Misuse of Xanax
Until five months ago, I was oblivious to the existence of the drug Xanax. It was only after I was contacted by a concerned mother that I became fully aware of the problem that is going on right under our noses. I am holding the first debate about Xanax in Parliament to raise awareness about a problem that could be widespread.
Xanax, or alprazolam, is a sedative from the benzodiazepine family of drugs. It is physically and psychologically highly addictive. Its sedative effects start 15 minutes after consumption and can last for between 10 and 20 hours. When it is taken with alcohol, the impact is multiplied, and one of the side effects is memory loss.
Xanax is licensed in the UK, but it is not prescribed on the NHS. It can, however, be prescribed privately by a doctor. Unsurprisingly, it is hardly ever prescribed in the UK, but it is widely available and prescribed to treat anxiety and panic attacks in the United States of America. It is reported to be the eighth most prescribed drug in the USA. Popular culture is glamorising the drug and creating curiosity and demand in the UK, and the drug is available online for as little as £1 a pill. It is causing a problem that seems to be spreading. That brings me back to my initial interest, which was the result of some casework I picked up in my constituency.
A concerned mother told me about how her 14-year-old daughter—I will call her Zoe for the purposes of this debate—had become a regular user of Xanax and how this had, in just five months, resulted in a downward spiral leading to Zoe’s permanent exclusion from school. This is Zoe’s story.
Zoe was a bright and popular girl and had a wide group of friends when she started at a local secondary school in 2013. As is sometimes the case with early teenagers, Zoe had some fallings out with her group of friends and was eager to do exciting things. In July of last year, Zoe and her best friend were approached by an older girl at school and introduced to an ex-pupil whom they started hanging out with, together with a group of slightly older people, some of whom were adults. Zoe and her friend started going to private raves with the crowd and to parties in houses across north London where, swept up in the whirl of the excitement of this new lifestyle, Zoe was introduced to Xanax.
Throughout July and August, Zoe and her best friend would be out regularly with this crowd, taking Xanax, mixing it with alcohol, and getting sedated and into a zombie-like state. On some occasions, Zoe would come home from a night out with marks and bruises on her arms and legs, and no recollection of how she got them. At best, she had a hazy notion as to what had happened. One of the side effects of Xanax is amnesia, and there is always a risk that users become extremely vulnerable to abuse when under the influence of the drug, and although there was no certainty about whether Zoe was sexually abused, the concern was there.
Over the summer Zoe had completely transformed. Her mother, like most parents, was absolutely horrified at the change in her daughter since she started hanging around with this new crowd. She started rowing with Zoe. On one occasion, with Zoe under the influence of Xanax, she tried to stop Zoe going out. Another side effect of Xanax is aggressive behaviour, so, in addition to the normal behaviour that teenagers express when rebelling against their parents, in this instance Zoe physically and violently attacked her mother, leaving her with bruises on her arms and legs. Zoe then ran out of the flat. Zoe’s mother was desperate and frightened, and had no option but to call the police to restrain her daughter. At the same time, she rushed out barefoot into the street to make sure that Zoe came to no harm, and watched in horror as Zoe stepped out in front of cars and a bus. The police came quickly and arrested Zoe, which seemed to calm the situation down; no charges were brought. The next day, after spending a night in the cells, Zoe had no recollection of what had happened, nor of her arrest.
The problems continued. Zoe’s mother discovered that Zoe and her best friend were visiting various houses across north London where kids were taking drugs and drinking. Zoe’s mother then found out some of the names of the older people Zoe was mixing with. It transpired that some of those people were known to the police. With the help of the police, Zoe’s mother managed to get abduction warning notices served on six people so that they could be arrested if they were found to be associating with Zoe. An even more worrying discovery by Zoe’s mother were some baggies—small plastic bags used by drug dealers for neatly holding small amounts of drugs—hidden in Zoe’s bedroom. Zoe was now hiding things for her new friends.
In conversations I have had with the NSPCC, its staff have told me that Zoe’s behaviour is typical of someone who is being groomed. Zoe had been cut off from her school friends and had been warmly embraced by this new crowd, who promised excitement. Having been initiated, she was now doing favours for them. Zoe was now at risk of being exploited by people who were drug dealers, whom she regarded as her new friends.
Despite Zoe’s mother’s heroic efforts, Zoe continued to find ways of accessing Xanax. Things took a turn for the worse when, in September, Zoe and her best friend were found to be high on drugs in a zombie-like state, with dishevelled clothes and messed-up hair, on the school premises. As anyone who has a connection to a school will know, being drunk or intoxicated by drugs on school premises leads to a permanent exclusion. Despite this and after being implored not to exclude Zoe, the school allowed her to stay on and some support services were provided for her.
The pressure on Zoe’s mother was unbearable. She was so desperate and struggling to manage that she asked the local council if it could step in and find temporary foster parents for Zoe. Zoe was placed in foster care for just over a week. Although that seemed to shake her up, she was soon back to her old routine when she returned home. Despite Zoe’s mother and the school trying their best to help, Zoe was still able easily to get hold of Xanax, which was being peddled by a dealer from a booth in a McDonald’s restaurant two minutes away from the school. At £1 a pill, it was well within what is affordable to some young people. To make matters even starker, the McDonald’s is next to a police station. All the information that had been pieced together was passed on to the police. Following pressure from the school, Zoe’s mother and me, in December the police arrested three people on drug-related charges. This was not, however, before Zoe and her best friend were found to be drunk on school premises and then permanently excluded from school.
