LOUISVILLE, KY -A nurse practitioner at a community mental health center here, had tired of the constant stream of patients seeking Xanax, an anti-anxiety drug coveted for its swift calming effect. Her employer, Seven Counties Services, serves some 30,000 patients in Louisville and the surrounding region. Because of the clamor for the drug, and concern over the striking number of overdoses involving Xanax here and across the country, Seven Counties took an unusual step its doctors stopped writing new prescriptions for Xanax and its generic version, alprazolam, in April and plan to wean patients off it completely by years end.
The experiment will be closely watched in a state that has wrestled with widespread prescription drug abuse for more than a decade and is grasping for solutions as it claims more lives by the week. While Kentucky and other states have focused largely on narcotic painkiller addiction, experts say that benzodiazepines, the class of sedatives that includes Xanax, are also widely misused or abused, often with grim consequences.
While the patients at Seven Counties are mostly poor, experts say the appeal of Xanax cuts across socioeconomic lines. Alprazolam was the eighth most prescribed drug in the nation last year, according to SDI, a data firm that tracks drug sales. Even more than the figures suggest, Xanax has become part of the popular lexicon, as well known as a panic antidote as Prozac is for depression.
The Centers for Disease Control and Prevention last year reported an 89 percent increase in emergency room visits nationwide related to nonmedical benzodiazepine use between 2004 and 2008. And here in Kentucky, the combination of opiate painkillers and benzodiazepines, especially Xanax, is common in fatal overdoses, according to the state medical examiner.
Seven Counties is not the first healthcare provider to cut off prescriptions for controlled substances at least several others around the country have stopped giving patients certain opiates and benzodiazepines but the practice remains contentious. Some doctors say that refusing to prescribe certain drugs under any circumstance is overly rigid, noting that Xanax helps many people who use it responsibly.
Xanax poses a particular risk for abuse and withdrawal, doctors say, because its effects are felt almost immediately, but last only a few hours. Users often quickly want more, experts say, and as their tolerance builds, they want increasingly higher doses.
At Seven Counties, some of the roughly 3,000 patients who were on Xanax have been switched to clonazepam, a longer-acting benzodiazepine that does not kick in as quickly and is thought to pose less risk of addiction. The eventual goal is to wean patients off clonazepam, too, he said. People with severe anxiety should ideally take an antidepressant as well as a benzodivazepine, he said, and learn coping mechanisms with cognitive behavioral therapy. Visit the New York Times for the article.