of the Annual Reports of the American Association of Poison Control Centers raises some questions about the Australian study. From 1992 to 2001, 34 Americans deliberately killed themselves using Xanax, which was only 4 more deaths than Valium. Aside from proving that Xanax is not an efficient for suicide attempts, it also appears to be about as equally as dangerous as Valium (despite their different half-lives). Although any benzodiazepine can be dangerous if not used as prescribed, it seems that more research is needed to determine which class of benzodiazepines are truly the most toxic and fatal, if any.