The rake-thin designer clothes horse, whose gleaming acrylic nails artfully hid her bitten-to-the-quick stumps, had flown in from London a day earlier. The dinner party, held in her honour at a suitably chichi inner-Melbourne terrace, was humming along as the 14 carefully selected guests hopped into the good stuff. But wine alone was not going to do it for my jet-lagged and famously neurotic friend. She turned to her host, Damien, a 45-year-old lawyer, and inquired casually, "You don't happen to have a few Xanax on you?"
He didn't but clinked his cut-crystal glass and demanded a bit of shush. "Have any of you lot got a Xanax in your pocket or perhaps your handbag?" he asked, smiling broadly because he knew that at least three of the guests seated around the table were certain to have a bottle of the football-shaped pink, blue or white chill pills.
Xanax is the 21st-century equivalent of Valium, the drug that Mick Jagger so famously wrote into last century's culture as "Mother's Little Helper". While Valium has never gone out of style, these days alprazolam, or Xanax as it is better known, is regarded as the anti-anxiety drug of our generation.
And, like Valium, it has become a cultural reference point in this never-ending age of anxiety. We have U2's Xanax and Wine, a former assistant to Courtney Love is apparently hawking around New York publishers a tell-all book with the working title Get Me a Xanax, the drug was implicated in the deaths of Heath Ledger and Michael Jackson and, initially, it was blamed
for causing known user Whitney Houston to tumble, fatally, into a bath at Los Angeles' Beverly Hilton earlier this year.
Recreational users include many middle-class people who believe that life's inevitable curve balls - grief, relationship breakdowns, job anxiety, jet lag, exams - require they keep a bottle of Xanax in their bedside drawer (or laptop bag) at all times.
So when my socially anxious friend called for a Xanax, she did not feel remotely self-conscious. In her world - where "Stressed out!" is the automatic answer to "How are you?" - it was as unremarkable as asking for a Panadol. What she and millions of others like her don't get is that, according to many experts, the pills they pop like Smarties are more addictive and harder to kick than heroin.
"Four people, including one doctor, immediately offered to help," another friend who was at the dinner party told me later. "In fact, they all had one." Jangled nerves soothed, the party kicked on.
The rise and rise of Xanax as the drug du jour - among "the worried well", street drug users who love the fact that it eases the jagged comedown from other drugs such as "ice" and heroin and, crucially, those with diagnosed anxiety disorders - is the dirty little secret in mental health.
Drug-addiction specialists, doctors and experts working in the criminal justice system spoke frankly to Good Weekend about what they all describe as a spiralling drug-addiction disaster that, until now, has slipped under the public radar. The ripple effects reach deep into our community because anxiety is our most common mental illness, affecting about two million Australians every year.
Xanax is, they say, seductively, dangerously better than anything else in the medicine cabinet for someone in the throes of a panic attack. As one user - who, ironically, works as a drug-treatment counsellor - told me, "No amount of deep breathing and talking to your therapist will do what Xanax does straight away."
But as she and many others interviewed for this story agree, getting off the stuff is hell on earth. The sting in the tail is that a doctor has legally prescribed every pill that is swallowed.
"Xanax addiction is the valium story all over again, but potentially much, much worse," says psychiatrist Dr Michael Baigent, an addiction and anxiety specialist and clinical adviser to Beyondblue, the national initiative to address issues of depression and anxiety.
He has seen the mess Xanax, like Valium before it, makes of his patients' lives as they become hopelessly addicted to their cure. Unequivocal in his condemnation of the drug, he tells me, "It has no place in the treatment of anxiety. It causes more problems than it solves, making sick people sicker and turning them into unwitting drug addicts. We are talking really nasty, potentially lethal symptoms as people try to get off it.
"A day, maybe two at most, after you stop taking Xanax, your anxiety returns, you feel really shocking, you are shaking, sweating, your pulse is racing. And, in some patients, I've seen they can become delirious and, if they try to go cold turkey, can suffer seizures."
Xanax was approved for use in Australia in 1981, initially for panic disorder. Unlike its close cousin Valium, which can linger in the system and has a reputation for leaving its users feeling hung-over, the effects of Xanax wear off about four to six hours after it takes effect. That's why it's so tempting to take another one.
Xanax and Valium belong to a group of drugs called benzodiazepines. They all work on the body's central nervous system to slow the brain down. They differ from one another in potency and duration; those that enter your brain most quickly, like Valium and Xanax, can make you high, fast.
