CHICAGO — Nick was a high school junior already well-acquainted with mind-altering substances when a friend introduced him to Xanax. He was immediately smitten.
The prescription anti-anxiety medication affected him differently from booze or marijuana, he said, smothering his inner turmoil so completely he became a fugitive from his own mind.
“Whenever I would take it, I felt very at ease,” said Nick, now 26. “It made me really unproductive. I’d be able to do the schoolwork but at the same time I felt really relaxed. Half the time I’d be forgetting the stuff I was doing.”
Xanax is a benzodiazepine, a class of drugs that includes Valium and Klonopin. They are normally used to relieve anxiety and insomnia, but as they have become more commonly prescribed over the last two decades, abuse and overdoses have followed.
The drugs have seeped into pop culture, with performers like Eminem to Future mentioning benzodiazepines in their lyrics. One entertainer, Lil Xan, derived his name from the most prominent brand.
But the November death of rapper Lil Peep, attributed to Xanax and the opioid fentanyl, illustrated the danger posed by the indiscriminate use of benzodiazepines, especially when they’re mixed with other drugs.
Cook County recorded 333 such deaths last year, nearly three times the number in 2015, according to data from the medical examiner’s office. Almost all came when benzodiazepines were consumed with opioids, a combination that can depress breathing to a lethal degree.
“If they didn’t take that benzodiazepine, could they have survived?” Medical Examiner Ponni Arunkumar said. “It’s hard to say.”
Despite the alarming death toll, some experts say benzodiazepine abuse appears to be growing. At the Gateway network of youth rehab centers, about 1 in 4 clients has an issue with the drugs, up from 1 in 10 five years ago.
“This has taken the place of ecstasy in the party culture for some people,” said Karen Wolownik Albert, executive director of Gateway’s Lake County services. “Because it’s a prescription drug, people can rationalize it. It doesn’t fit into people’s concept of what drug abuse looks like.”
Benzodiazepines produce a soothing calm by binding to receptors in the brain, blocking neurons from firing at “anxious moments,” said Shiyun Kim, a clinical pharmacist at the University of Illinois at Chicago.
That makes them a valuable medication for people who have anxiety or sleep disorders, but the drugs come with a potentially dangerous side effect: They can inhibit breathing.
Opioid painkillers have a similar property, but for reasons that aren’t clear, the number of people taking both medications rose sharply over the last 20 years, leading to a sharp increase of overdose deaths.
Dr. Marcus Bachhuber of New York’s Montefiore Medical Center chronicled the phenomenon in a 2016 paper. He speculated that people have increasingly received both drugs because chronic pain patients often have other conditions that are treated with benzodiazepines.
Megan Ehret, president-elect of the College of Psychiatric and Neurologic Pharmacists, suggested another possibility: People often see different doctors for different issues, and one might not learn what the other is prescribing during a hurried visit.
“A lot of physicians don’t have time to review these (medication) profiles,” she said.
Other people get their benzodiazepines on the black market.
Steven Kurtz, of Florida’s Nova Southeastern University, said his research shows that clubgoers often use Xanax to ease their way down from a cocaine rush.
And because illicit Xanax costs only a few dollars per pill, he said, people who can’t afford cocaine mix it with alcohol to produce an inexpensive but prodigious high.
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“It’s a cheap way of going out,” he said.
In Chicago, police say the drug generally isn’t sold on the street alongside crack and heroin; users more often obtain it from friends and family or with illegitimate prescriptions. Recently, though, detectives have encountered its sale in social media chatrooms.
“Benzos have been trafficked for a long time,” Police Department spokesman Anthony Guglielmi said. “Now they’re just finding new ways to conduct that.”
The hazy, anesthetized sensation produced by benzodiazepine abuse has enchanted hip-hop artists in recent years, with young performers crowing about their consumption of “bars” (high-dosage Xanax pills have a rectangular shape).
Lil Peep — the stage name of 21-year-old “emo rapper” Gustav Ahr — was one notable devotee, describing his use in lyrics, interviews and social media posts. But in November, just before he was to perform a concert in Arizona, he was found dead on his tour bus, the victim of a Xanax and fentanyl overdose.
After his death, other performers swore off illicit Xanax consumption, including some who had earlier boasted about their use. Even Lil Xan said he was done.
“I really don’t agree with glorifying the drug at this point, especially in light of Lil Peep’s death,” he told MTV last month. “… I was already doing the anti-Xan thing, but you just gotta get off that stuff, man. It’s not good for you.”
Federal officials in 2016 cautioned about the hazards of combining benzodiazepines and opioids. The Food and Drug Administration required new warning labels, and the Centers for Disease Control and Prevention recommended that doctors avoid prescribing both medications concurrently.
Ehret said state-run databases that monitor opioid prescriptions are increasingly tracking benzodiazepines too, alerting physicians when patients receive both.
It’s unclear whether those measures are effective. Dr. Eric Sun, a Stanford University health policy expert who has tracked the rise of such dual prescriptions, was skeptical, noting that the hazard of combining the medications has long been common knowledge.
As for illegal benzodiazepine use, experts say the drugs produce a physical dependency and are extremely hard to quit. Rehab centers differ on the scope of the problem, but even some that haven’t treated many benzodiazepine-abusing clients worry about what might be coming.
“I’m hearing the whispers,” said Aaron Weiner of Linden Oaks Behavioral Health in Naperville. “Once opioids recede, are benzodiazepines going to be the next thing?”
Nick, who spoke on the condition that his last name not be published, said his Xanax use followed a perilous course during his youth in Elgin.
He frequently mixed it with alcohol and heroin, leading to multiple life-threatening overdoses. When he was forced to come off the drug because of jail or rehab, he suffered through harrowing withdrawals.
His third attempt at treatment brought him to Gateway when he was 24, he said, and that time he was able to maintain his sobriety. He now works for an organization that helps other people with drug and alcohol issues.
He said he views his former use as an extension of the modern impulse to solve problems with a pill — an urge that is especially thorny when the pill has a legitimate use.
“It’s a medicine, so when the younger kids hear it in the music, they think everyone’s taking it and that it’s fine,” he said. “It’s not heroin. It’s not crack. People don’t see it as such a problematic thing, but they don’t realize they’re still getting into something that can take their life away.”