How Anxiety Meds Are Killing Celebrities
Soraya Roberts | Toronto Star
It used to be that hard drugs were the cause of celebrity overdoses, like heroin in the case of Janis Joplin and Jim Morrison or speedballs, a killer mix for John Belushi, River Phoenix and Chris Farley.
In the post-“crack is whack” era, that’s all changed.
Of the celebrities who have overdosed on drugs in the past five years, eight appear to have taken prescription medications — specifically, a mix involving easily accessible anti-anxiety medications known as benzodiazepines or “benzos.”
Soul singer Amy Winehouse’s death last year was ruled an accidental alcohol poisoning, though her dad later told CNN she also had benzos in her system when she died. Two years prior, actress Brittany Murphy died from pneumonia and multiple drug intoxication that included two benzos. That same year, DJ AM (Adam Goldstein) overdosed after taking a number of drugs, including the same benzos as Murphy. Michael Jackson famously passed away from Propofol intoxication, though the effects of anti-anxiety drugs were not discounted.
Heath Ledger, was found in his Soho apartment in 2008 having ingested a mix of meds including benzos, and Anna Nicole Smith also passed away after a multiple-drug overdose in 2007.
Though Whitney Houston’s toxicology report is still pending, sources close to the family have told TMZ they were notified by the L.A. coroner that she died earlier this month of a combination of benzos and alcohol. Mike Starr’s toxicology report has not been released either, but the Alice in Chains bassist’s roommate told TMZ that Starr was mixing methadone and anti-anxiety medication hours before his death last year.
From the looks of it, celebrities are some of the most anxious people on the planet. Turns out they are. Many public personalities have “co-occurring anxiety disorder” (i.e. the anxiety occurs alongside any other psychiatric disorder they may have),” says Dr. Harris Stratyner, Clinical Associate Professor of Psychiatry at New York’s Mount Sinai hospital and vice-president of New York Clinical Regional Services at Caron New York’s Recovery Center, the rehab facility where Steven Tyler, Liza Minnelli and Miss USA Tara Conner were treated for substance abuse.
“One of the finest and best things you can use for co-occurring anxiety if you’re going to use a medication is a benzodiazepine,” he says, adding that the pills are also “phenomenal muscle relaxants” making them attractive to a “pill-oriented society” that has little time to de-stress using meditation or yoga.
Some of the more popular benzodiazepines include Ativan (lorazepam), Xanax (alprazolam), Valium (diazepam) and Klonopin (clonazepam), known as Rivotril in Canada.
Benzodiazepines were discovered in 1955 and marketed as a safer alternative to barbiturates for treating anxiety, insomnia and seizures. They enhance the actions of a chemical, GABA (gamma-aminobutyric acid), that inhibits the brain, thereby quieting it. A hypnotic and a tranquilizer, the drug depresses the central nervous system, relieving anxiety, promoting sleep, relaxing muscles, stopping fits and impairing short-term memory. It can also be used clinically for alcohol detoxification (much like methadone for heroin addicts, it acts as a replacement drug for withdrawal).
Short-acting benzodiazepines such as Ativan or Xanax are ideal for treating acute anxiety, says Andrew Kolodny, president of the Physicians for Responsible Opioid Prescribing and chairman of the Department of Psychiatry at Brooklyn’s Maimonides Medical Center.
“If you’re in the middle of a panic attack and you take a Xanax, you’re going to get good relief,” he says. “It works the same way Tylenol works for headache.”
The down side to this is that because Xanax is so fast-acting (its half-life can be as short as six hours), it — and short-acting Ativan — has a “greater euphoric effect,” which makes it higher risk for addiction, says Dr. Meldon Kahan, associate professor in the Department of Family Medicine at University of Toronto and Medical Director of the Addiction Medicine Service at St. Joseph’s Health Centre. Because of this, the medium-acting Klonopin/Rivotril (clonazepam) is preferred for addicts.
According to Dr. Kahan, the choice of the shorter, medium or long acting benzos “depends on clinical circumstances.” For example, the longer acting Valium (diazepam) is “ideal” for alcohol withdrawal because detox lasts several days as does the drug, so “ongoing dosing” is not needed. Shorter acting Ativan (or Xanax) can be used for insomnia because it has less “hangover.”
Houston, who was set to attend a pre-Grammy party, reportedly popped Xanax the day she died. Alesandra Rain, a former benzodiazepines addict and co-founder of Point of Return, a non-profit rehab in California for prescription drug abuse, thinks the Bodyguard star may have experienced anxiety for much the same reason as other celebs — because of her lifestyle.
“Celebrities like Whitney, they’re so figure conscious and diet conscious, odds are they’re drinking a ton of diet soft drinks and aspartame and often that’s what’s causing the anxiety,” she says, referring the artificial sweetener that some consumers have claimed caused them to have panic attacks. Not to mention the peripatetic life of A-listers which puts them in a “perpetual state of jet lag,” affecting their melatonin (the hormone that controls the body clock), which, when low, can lead to anxiety.
