Front Burner - How benzos and Xanax culture propel the opioid crisis

Episode Date: January 9, 2019

Why have benzodiazepines like Valium and Xanax been involved in a large number of Canadian opioid overdose deaths? Zachary Siegel, a journalist and fellow at Northeastern University, breaks down benzos, why they're having a moment in the rap world and what role the drug plays in the overall overdose crisis.

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about hidden disabilities. Short Sighted, from CBC's Personally, available now. This is a CBC Podcast. Hello, I'm Jamie Poisson. We hear a ton about the opioid epidemic and dangerous opioids like fentanyl and Oxycontin. Health officials are linking opioids to a decreasing life expectancy in B.C. China has been working with Canadian officials on the flow of fentanyl into Canada. But there's another set of drugs that is increasingly linked to this crisis. And we don't talk a lot about them.

And those are benzodiazepines, or benzos for short. Prescription drugs like Xanax, Valium, or Ativan. And these drugs, well, they're propelling this opioid crisis. The new stats on fatal overdoses are really alarming. In Nova Scotia, for example, more than half of the 442 people who have died since 2011 by overdosing on opioids had also taken benzos at the same time. And those numbers are pretty similar in Ontario, New Brunswick, and Manitoba. And here's the thing, benzos are having a bit of a moment in pop culture and drug culture right now.

So, with Canadian addiction experts warning about how deadly benzos can be when mixed with opioids, today we're going to look at what these drugs do and how the culture around them has evolved. I'll be talking with Zach Siegel. He's a journalist who writes a lot about drugs, addiction, and public health. This is FrontBurner. Hi, Zach. Hey.

Thanks so much for being on the show, and I'm glad we're reaching you in Chicago today, one of my favorite cities. Yeah, I'm happy to be here. So we just heard off the top of the show these numbers, which are really staggering. So in Nova Scotia here in Canada alone, more than half of 442 people who died overdosing on opioids had also taken benzos. Does it surprise you that benzos are playing a role in so many opioid

related deaths? No, definitely not. Especially coming at this from the U.S. perspective. The majority of fatal overdoses that occur here involve more than one substance. So we often hear that there's an opioid crisis. My administration is officially declaring the opioid crisis a national public health emergency. Which is true, but what's less discussed is that in all these toxicology reports that get analyzed, there's usually another drug involved. So benzodiazepines are depressants, and when you mix them with an opioid, the risk of overdosing increases severely because they're both depressants, and it lowers the heart rate rate and slowly you stop breathing.

Wendy Golden keeps the photos of her son, 20-year-old Cody, stored away. Ambulance arrived and tried everything they could to bring him back, but there was nothing that they could do. I want to get a sense of what benzos are for people who might not know. Can you give me a little bit of a tutorial? Sure. So benzodiazepines are a class of drug that depress the central nervous system. So they slower your heart rate, which makes them very effective at treating panic and anxiety. They're also muscle relaxants and they treat insomnia.

So basically they're sedatives. And can you OD from just taking benzos? You can, but you would need to take a lot. So we typically don't see benzos causing overdoses by themselves. But typically, when benzos are mixed with an opioid or with alcohol or even with a stimulant, that's when the body runs into some serious danger. So like you just mentioned, the idea here is that when benzos are mixed with an opioid like Like you just mentioned, the idea here is that when benzos are mixed with an opioid like Oxycontin, they work synergistically, right, to lower your breathing. Am I right?

Yeah. So they amplify one another's effects. When were benzos created? So in the 50s, they were accidentally synthesized. And then by the 60s, Valium, a very popular benzo, came on the market and these largely replaced barbiturates. And Marilyn Monroe, there's a lot of famous celebrities who died from overdosing on barbiturates. One of the most famous stars in Hollywood history is dead at 36.

Marilyn Monroe was found dead in bed under circumstances that were in tragic contrast to her glamorous career as a comic talent. And benzos were a safer alternative to these drugs. And so for people, the popular names for benzos would be like Xanax, Valium. What else are we talking about here? Klonopin is another big one. And these all have chemical names, lorazepam, alperazolam.

So those are the big ones, though. And we should mention, benzos have done a lot of good for people, I would imagine, too. Yeah, I think for a lot of people who suffer from panic disorders and anxiety, benzos really do work. And that's, I think, why people take them, because they're effective. They really do their job well. But what we're talking about here today is when we start to mix these drugs with other things, particularly opioids. It feels like it's this additional layer to the opioid epidemic.

Yeah, definitely. And I prefer to call what we're experiencing right now an overdose crisis, because like we were talking about, it's not necessarily opioids themselves that are causing all these overdoses. So really, people are fatally overdosing en masse in Canada and the U.S. And yes, opioids are driving a lot of these, but there's also a ton of drug mixing going on. And that isn't talked about enough. One really interesting aspect of this story is the culture around benzos. So we've talked about how benzos have been prescribed since the 1960s for decades to address things like insomnia and anxiety. But how has the culture changed over time around benzos?

