X is for Xanex
When the Governor of Florida’s daughter Noelle Bush was arrested for prescription fraud in 2002 after trying to purchase Xanax pills with a fake prescription it highlighted the issues connected to the millions of ‘bars’ that were being churned out by big-pharma companies every year. Noelle could have been buying this drug to self-medicate for anxiety, but much of the media at least implied Xanax was being used to help her ‘settle down’ after using Ecstasy at a dance club.
Xanex is the leading brand name of Alprazolam a benzodiazepine developed by Upjohn Laboratories of Kalamazoo, Michigan in the late 1960s. Although the patent was filed in 1969 medical sales in the United States did not start until 1981 and the patent expired in 1993. Like many such products the route to profitability lay in adopting a catchy brand-name and associating the name in peoples mind with a particular medical problem.
In terms of marketing this is a somewhat difficult act to pull off. Many people still refer to any vacuum cleaner as a ‘Hoover’. Biro, Pritt-stick and Blue-Tack are other good examples, even when we are using generic or otherwise branded alternatives. We even ‘google’ a query online when using any old search engine. Other examples which were once ubiquitous now seem archaic, it now seems odd to ask for a ‘Xerox’ when you simply what a photocopy.
With a switch of a couple of vowels we come back to the palindromic sounding ‘Xanex’. The brand-name was patented by the Upjohn pharmaceutical company, and despite the hundreds of other brand-names tried by other manufacturers of the generic Alprazolam, it has remained the most well-known brand. It has also spawned a range of other slang terms. These ranged from the classically short ‘X’ or ‘Z’ (having a phonetically similar first letter), through rather obvious terms like ‘Xannies’ or ‘Zannies’ to the somewhat bizarre ‘Speedy Gonzales’, ’Handlebars’, ‘Zebra’ or ‘School bus’. Another term ‘Chill pill’ or ‘Take a chill pill’ has come into common usage as well coming to mean simply ‘take a moment’.
As Alprazolam was being developed the Upjohn company had in mind the market for sleeping tablets, believing that they could create a superior product by utilising the drug’s muscle relaxant qualities. With ongoing research they realised its effectiveness on anxiety, panic and mood disorder. In the 1970’s many of the, other antidepressants that were on the market were perceived as being harsher and more toxic. As the market for benzodiazepines was shrinking at the time Upjohn attempted to reposition its benzodiazepine as a drug specifically purposed for “panic disorder”, which was more commonly being diagnosed at the time.
Upjohn went on to present Xanex to the FDA (the Food and Drug Administration of the United States) as an antidepressant, producing about 50 double-blind studies, proving that Alprazolam was better and less toxic than other drugs available at the time.
The FDA duly gave Upjohn approval, but then changed their minds and decided Upjohn could not launch Xanax as an antidepressant, but as an anti-anxiety medication that “does not produce depression.” As the company had already spent millions of dollars on studies of Xanax to establish that panic attacks really were an independent disease, the FDA did not require them to compare it to placebos or other anti-anxiety medications available at that time (Valium, Librium, etc.).
This development brought up the interesting question of the difference between anxiety and depression and where “panic disorder” lies within that picture.
Everyone experiences feelings of anxiety and panic at certain times as a natural response to stressful or dangerous situations. The terms “anxious” and “depressed” get thrown around a lot in casual conversation—and for good reason. Both are normal emotions to experience, routinely occurring in response to high-stakes or potentially dangerous situations (in the case of anxiety) or disappointing, upsetting circumstances (in the case of depression).
Someone with panic disorder however has feelings of anxiety, stress and panic regularly and at any time, often for no apparent reason.
Anxiety and depression share a biological basis with low serotonin levels thought to play a role in both, along with other brain chemicals such as dopamine and epinephrine. Despite the biological similarities, anxiety and depression are often experienced differently. In this way, the two states can be considered two sides of the same coin.
It’s also the case that anxiety and depression can occur sequentially (one in reaction to the other), or they can co-occur. The relationship between these emotions and their associated clinical conditions, anxiety and mood disorders is complex one and open to professional interpretation.
This placed Xanex in a somewhat unusual position of being strongly connected in the minds of both patients and medical professionals with the idea of ‘panic disorders’, something that seemed sit somewhere between the two conditions.
By the early 1990s, Xanax had certainly become one of the most prescribed drugs in psychiatry, certainly the most prescribed benzodiazepine. Some, perhaps more cynically-minded individuals jokingly began referring to panic disorders as “the Upjohn illness.”
The continued attachment to the brand ‘Xanex’ by patients and doctors is purely an effect of this marketing prowess, and being given a ‘head-start’ by being the only branded product available whilst Alprazolam was still in-patent. Once the patent had expired dozens of generic versions, often with their own brand-name attached began to flood the market. Any generic drug should have the same intended use and effects as the originally patented drug. They should also have the same dosage, side effects, and risks. Generic versions of drugs are usually cheaper because their manufacturers have not had to spend time or money on research or development. If they are sold simply as a generic drug without an attached brand-name then marketing too becomes simply a question of price.
Many patients who switch from Xanax to another generic drug find that they benefit in the same way but others are vocal in claiming that generic alprazolam doesn’t work. They may say that they experience different side effects or find that their anxiety isn’t relieved.
It’s the case that generic drugs contain different binders and fillers. These make up around 90% of the tablet. Some pharmacist argue that these chemicals affect the absorption of the active ingredients or increase inflammation in the nervous system. There can also be allergic reactions. Even though the active ingredients are the same, their interaction with the binders and fillers can cause different outcomes in patients. Interestingly the FDA (Food and Drug Administration) in the United States insists that generic drugs are ‘bio-equivalent’ but it doesn’t actually test to see whether they work in the same manner on patients. Since everyone’s body reacts differently, finding the right brand to use for an individual simply becomes a matter of trial and error.
Many patients who suffered from anxiety and depression were treated with Xanax for long periods of time, experiencing antidepressant effects. Despite its efficacy in certain situations the misuse of the drug by individuals has led significant concerns with hospital admissions topping over 100,000 in some years in the United States. Fatalities may run to over 6,000 a year, usually linked to the use of other substances such as alcohol or opiates. The problem is not limited to the United States with some 63 people identified in 2017 in Ireland as having passed away following the misuse of Alprazolam, again usually alongside other drugs.
The issue has been compounded by the fact that many ‘fake’ versions of Xanex have been put onto the black market. This has been particularly noted in Northern Ireland where dozens of fatalities have been linked to the fake versions of the drug. It’s thought that it is commonly pressed into the familiar bars by criminal gangs who purchase the powder in bulk from producers in the far East.
Concerns for the welfare both of those who use Xanex on a long-term basis under medical advice and those who use the drug for self-medication or ‘recreationally’ means that calls have been made to discontinue sales of Xanex. In the UK and it is now only available on a private prescription. In common with the vast majority of counties the Irish position remains that it is prescription-only medicine. Some countries have also introduced tighter or more enhanced procedures.
Perhaps the bigger question here is why so many people feel heightened levels of anxiety in our modern world, and perhaps why we become so anxious about our seeming inability about why we feel so anxious.
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Western Region Drug and Alcohol Task Force,
Unit 6, Galway Technology Park, Parkmore, Galway H91 W30F
Tel: 091 48 00 44 Email: info@wrdatf.ie