Houston, like the other celebrities who died of overdoses in the past five years, had a history of substance abuse, which made her the wrong candidate for benzo use. These drugs are highly addictive (“You can get a 30 days’ supply and you’re hooked,” says Rain) because they affect the limbic system, also known as the pleasure/reward system. They are so strong that even non-drug abusers can, according to Rain, become “innocent addicts.”
“(Benzos) cause that part of the brain to light up many more times than they would from a natural high,” Kolodny explains. “You can almost think of that part of the brain as becoming hijacked by the drug and it becomes very difficult not to use it again.”Because of their high probability of dependence, Stratyner suggests using benzos only short term (up to 10 days), usually for alcohol detox, in a monitored hospital environment. He says benzos should not be used as a first-line drug for anxiety and should “never be prescribed ever” to ex-addicts.
“It will always lead them back to their drug of choice,” he says. “That’s a fact.”
Relapsing is bad enough, but, though benzos rarely cause overdoses on their own — “You could take a lot of Xanax and it would slow down your breathing and you’d pass out but it would be pretty hard to die from it,” Kolodny says — they increase the fatality of other drugs like opioids — Vicodin (hydrocodone/paracetamol) or OxyContin (oxycodone) — and alcohol, says Dr. Kahan in the Spring 2011 issue of CrossCurrents — The Journal of Addiction and Mental Health.
Mixing benzos with opioids, alcohol, Benadryl, major tranquilizers or even other benzos (which may be prescribed if a patient has a damaged liver from substance abuse causing them to require a higher dose of the benzo to get an effect, says Rain) is fatal because, according to the Ashton Manual — the unofficial encyclopedia on benzos — benzos have a synergistic, or additive, effect with these substances.
“Say you’re on a milligram of Xanax and then you decide to have a drink or two — that milligram can become two milligrams pretty easily,” Rain explains. The combination is calming at first, but anxiety increases between doses, which may cause one to take more benzos, which can end up suppressing the central nervous system further to the point that breathing stops, which may have occurred in Houston’s and Winehouse’s cases.
“When there’s a benzo overdose and a death results, the cause of death is usually stopping breathing,” says Sigurd H. Ackerman, president and medical director at Silver Hill Hospital, which has treated A-listers including Mariah Carey, Michael Jackson, Billy Joel and Diana Ross. He adds that the most common addiction he sees coming through his rehab centre involves “multiple medications of abuse and it commonly includes benzos.” This is supported by stats from the U.S.’s Center for Disease Control and Prevention.
The CDCP released a report in 2010 that the estimated number of emergency room visits involving abuse of benzodiazepines increased 89 per cent from 2004 to 2008 (143,500 to 271,700 visits) and 24 per cent from 2007 to 2008. According to the report, 21 per cent of benzodiazepine-related visits did not involve other drugs, while alcohol was involved in 25 per cent of the cases and opioids were involved in 26 per cent of them.
According to the Canadian Institute for Health Information, benzodiazepine poisonings in Canada have increased by 1,804 over the past few years — from 8,433 in the year 2009 to 2010 to 10,237 in the year 2010 to 2011.
The opioids Vicodin, which was found in the systems of Murphy, DJ AM and Ledger, and OxyContin, which was found in the systems of the latter two stars, are “identical to heroin” (also an opioid) in their addictiveness, says Kolodny, which may have led the three stars to anti-anxiety meds.
“(Addicts) are craving to feel the effects of the drug and when you mix the painkillers with Xanax, for example, it packs more of a punch,” he says, adding that the anti-anxiety meds may also quell withdrawal symptoms like anxiety between doses.
And, contrary to popular belief, you don’t need to mix a particularly large amount of benzos with alcohol or opioids to stop your breathing.
“For people who have a tolerance to very high quantities of narcotics like pain medication, sometimes if they take just a little bit of benzodiazepine on top of their dose, that’s enough to push them over the edge and to have an overdose,” Kolodny says.
And “a little bit” of benzo appears to be going a long way in U.S. doctor’s offices. According to IMS Health’s National Prescription Audit, from 2006 to 2010, the number of Xanax prescriptions in the U.S. has increased 23 per cent from 37.6 million. Though Vicodin is by far the most prescribed drug in America (at 131.2 million prescriptions in 2010 for a population of around 313 million people), Xanax is No. 11 on the list of most prescribed drugs at 46.3 million of all U.S. prescriptions.
According to IMS Brogan, the Canadian unit of IMS Health, benzodiazepine prescriptions have increased 9.3 per cent over the past four years, from 11.1 million prescriptions in 2006 to 12.1 million in 2010. Two years ago, benzodiazepines made up almost 26 per cent of the 47 million anxiety/depression medications prescribed nationally. And, while in the U.S. Xanax (alprazolam) is the most prescribed benzo, in Canada it is Ativan (lorazepam), which, in 2010, made up almost 7 million of the benzodiazepines being prescribed nationally.
According to Kolodny, it’s more often GPs, interns and primary care physicians than psychiatrists who prescribe benzos to former addicts in the U.S.
“Some just don’t know any better, some just don’t care and some are just really no better than drug dealers,” he says. “And some who have celebrity clients, or who have customers they just don’t want to disappoint, are just giving people what they want.”
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*Opinions offered may not reflect the views of Point of Return.