What's it like today versus what it was like several decades ago? So I think a lot of people my age, so I'm 29, we're millennials. A lot of us were prescribed Adderall and Ritalin growing up and antidepressants. And we grew up taking pharmaceuticals. And I think we're much less skeptical of pharmaceuticals and they're much more normalized, at least in my generation. And so if you're growing up on a cocktail of drugs, yeah, I think there's less of a fear around them. And so that's definitely new. And this all sort of came about in the 90s when, you know, big pharma was deregulated and a lot of sales and marketing was going on

and doctors were, you know, getting flown out to conferences and beach parties and there's crazy stories of just how intimate the pharmaceutical industry is with prescribing physicians. According to a 2017 study out of UC San Diego, prescribing physicians. According to a 2017 study out of UC San Diego, about half of U.S. doctors receive meals, gifts, or payments from pharmaceutical and medical device companies. And I think so many factors like this have led us to where we are today, where basically, if you have a problem, there's a pill to solve it. And I think that's definitely the case with something like anxiety, where take a pill, it works. Yeah. You know, I'm a millennial too. And when it comes to our generation, you hear the word anxiety a lot. There's a lot to panic about. I mean, our politics,

our economic security is totally uncertain. That I think it makes sense why opioids and things like Xanax, these things that sort of calm us down and make us comfortable in our own skin, all these things, it doesn't surprise me why these drugs are sort of going through a moment. One thing I find really interesting and something I don't know very much about is this whole drug culture moment happening around benzos and rap music. Can you tell me a little bit about that? Yeah, so this is a very strange and bizarre sort of cultural artifact. So they're called SoundCloud rappers, and one of the more popular ones, his name is Lil Xan. I got lots of jazz bands like it then, and I pop, pop.

I got lots of jazz bands like it then. So he was born in 1996, and a lot of these SoundCloud rappers are in their teens and early 20s. It's just a super popular genre of rap music that really can't be disentangled from the drug use. His name is Lil Xan. That is short for Xanax. So he's named after Xanax. Yes. And even weirder is his pal named Zan Frank. And I saw a picture of this guy. He has a tattoo of Anne Frank on his face. Yes, he does. And it's interesting thinking about even just the style of their music. It's very slow and mumbling and meandering, like even the words and the beats

are sedated. And aside from explicit references to, you know, washing down Xanax bars with codeine syrup, these rappers are rapping about life being pointless and there's a sort of depressive nihilism that pervades their lyrics. Pray to God like a lie, please let my go And when you lie, I wanna die, please let my go And young people listening really find themselves in the sort of blunt sadness of their songs.

I was listening to some of it earlier today, and it did strike me how depressing it all was. It's sad, and they're sad. And I think thinking about rap historically as a sort of masculine, like, gun-toting, macho culture, here we have a bunch of rappers who talk about their emotions and how lost they feel. And sort of zooming out into broader cultural trends right now,

suicides are up, overdoses are up, alcohol use is up. These are diseases of despair. Economists call these diseases of despair. And it's no surprise that young people growing up in the sort of volatile and confusing moment we're in are reaching for something that calms them down. I just want to pick up on one thing you said, how these rappers are rapping about Xanax bars. Can you tell me what Xanax bars are? Sure. So Xanax bars are sort of a, have become a visual symbol of the culture. So Xanax comes in multiple dosages and, you know, 0.5 milligrams might be a typical dose, but there's these two milligram doses and they come in what are called Xanax bars. I asked, too, because I saw you tweet out an image of a Xanax bar that looked like a pendant today.

You can buy that on Etsy. Wow. It's like there's a whole sort of gallery of jewelry modeled off of Xanax pills. We need to talk about one more rapper, Lil Peep, who I understand was on his way to being a superstar as part of this group of SoundCloud rappers. And he died. And before he overdosed, he posted a video of himself on Instagram eating a bunch of Xanax and shaking a pill bottle. Oh, pass out. I took six Xanax and I was lit. I'm good. I'm not sick. So Lil Peep was really popular and was definitely in the sort of group of rappers with Lil Xan.

I found some Xanax in my bed. I took that shit and went back to sleep. in the sort of group of rappers with Lil Xan. And he died from an overdose of fentanyl, and there were benzos in his system. So he was mixing the two drugs. And recently another rapper, Mac Miller, died. And so both of these deaths sort of landed hard on Lil Xan and prompting him to try to get treatment for his own drug use. I just feel like it's time to get, you know, better. My goal is to come out of rehab with the name just Diego.

