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.
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18 Comments
Add CommentUsing a hot tub after taking these drugs promotes a lower blood pressure which contributes to fainting - and consequently drowning.... this is what probably happened in Housten's case.
Reply | Report Abuse | Link to thisYes, but nobody dare point out the facts concerning a dope addict else they get suspended from their radio show!
Reply | Report Abuse | Link to thisA small but important clarification if I may.
Reply | Report Abuse | Link to thisEvery person reacts somewhat differently to every psychoactive drug. You cannot accurately predict how a drug like alcohol or Xanax might effect you by observing its effects on others. So, even if it is prescribed you need to check your personal reaction carefully and contact your doctor immediately if you feel that something is wrong. Also, your past experience with a drug may not be predictive of future experiences. Good trip/bad trip. You just don't know beforehand.
If you use two psychoactive drugs together you dramatically increase the likelihood of something going very badly wrong. There are two common problems:
A synergistic reaction. The two drugs together produce an unexpected and unpredictable effect that neither of the drugs alone would be likely to produce.
Potentiation. The two drugs enhance each others effects in such a way that the overall effect will be much greater than if you took just one drug alone. Again this is unpredictable.
Synergy and potentiation can occur together.
If that doesn't scare the #%@!!?* out of you I don't know what will.
Of course studies mean nothing to druggies, but most of the addicted people I've treated over the past 5 years got there on prescription meds, then added alcohol and other drugs, and really had no clue what was happening to them. Better information is important for all of us regardless of the %age of folks who won't pay attention. Sorry to sound so preachy, but recently I've seen so many confused (how did I get like this?) people, and its sad.
Reply | Report Abuse | Link to thisSelling pain killers & hypnotics to adults, like how alcohol is sold, is the best way to handle the overdose & addictions problems (in conjunction with increased education about drugs in general). Having a doctor give the drugs as medicine implies that there is a health benefit to using them; that illusion fools many. I was fooled by that illusion about amphetamine, plus, I kept getting them because I was afraid of losing the prescription & thus access; because I couldn't buy them legally, I couldn't wean myself off very easily & I ended up in rehab & with lots of suffering. Education & legalisation is the best approach to drugs; alcohol use should be scrutinized to the same extent the use of other hard drugs is too.
Reply | Report Abuse | Link to thisStudies do mean something to 'druggies': it seems that most 'druggies' who drink wine or beer each night do not even know they're using a hard drug. Education about drugs should improve & terms like 'druggies', which have an air of slander via the suggestion that the addicted people are defined only by the addiction, should be avoided.
Reply | Report Abuse | Link to thisI disagree; education affects people. ~50% of human behavior is genetic, ~40% comes from the environment/peers & 10% of behavior comes from one's parental/guardian influence: therefore, 50% of behavior can be shaped by education. The positive affects of good education are well documented, so the slanderous & rude comment about hard-drug addicts being flippant to facts is not fair.
Reply | Report Abuse | Link to thisSorry Toby, I was just responding with his language. I agree that word usage matters, and that turning people into "junkies" or "stoners" is harmful. People with an addiction need assistance, not judgement
Reply | Report Abuse | Link to thisi repeat. a silly study. doctors are going to suddenly say : Gee whiz!". Crap, they've ebeen told this 40 years ago, 20 years ago, last year.
Reply | Report Abuse | Link to thisDoctors don't turn anyone into stoners. People are responsible and do it to themselves. Druggies are responsible for their own behavior. Alcoholics are responsible for their own behavior. The idea that peope are too ignorant to know not to take too many drugs or not to drink too much is naive. It's just enabling further bad behavior,
This is a good article, but there is a small error. It is true that alcohol can inhibit the metabolism of some other drugs via competition for cytochrome p450 enzymes. See, for example, this article: http://pubs.niaaa.nih.gov/publications/arh23-1/40-54.pdf. However, there are many different enzymes in the p450 family. Alcohol (ethanol) is metabolized (in part) by a kind of cytochrome p450 enzyme, CYP2E1. CYP2E1 also is responsible for metabolizing Tylenol and barbiturates; these are important interactions. The point is that Xanax (alprazolam) is not metabolized by CYP2E1. Rather, it is metabolized by a different cytochrome p450 enzyme: CYP3A4. (http://www.nature.com/tpj/journal/v2/n4/abs/6500115a.html)
Reply | Report Abuse | Link to thisOf course, alcohol and Xanax do interact, but the interaction is a pharmacodynamic one, not a pharmacokinetic one.
thank you for the precise detail on drug clearance. I note that this makes alcohol and acetaminophen a really bad combination too; how many people have been made aware of that? Acetaminophen kills at least 100 people a year through liver failure, and hospitalizes thousands.