Getting precise numbers on Xanax use in Australia is difficult because hundreds of thousands of scripts are issued privately to non-concession-card holders - which accounts for the vast majority, suggests Baigent - meaning they are not captured in the Pharmaceutical Benefits Scheme (PBS) database. Even so, figures supplied to Good Weekend by the Commonwealth Department of Health and Ageing show that, on PBS statistics alone, nearly 400,000 prescriptions for alprazolam were written in 2010.
Melbourne's Alfred Hospital addiction specialist Dr Benny Monheit, in an analysis of the data in the Royal Australasian College of General Practitioners publication the same year, concluded that "while there had been a reduction in overall benzo prescribing, alprazolam sales rose by 28 per cent". Plus, he wrote, private scripts for the drug added an extra 32 per cent of prescriptions a year.
This is unsurprising, says researcher Dr Belinda Lloyd from Victorian drug-treatment agency Turning Point, where her latest analysis of ambulance attendances in metropolitan Melbourne shows that, compared to other benzos, there has been a threefold increase in Xanax-related triple-0 calls in the past decade.
"This tells us we need to understand much more about this drug," says Lloyd. "Anecdotally, we are hearing from the police, other drug-treatment agencies, hospitals and the ambulance service that this drug is a big concern. Xanax is on our collective radar."
Not long ago, I was at a party and was offered a .05-milligram pill by a total stranger after I'd confessed to her over pre-dinner drinks that I was feeling a little nervous because I didn't really know anyone. Throwing it back with my sauvignon blanc, I reasoned that one couldn't hurt me.
But unlike the recreational Xanax users I spoke to for this story - who assured me that I would feel an almost instant soothing sensation, "a bit like having your edges smoothed into cruisey relief", gushed one - I just got drunk quickly.
I was lucky. Many people under the influence of Xanax underestimate its potency and take too much - particularly when they mix it with other drugs or alcohol. They become so uninhibited, so "chillaxed", that they do things they wouldn't normally do.
And so many anxious middle-class casual Xanax pill poppers who take one, or perhaps two, tablets before an international flight or a board meeting could get into trouble. Yes, says Professor Gavin Andrews, from the University of NSW and the director of St Vincent's Hospital's Clinical Research Unit for Anxiety and Depression, it's all relative. But Xanax is like no other benzo. "You take one and you feel better quickly, but then it wears off and your symptoms re-emerge and so you take another one, but it's the withdrawal causing the symptoms, not your anxiety. But trying to work that out is pretty hard when all you know is that this drug makes you feel lovely.
"Yes, it's okay to have the odd one if you're getting on a plane - just like it's okay to have a bit of heroin or cocaine - but the addiction potential is about the same, if not worse," Andrews says.
But, he says, "and you must quote me on this, chronic benzo use - and Xanax is the most potent - produces stupid people.
"We teach our medical students at the University of NSW not to prescribe benzos for panic disorder - full stop."
One person I spoke to admitted to having sex with her best friend's husband. Another, a 35-year-old recovering Xanax addict named Graeme, said, "You just get this out-of-body feeling, especially when you have a couple of pills with some grog, and you say and do things you don't even remember later. I kept ending up in bed with this really close friend and later couldn't remember the conversations that got us there. It was really unnerving."
In medical terms, this confusion and memory loss so common with Xanax is called "temporary cognitive impairment". In the real world, it's called screwing up big time.
The uncomfortable fact about Xanax, says Nicola Cowling, a project leader from drug-treatment agency Anex, is that it works really well for anxiety, but it also has a paradoxical effect. "People who think they are going to have their rough edges knocked off by dropping a few tablets can sometimes find themselves experiencing acute rage, becoming extremely uninhibited and having no recollection of what they were doing when they were off their faces on the drug," she says.
"Some people see CCTV footage of themselves and just go, 'Oh my God, that can't be me.' One woman I know had to watch herself shoplifting in the nude, and then there are others who wake up in the watch-house and have no idea why they're there.
"People become very passionate about their Xanax; everything seems to be amplified. One guy I was working with cried when I told him he couldn't take it when he went to jail."
New York Magazine recently stated, "If the '90s were the decade of Prozac, all hollow-eyed and depressed, then this is the era of Xanax, all jumpy and edgy and short of breath." But that neat piece of cultural commentary ignores some basic facts about anxiety as a serious public-health issue. There is nothing 21st century about anxiety. It's been around under different guises forever but has often been misunderstood, even trivialised.