No more celebrating or, you know or talking good about drugs. You know, to the extent that these young guys were glorifying the pills and the drugs and the culture, you know, a lot of people arguing that they are. But now this sort of seriousness and the reality and the dangers of what they were doing is sort of coming to light with so many celebrity deaths and their own friends dying. I know that you know something about opioid addiction. Could you tell me about that? So growing up in the suburbs of Chicago, I went to a huge high school with almost 4,000 kids and pharmaceuticals were

traded and exchanged and all our parents had cabinets full of Vicodin and Xanax and Adderall and kids were prescribed Adderall. And so me and my friends were all using them and experimenting with them. And then I tried opioids as like a 17 year old. And finally, I found something that made me feel okay and normal and comfortable in my own skin. And I think the reason why I reacted to opioids the way I did, which is sort of different from the way most people who take opioids do, like most people when they take opioids, they get sort of itchy and uncomfortable and nauseous. For me, when I took them, I just felt normal. And I think that's because I had some depression and anxiety and opioids, they just really worked and really calmed me down.

And so later on, as I continued to use them, the dependency and then eventual addiction really creeps up on you quite insidiously. In the moments you're taking them, you don't know how important they are to your system just to get out of bed or eat food. Like, like it really just becomes as important as breathing and sleeping and eating. And so, yeah, I, I really had a difficult time first realizing that I indeed was addicted to opioids, and then later on trying to get off of them is really difficult.

And I think one of the first times I really confronted how dangerous these chemicals can be is when one of my friends died from an overdose. And it was well known that it was both the opioid and the benzo that eventually did him in. And so that was 10 years ago now. And since then, the problem has just gotten scarier and more prevalent and doesn't sadly seem to be going anywhere. So your friend died because he mixed these two drugs together. Yeah. What do we know about how people are getting these drugs?

Are they being prescribed to them by doctors or are they getting them another way? These drugs are definitely being prescribed more and more frequently. And for the U.S., between 1996 and 2013, the number of adults filling a benzodiazepine prescription increased by 67%. So there's a lot of pills flowing around out there, and there's definitely no shortage of benzodiazepines flowing around the black market. And do we know about any other groups who are using or are being prescribed benzos a lot? Yeah, so benzodiazepines are very often prescribed to women, far more than men. And this is sort of popularized in a Rolling Stones song called Mother's Little Helper.

Kids are different today, I hear every mother say. Mother's Little Helper. And it's sort of, you know, casual misogyny about, you know, moms needing something to do around the house. Like it's always sort of been prescribed to women. And there's this sort of housewife trope of like the wine mom, you know, popping some Xanax. And that's a very entrenched cultural stereotype. But the numbers also bear out that women are prescribed benzos more frequently. Are we seeing any debate from the metal community here about the harm versus the value of benzodiazepines? Doctors are being told to prescribe fewer of them. And this gets into very sticky and complicated territory because if someone is addicted to a drug, just taking the drug away isn't an effective solution. It doesn't end the addiction. has a legal supply of benzos and then the doctor realizes that they're addicted and stops prescribing, well then what does that person do? They might end up going to the black market where they could find counterfeit pills that might be laced with fentanyl or other things. And so we get into this

very sort of sticky area of policy that we don't really have good answers for right now because it's very hard to treat someone who is dependent or addicted to benzos. and addiction. But this discussion about benzos is really not one that we're having very often. And why do you think the narrative surrounding opioids differs from how we talk about benzos? Yeah, this is a really interesting thing to think about just from like a media and media criticism perspective, because the opioid crisis has very identifiable villains and victims. There's greedy capitalist big pharma who duped all these unenlightened doctors into prescribing en masse this addictive drug that addicted all their patients who, through no fault of their own, followed the doctor's orders.

So you have this sort of innocence narrative for all the patients who were prescribed opioids, which is much different than if we're thinking about the so-called crack crisis, where it was urban, black communities, and these were depraved criminals who needed to be locked up. We're not really responding to the opioid crisis that way because the victims are by and large white, they're middle class, they were just doing what their doctor told them. So there's a lot of problems with this narrative for the opioid crisis, but it has its allures. And that narrative doesn't really map on that well to benzos. Because unlike opioids, a lot of benzos have generic formulations on the market.

So no one is making buku bucks from all these benzos being prescribed. Oh, interesting. Yeah, I had never thought of that. There wasn't any massive pharmaceutical marketing campaign that were directed at benzos. And so, like I was saying earlier, it's not just an opioid crisis. There is an overdose crisis. And if we start thinking about an overdose crisis that takes our attention away from one singular drug to tackle and then takes us to what's in the systems of all these overdose victims. And then there we can find all the drugs being used

and then potential public health policy solutions to prevent what are preventable overdoses. Zach, thank you so much for having this really important conversation with us and for being so open. Thank you. You're welcome. Thanks for having me on. We'll continue to keep an eye on this really important story. If you're curious about how common benzos are, well, in 2017, 26 million prescriptions for benzodiazepines and related drugs were written in Canada. And in Newfoundland, Nova Scotia, and New Brunswick, doctors are prescribing more than the national average. That's all for today. I'm Jamie Poisson. Thanks for listening to FrontBurner. For more CBC Podcasts, go to cbc.ca slash podcasts.

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