Reply | Report Abuse | Link to thisYes. Studies do mean something to "druggies," sometimes they mean a lot.
Reply | Report Abuse | Link to thisA mechanism in this kind of deaths is suspected from a long time, and the death of Marilyn Monroe may have followed such a path. The person suffers from chronic sleep problems, and is using some kind of drug to relieve this, and also is an alcohol user. He/she goes to bed, and takes an sleeping pill, becoming drowsy, entering a reduced or dawn conscience state. As he/she's not sure of having taken the pill, he/she takes another one, the process is repeated several times, resulting in a lethal overdose, tha was easier to reach with Barbiturates, the kind of sleeping pills in Marilyn's times. A pity, let them rest in peace. Salut +
Reply | Report Abuse | Link to thisHow about the over-the-counter drugs so heavily promoted on TV?
Reply | Report Abuse | Link to thisNyQuil is a sedative promoted as a cold remedy. My pharmacies do not stock Motrin, only their store-brand substitutes, so when an MD advises "Motrin" the only one found on my local pharmacy shelves is "Motrin Plus", which the fine print explains includes a sedative. Does every drug store customer carry a magnifier to read the fine-print ingredients? "Plus" implies it's better than the non-plus variety, w/o warning that it is even more dangerous.
Too many people still regard addiction as a character defect rather than a legitimate brain disease. Education about the science of addiction can help combat the stigma and encourage people to get treatment. For a website that discusses addiction science in accessible English, from the viewpoint of a long-term sober alcoholic, please check out www.AddictScience.com.
Reply | Report Abuse | Link to thisI took my time and read all the statements here, I will not use a PHD that I do not have but I will share a truth, most alcohol drinks have Opoits, known as Opoid. Heroin to be more to the point.
Reply | Report Abuse | Link to thisIt should also be noted that in fact 27,000 Americans did die from This Health Care Concept for Pain. But in a study 1.3 Million people between Canada and the USA are also dead, in the last 10 years.
This study also placed a fact that not one Government Official or any one within their family died from Oxy Heroin.
Within the Cartel Family it is forbidden to give family members Narcotics, but some Drug Lords do indulged.
The thing you over look is that if this Oxy Heroin was so good for our Economy, Where Is The Money ? Seeing how Government Officials state our children are around $30,000 dollars in debt to cove our Economy fall out. I wonder how Mom can share with a 4 year child that they are in debt. I shared this here like this in order to show you that in all things is a truth, and some how in my life I have become the Founder and Director of the International Boycott Of The Arabic Drug Empire.
Sometimes I do not think people hear the tear of the ones who died. The reality of this are the on going deaths clime, according to your Laws, was it to be noted something is terribly wrong after 5000 deaths, or 10,000 or how many people have to die from a Health Care Concept that has failed and is in conflict of your Constitutional Laws in and for The Safe Keep Of The people.
Sin.,
Henry Massingale
@ jgrosay 03:42 PM 3/1/12
Reply | Report Abuse | Link to thisGood point. Also factored into the equation is the amnesia-related side effects of most benzodiazepines. (Not sure about the selective GABA inhibitors such as zolpidem)
Benzo's cause retrograde and anterograde amnesia in varying degrees depending on the particular drug in question.
Flunitrazepam (Rohypnol) was a classic drug re: this side-effect, thus it was first choice as a date-rape drug.
It is now classed as an S8 drug in Australia, same as Scedule II narcotics in the U.S....much harder to obtain.
Not sure if this was a genuine side effect of the Barbiturates though the associated confusion after swallowing a couple of Seconal's would be on a par with the retrograde amnesia.
@ jgrosay 03:42 PM 3/1/12
Reply | Report Abuse | Link to thisGood point. Also factored into the equation is the amnesia-related side effects of most benzodiazepines. (Not sure about the selective GABA inhibitors such as zolpidem)
Benzo's cause retrograde and anterograde amnesia in varying degrees depending on the particular drug in question.
Flunitrazepam (Rohypnol) was a classic drug re: this side-effect, thus it was first choice as a date-rape drug.
It is now classed as an S8 drug in Australia, same as Schedule II narcotics in the U.S....much harder to obtain.
Not sure if this was a genuine side effect of the Barbiturates though the associated confusion after swallowing a couple of Seconal's would be on a par with the retrograde amnesia.