In World War I what we now know as post-traumatic stress disorder (PTSD) - which is an anxiety disorder - was called shell shock or sometimes, cruelly, cowardice. Says Baigent, "Anxiety has not had the public-education profile that depression has had in recent years and so, even though it affects more people and causes nearly as much suicide, it falls below the radar."
"Anxiety" is an umbrella term to describe a range of problems including PTSD, obsessive-compulsive disorder, generalised anxiety disorder, phobia and panic disorder. Some of the most disabled patients Baigent treats are those with an anxiety disorder.
"There's the woman who stood on a bathroom tile in her bathroom for 23 hours paralysed by fear of contamination, or another patient whose spider phobia was so great that she never left her home after dusk and always emptied a full can of insect spray inside and under her car before she could get in it," he says.
"People can stay inside their homes for years, unable to catch public transport in case they get lost and have to ask someone for help, [some can't] queue in a supermarket or even answer their phone. It is often impossible for them to work or maintain relationships."
Actor Garry McDonald has suffered from serious anxiety disorder for most of his adult life. Now well, he is a passionate exponent of cognitive behaviour therapy and meditation. His problems started, he says, when he was 22 years old and smoked some hashish. "I had this extraordinary reaction, total panic and paranoia," McDonald says. "Then, 20 years later, I smoked some dope and, bang, it happened all over again, and so I've never touched the stuff since."
His mother and grandmother suffered from anxiety disorders and other members of his family have also been diagnosed.
"It feels terribly unmasculine to be frightened," he says, summing up the inherent shame so many people with anxiety disorders say they feel.
He's been well since 2003, but the year before, when his close friend and Mother and Son co-star Ruth Cracknell died, he slipped into severe anxiety. He was also deeply affected by the events of 9/11. But, he says, "My most crippling period was when I had a nervous breakdown in the early '90s, when I was trying to bring Norman [Gunston] back. I tipped over into depression and when that cleared, I was left with this terrible anxiety."
Although he has in the past taken antidepressants, he has largely steered clear of Xanax, having seen the effects of the drug on others. "I know one actor who had a major role in a play and was experiencing dreadful anxiety and so a friend gave him two Xanax tablets. The only problem was, this fellow took both at once, then went on stage that night, and it was just an absolute debacle."
The few times McDonald took Xanax for anxiety attacks, he says "it knocked me for six". Do modern realities merit an increased dependence on drugs like Xanax? Steven Hayes, a clinical psychologist at the University of Nevada, told New York magazine that benzos plug a gap that evolution has yet to fill. As humans try to control the exponentially growing number of inputs with which they are confronted - the constant pinging of incoming emails, texts about what's for dinner or, more pointedly, who's cooking it, tweets alerting us that another boat has just sunk off Christmas Island - our on button is never turned off.
"Our attention becomes less flexible," Hayes said, "our minds become more chattering, and the next thing we know, we're frantic."
According to Hayes, we are ill-equipped to process or manage all these new signals. "Our task now is to create modern minds for the modern world, and that modern mind has to be psychologically flexible."
Dr Jeremy Hayllar, clinical director of the Metropolitan Northern Alcohol and Drug Service in Queensland Health, calls Xanax "alcohol in a pill". He is proud that he has never written a prescription for Xanax but is alarmed at how cavalier or ignorant some of his medical colleagues are when it comes to issuing scripts.
"I hear about people on private prescriptions being given scripts for 100 two-milligram-strength tablets with three repeats, and that is an absolute recipe for addiction. Any doctor who writes a prescription like that has, in one consultation, created a new Xanax addict."
Until three months ago, Magistrate Margaret Harding presided over the Victorian Drug Court, as she had for nearly a decade. Her job has given her a "hothouse look" at the worst outcomes in the criminal justice system because of Xanax. The court was set up to divert drug offenders from jails and into treatment. There are numerous conditions with which people on drug treatment orders (which effectively mean their sentence is suspended unless they reoffend or fail to comply with the order's conditions, including undergoing regular drug screening) must comply.
Without doubt, Harding says, Xanax has been responsible for her revoking more drug orders than any other substance, including heroin, methamphetamines and alcohol.
