Alcohol and Xanax—both of which reportedly were found in Houston's hotel room immediately after her death—are dangerous when consumed together for several reasons. One has to do with the similar processes by which the body expels them. Alcohol circulating in the body eventually ends up in the liver, where it is metabolized by enzymes called alcohol dehydrogenase and cytochrome P450. The latter is also responsible for breaking down Xanax. The alcohol and drugs therefore compete for the enzyme, and this slows their rate of clearance from the body, causing them to remain in the blood longer, and at higher concentrations that make overdoses and accidents more likely.
In addition, alcohol and Xanax both inhibit the central nervous system, lowering heart and breathing rates, and their effects can be synergistic—meaning that their combined effects can be greater than the sum of their individual effects would suggest. And because both substances impair memory (Rohypnol, the "date rape" drug, is a potent member of the same drug class as Xanax), the combination can cause users to forget their actions while under the influence. It can thereby lead them to reach for another pill, for instance, further increasing the risk for an overdose.
Feeding the problem
Once people get hooked on prescription drugs, it is fairly easy for them to stay addicted. Painkillers, in particular, are much more easily obtained than they used to be. In 2001 The Joint Commission, a nonprofit organization that oversees the accreditation of more than 19,000 health care organizations in the U.S., set aggressive pain-management standards that encouraged physicians to be more liberal about prescribing pain drugs. As a result, prescription painkiller sales to pharmacies, hospitals and doctors' offices have quadrupled since 1999.
The Internet adds another layer of complexity to the problem. An estimated 85 percent of Web sites offering prescription drugs do not require a legitimate prescription; those that do sometimes accept faxed scripts, which can be forged or used multiple times. In 2008 Congress banned sites from distributing drugs to people without prescriptions from doctors who had physically examined them as patients. Since then the U.S. Food and Drug Administration has written warning letters to more than 100 violating online pharmacies. But these efforts have had limited success in part because Web sites go offline and then reappear online under a new domain name or with a new IP address, making it hard for the agency to track them. In addition, the many pharmacies located abroad are "nearly impossible for the FDA to have any effect on because they can't stop the Internet service providers from hosting the Web sites," says Anupam Jena, a clinical fellow in medicine at Massachusetts General Hospital who studies the role of the Internet in prescription drug abuse.
What's worse, people who are addicted or dependent rarely seek help right away, and their loved ones are also often slow to intervene, too. "We see this over and over again, not only with celebrities but in people who come into our treatment program: The people around them have known for a long time that they've been using," Morgenstern says.
Indeed, the average person waits 10 years from the start of an addiction to the time when he or she actually seeks help, he says. Many lives could be saved if people thought of addiction as the chronic illness that it is—a deadly disease similar to, say, a cancer. "If you catch that tumor before it spreads, it's a treatable disease," Morgenstern says. But if you wait, "you're playing Russian roulette." The same goes for substance abuse.