YOUNG AND NUMB
Why are so many millennials turning to illegal Xanax to self-medicate their anxiety?
Sarah* starts to think about her weekend on Thursday. She’ll text her dealer and he’ll drive to her house to drop off the pills. She isn’t scoring coke or MDMA; nor is she looking for a high. Sarah’s buying Xanax. The brand name for alprazolam, it’s a powerful sedative up to 20 times stronger than Valium, and a vital part of her weekend wind-down routine. ‘It’s my equivalent of a bath and a glass of red wine,’ she tells WH. ‘I don’t take it to get fucked up; it’s a way of switching off, an end-of-the-week panacea before the working week comes around again.’ While the drugs of choice for young people in the 80s (cocaine), 90s (ecstasy) and 00s (mephedrone) were uppers that delivered a high, Xanax is a downer, inducing a kind of calm so intense that regular users have been likened to zombies. Sarah, 26, is seeking a Zen-like oblivion in pill form, and so are a frighteningly large number of her contemporaries. Exactly how many young women are taking Xanax is difficult to say, but the stats paint an unexpected picture of present-day drug culture. The UK is the second largest market for global untraceable online sales of Xanax, and records of alprazolam police seizures show an 80-fold increase between 2016 and 2017; the kind of numbers that serve as rocket fuel for tabloid scaremongering. If you’re unfamiliar with Xanax, ‘Xans’ or ‘Xannies’, alprazolam is a potent benzodiazepine. On a chemical level, benzodiazepines affect the brain’s GABA-A receptors – those in charge of sedative effects. They can be influenced by naturally occurring amino acids and enzymes in the body, but benzodiazepines trigger the receptors synthetically. First approved in the UK in 1985, Xanax soon got lumped in with other sedatives, such as Valium, as being ‘mother’s little helper’, in reference to its use as an anti-anxiety elixir for strung-out, overwrought housewives. Today, it’s widely prescribed in the US for anxiety and panic disorders. Here in Britain, benzodiazepines are categorised as class C drugs, so it’s illegal to be in possession of or sell them – which means you’re not getting your hands on Xanax unless you’re a medical professional or you’re prescribed it by a private doctor. Or you buy it online, through channels that only would-be users and dealers of Xanax know about. Importers advertise their wares on social media sites, such as Instagram and Snapchat, under increasingly bastardised hashtags in order to swerve the sites’ moderators. And legitimate-looking websites offer advice about anxiety alongside drop-down menus, meaning you can order drugs online as easily as you can buy courgettes from Ocado.
SHELF CARE
Take a look at the mental health stats – or, indeed, around your friendship circle – and you begin to understand how we got here. One in four women aged 16 to 24 has suffered from anxiety and depression, and a recent report from the charity Young
Minds found that three quarters of young people will experience a downturn in their mental health before it gets better, due to NHS waiting times. Sarah points to the tricky combination of a high-stress job and an existing mental health condition for driving her to take Xanax for the first time. She was diagnosed with bipolar II disorder – a less intense variation of bipolar disorder involving ‘hypomanic episodes’ as opposed to mania – aged 14. While school was manageable, university proved a lot tougher and the medication available – first lithium, then antipsychotics – dimmed her mood so much that she felt numb. So she went without and, by the time she was 25, with ‘highs higher than most and lows lower than most’, she was struggling to cope with the pressures of her high-level security role. Reluctant to see a doctor for fear of being diagnosed with bipolar disorder as an adult and having to tell her employer, she took the matter into her own hands and bought Xanax from a friend. ‘I felt uninhibited, not at all self-conscious, which progressed to a sense of calm and sleepiness,’ she explains. ‘Not a high, nor low, it was an escape.’ So Sarah started taking one 5mg tablet more regularly, and it’s now an integral part of her downtime; a form of self-care, even. ‘I really like my job and, if I was completely mentally healthy, I’d probably be able to manage it with the odd glass of wine and a face mask after a particularly tough day,’ she says. ‘One tablet of Xanax takes me out of myself and whatever has happened during my day; it’s how I switch off from stress.’ Just as Sarah self-medicates with Xanax to swerve a diagnosis she doesn’t want on her record, other women are taking it because they feel disillusioned with medical treatments more readily available. Take Rachel*. The 29-year-old documentary filmmaker has suffered from insomnia since ‘before my first period’ – less ‘eugh, I slept so badly last night’ and more ‘I’ve been awake for 72 hours and counting’. So tormenting was the experience and knock-on effect on her health, that she described feeling ‘detached from my body’, made worse by a merry-goround of GP appointments. ‘I was told it was probably my time of the month, diagnosed with depression and told I needed counselling, which I couldn’t access because the waiting list was too long in my area,’ she says. Rachel tried yoga, magnesium supplements and herbal remedies before a friend mentioned Xanax. ‘She told me she could get me some from a dealer – the real thing, officially branded, in the box – so I thought I had nothing to lose.’ Now, she takes it between two and four times a month when her insomnia is at its worst. ‘I don’t blame the NHS doctors – it’s the system. You only have a matter of minutes and they need you out the door,’ she says. ‘Insomnia is misunderstood and doesn’t get treated with the weight it deserves, because it can’t be seen and everyone complains about a lack of sleep at some point. It’s only now that people are beginning to talk about the impact sleep has on your life; it’s as important as eating the right foods and doing exercise. Xanax is the solution I’ve found that works for me.’
NUCLEUS REACTION
Nicky Walton-flynn, addiction and trauma therapist and founder of Addiction Therapy London, suspects that women like Sarah and Rachel feel safer taking Xanax because it’s available on private prescription. ‘But it’s a false sense of security,’ she argues. ‘That Xanax is a prescription drug displaces the sense of responsibility that might prevent a person from taking other illegal drugs.’ She suspects it’s the reason more women are turning up to her clinic and reporting an addiction to prescription painkillers.