"Time after time I heard the same story. People who had struggled really hard to get off heroin and methadone start to get their lives back on track, see their kids again, and then one night on Xanax and it was all gone. They'd go out and commit a string of burglaries and not even remember they'd done it.
"And when they came before me - and these were people whose lives I came to know a lot about - and I asked, 'What went wrong?', they would tell me it was much easier to say no to heroin than to Xanax."
There is a roaring street trade for Xanax, known as "bricks", with an estimated selling price of $5 for a 2 milligram tab but, overwhelmingly, most people get their script the old-fashioned, legal way.
"This drug is a scourge on our community but one that could be so easily fixed," Harding says. "I'm sure 99 per cent of doctors take very seriously their ethical responsibility to 'do no harm', yet we also know that large amounts of alprazolam continue to be prescribed. How did this happen and why isn't something being done about it?"
Harding and all the drug-treatment specialists interviewed by Good Weekend believe that Australia's regulatory drug watchdog, the Therapeutic Goods Administration (TGA), should impose tougher restrictions on alprazolam and better educate GPs on the side effects of the drug.
Twice the National Drugs and Poisons Schedule Committee of the TGA has considered applications to reschedule the drug from its current schedule-four classification to the more restrictive schedule eight, reserved for the most addictive drugs. The last time, in 2010, according to records from that meeting obtained by Good Weekend, the committee was told there was strong evidence to suggest that alprazolam was addictive and "once dependent, withdrawal is markedly unpleasant and may be fatal". Further, the records say, "even after small doses, memory loss, uncharacteristic behaviour, sedation and coma may develop.
"It is over-represented in deaths or injury from overdose, suicide, motor-vehicle collisions and crimes. It has been used as a 'date rape' drug."
The committee was told that patients who overdosed on alprazolam were twice as likely to require admission to intensive care as those taking other benzodiazepines like Valium. Ultimately, the committee decided that the current restrictions remained appropriate and that a "national response was not necessary at this time".
A spokeswoman for the TGA says there are no plans to reconsider rescheduling alprazolam and that no application has been received requesting it.
Pfizer, the drug giant that manufactures Xanax worldwide, is upfront about the risks. "With the exception of the use of Xanax for the treatment of panic disorder ... continuous long-term use of Xanax is not recommended," its information to doctors reads. Otherwise, benzodiazepines such as Xanax should be prescribed for two to four weeks only, Pfizer recommends (and most mental-health specialists agree). "There is evidence that tolerance develops to the sedative effects of benzodiazepines," continues Pfizer's information. "After as little as one week therapy with recommended doses, withdrawal symptoms can appear following cessation of treatment, for example, rebound anxiety ..."
But, as one eminent psychiatrist who asked not to be named says, voicing the same frustration as other specialists interviewed for this story, "In general practice if a patient is giving you a hard time about their panic attacks or their anxiety levels, then some doctors just give them a script to shut them up and make them go away."
Reading the leaflet that the drug companies that make alprazolam produce but which is rarely handed out with a bottle of the tablets by pharmacists would not have helped Megan Barrows. Her anxiety started when she was six years old. "Imagine feeling psychologically nailed to your bed, gripped with fear because of what tomorrow might bring," she says. That is one of her earliest memories or, rather, childhood feelings. It is easy for Barrows to summon because it never went away. She is now 40, runs her own marketing business and is a Xanax addict.
"I take Xanax these days because I'm addicted to it like a heroin addict taking methadone," she says. "I have spent years doing the hard yards with cognitive behaviour therapy and it has worked for my anxiety but I'm left with this addiction."
Like Garry McDonald, she talks about shame, but for her it is closely related to being an addict. She remembers being berated by a pharmacist in a store full of customers while she waited for her script to be filled. "He said, 'Do you know this is harder to get off than heroin?' I burst into tears and walked out."
Very carefully over the years she has weaned herself off her original high dose, which she was first prescribed when she was 26 and her world was confined to the couch in her parents' home. She remembers lying there with her finger on her pulse all day to make sure her heart was still beating.
Her psychiatrist was honest with her when he put her on a high dose of the drug. He spelt out the risks. "It felt like a miracle almost straight away," Barrows says. "I could sleep and, while my mind was still ticking away, my body was relaxed and I could function. Xanax wasn't the answer but it got me off that couch and into therapy. I'm starting to feel less ashamed about being on Xanax. My goal is to one day be off it completely but I also understand that day might not come."
Lifeline Australia: 13 11 14.
From: Good Weekend