‘I felt uninhibited, then a sense of calm and sleepiness. Not a high, nor a low, it was an escape’
Every Xanax user WH spoke to confirmed Walton-flynn’s theory; that taking Xanax feels sanitised because it’s a recognised medical treatment, regardless of where they’re turning to to get their supply. But that’s a dangerous assumption to make. ‘Xanax is a prescription medication because its use requires input from pharmacologically qualified professionals who will take into consideration the complete range of presenting issues,’ adds Walton-flynn. It means that by taking it when you haven’t been prescribed it, you fail to tackle the root cause of the issue – and that isn’t the only reason you’ll create more problems than you’ll solve. Xanax is highly addictive. ‘It should only be taken under medical supervision because a tolerance to the drug quickly develops, meaning more must be taken to sate the craving,’ says Walton-flynn. FMRI scans of brains under the influence of Xanax show that alprazolam acutely increases activity in the nucleus accumbens, a key reward-processing region linked with addiction. And in spite of their relative scarcity, benzodiazepines were the second leading cause of prescription-drug-related deaths from 1993 to 2016, behind opioids. It’s the reason they’re classified as a class C drug in the UK. That’s if those little pills are really Xanax. Because of its legal status, authentic Xanax can be in short supply, meaning dealers cut alprazolam with all sorts of passably similar substances. ‘Almost [all Xanax] presented to our front-line workers is fake,’ says Karen Tyrell, executive director of alcohol and drug charity Addaction. ‘People with pill presses use the active ingredient alprazolam and create their own Xanax. There are reports of very high-strength and highpurity strains and there’s no way of knowing what constitutes a “safe” dose.’ It means one week’s batch might be different to the next. With high purity comes a higher risk of overdose – and the consequences can be fatal. In late 2017, US rapper Lil Peep died at the age of 21 after taking a counterfeit Xanax laced with fentanyl – a powerful opioid. And it’s happening here, too. Earlier this year, Public Health England issued a warning after reports that Xanax laced with fentanyl had hit the UK marketplace, and 113 people have died using fentanyl in the UK since March 2017, according to the National Crime Agency.
DARK DEALINGS
Part of the problem is the way in which the internet has transformed the drugs landscape; the dealer on the street corner has been replaced with a search bar. Should you find your way on to the dark web – a corner of the internet not reachable by search engines, where activity is untraceable and deeds are, well, dark – you can get any drug you want delivered to your door and an ebay-style review system means you have a pretty good idea of what you’re getting. But you don’t need access to the dark web to get hold of Xanax. When a WH reporter typed the word ‘Xanax’ into Google, a legitimate-looking website appeared. Alongside advice on how anxiety presents in symptoms and how Fda-approved Xanax can help was the offer to buy it, along with other restricted benzodiazepines, in bulk. She selected ‘40’ from a drop-down menu before entering her address and card details. It came to £38, working out at 95p a pill and, six days later, a small padded envelope arrived at her door containing two blister packs of pills. There was no box, nor leaflet explaining the side effects, and the blueish tabs weren’t Xanax at all, but Ksalol, a Serbian pharmaceutical company’s brand name for alprazolam. Because it’s an offence to possess alprazolam without a prescription, the Ksalol was immediately destroyed at the WH offices under supervision. But all in all, the transaction was as easy as ordering a pair of shoes from Asos. The ease with which you can get hold of it is part of the appeal, explains Paul North, director at Volteface, a think tank that explores alternatives to current drug policies. ‘This is a drug that’s being used mainly by young people, particularly student populations – at universities and colleges,’ he says. ‘It’s a social group made up of a lot
‘There’s a group of people using it to deal with worry, anxiety and other mental health issues’
of over-stressed people who are struggling to manage a wide range of factors in their lives. Xanax is easy enough to get hold of if you’re digitally savvy – which this group is – but it’s also incredibly effective at reducing anxiety, so if that’s why a growing number of people are using it – it technically does the job.’ Look at when individuals are taking it and you start to understand why. Users tell WH they take it on a comedown – to quieten a racing mind after a night of taking stimulants – at parties or after a heavy day of studying to ‘switch off’. From what? Pressure. ‘Drug trends reflect the culture and the mindsets of the groups who use them,’ adds North. ‘Take heroin – it’s used by people who want to completely escape their reality, who are in pain and want the strongest painkiller available. So, given the popularity of Xanax at the moment, we can see we have a group of (largely young) people who appear to be using a drug to help deal with worry, anxiety and other mental health issues. That sends a clear message that that group needs more help.’ A spokesperson for the Home Office, which oversees UK drugs policy, told WH that law enforcement agencies continue to work with internet providers to shut down Uk-based websites found to be selling these drugs illegally. But North isn’t convinced. ‘The concept that you can eliminate illicit drugs and stop people using them through policing is proving to be a complete falsehood. People will always find a way; new drugs will always emerge,’ he says. What we do need to do, he says, is take a closer look at what drives a person to take Xanax in the first place, and address those issues. ‘First, we need to improve the conversation around mental health, to show people that they can feel better by engaging in some kind of treatment, rather than popping pills.’ NHS England has promised more investment in young people’s mental health services, including an expansion of access to services by 2021, which it claims will see an additional 70,000 children and young people getting help. ‘But if I were to make one policy recommendation, it would be to improve drugs education. We need to provide young people with support and advice around drugs that helps them to understand the real risks around what they are taking, so they can make more informed choices.’ Choices that don’t involve placing a drugs order alongside your ebay transaction, choices that lead you to seek support rather than oblivion, choices that see a face mask and a bath as enough.