Zoe’s case is not the only one of its kind. On researching the subject, I discovered that on 9 May 2017, some 20 15-year-olds and 16-years-olds were taken ill in Salisbury, Wiltshire and received medical treatment after taking Xanax. A further eight young people were hospitalised in Sussex over the Christmas period after taking the drug, and in Scotland in the past month there has been an unconfirmed cluster of deaths from people injecting Xanax. Since securing this debate, I have been informed by hon. Members of further cases of Xanax abuse that have resulted in the hospitalisation of teenagers. Data about how widespread the misuse is of Xanax is patchy at best.
Last week, I met King’s College London’s emeritus professor of clinical psychopharmacology, Malcolm Lader OBE, who has over 50 years’ experience of working in this field. He told me more about the effects of Xanax. He said that Xanax was a powerful benzodiazepine which, if overused, could lead to a constantly dazed, zombie-like state and cause amnesia, depression, psychiatric disorders, rage and aggression. Taking it with alcohol would result in faster metabolism absorption of the drug and an amplification of the symptoms. He added that it was highly addictive—more difficult to come off than heroin—with prolonged psychological and physical reactions of muscle tensions, tremors, and perception disorders in relation to light, sound and noise. He added that in serious cases of overdose, it could lead to death due to slowing down of the heart and breathing problems.
So why has Xanax become so popular recently? Apart from being cheap—I mentioned that it is being sold for £1 a pill in my constituency—and just a click away on the internet, it has been glamorised in American rap music. The rapper Future has referred to Xanax in songs such as “Xanny Family” and “Perkys Calling”. Lil Uzi Vert has done the same in his song “XO Tour Llif3”, also known as “Push me to the edge”, which, as of today, has been viewed 147 million times on YouTube. The artist 6ix9ine, who has over 1.5 million Instagram followers, often makes references to Xanax in his songs, as does Lil Wayne, such as in his song “I Feel Like Dying”. The list of rap songs mentioning Xanax, or “Xannies”, is endless. I wish to thank my nephew Alex for enlightening me about rap music.
This is not a new issue. Body Count, rapper Ice-T’s rock band, sang in their 1997 song, “Dr K”:
“Need some (X)anax…want some pills..I want the grim reaper as my guest!”
Ice-T’s social commentary was a way of getting to the heart of the issue 20 years ago. Does my hon. Friend agree that some rappers, like Ice-T, do not glorify Xanax but give the grim reality?
My hon. Friend makes an excellent point. I am about to come on to how some rappers have been dealing with the issue of Xanax in a very different way.
Some rap artists have even allowed themselves to be filmed in a zombie-like state, after claiming to have taken Xanax, before they eventually lose consciousness. But even in the world of American rap, things are changing. On 15 November 2017, American rap artist Lil Peep bragged about taking six Xanax pills on camera. Hours later, he was found dead on his tour bus as the result of an overdose. The clip of him bragging is still available for all to see on YouTube and other social media. Following the death of Lil Peep, the rapper Lil Pump, who previously had a song called “4 Xans” and other songs with references to Xanax, and who had posed for a picture with a Xanax cake to celebrate achieving 1 million followers on Instagram, announced on new year’s day that he would no longer be taking Xanax. Three-time Grammy winning artist Chance the Rapper has also been candid about his addiction to Xanax up until 2014. He told his 6 million Twitter followers—I am paraphrasing—that Xanax was the new heroin and not to be fooled. He has gone on to do interviews where he talks about the damaging effects of Xanax on him and his recovery from addiction.
Whether this is a matter of art imitating life or of life imitating art, the problem is certainly a real one in the UK. Having questioned adults over the age of 30, I found that very few had heard of Xanax, yet those who are younger, ranging from 12 to 24 years of age, had heard of it and would sometimes mock my ignorance and that of their parents. At the older end of the range, users are self-medicating with Xanax to ease their anxiety.
The truth is that there is a cultural and age divide, and whatever the reason, the fact remains that Xanax is certainly the drug of choice for some young people. It may be because it helps to numb the pain, because it is a fashionable drug, or because it is cheap and easy to get hold of—I can only speculate—but what I do know is that not enough is being done about the problem, which I believe is likely to get worse. Xanax is the drug of choice for the young generation. If steps are not taken now to tackle the problem, we will suffer the consequences both in the cost to the NHS and in personal tragedies.
Although it is pleasing to find that Xanax is the No. 1 news item on the Government’s “Talk to Frank” website, which is designed to be accessed by young people, much more needs to done. In the United States of America, abuse of Xanax is endemic and even some of those who were legally prescribed Xanax are dependent on the drug.
There is widespread ignorance of Xanax among the general public. There is very little, if any, research into or data on the misuse of Xanax and the reasons people use it, and very little is being done for those dependent on it. There are also enormous pressures on children’s and young people’s mental health services. There is a mental health crisis in our classrooms, and funding for child and adolescent mental health services has been cut. There is a window for early intervention, and that is key because half of all mental health problems are established by age 14 and three quarters by age 24.
If the Government want to do something about the problem, I would strongly suggest that they do three things. First, they should be running campaigns to raise awareness of the dangers of misusing and abusing Xanax to inform the public. The lack of knowledge about Xanax and its side effects is startling. Secondly, they should be providing more support, via specialist drop-in centres, for young people who develop a dependency on Xanax. They should not be relying on existing addiction centres because adult drug and substance misuse services are not appropriate for young people. Children and young people’s mental health services also need to be better resourced to cover this need. Thirdly, the Government should commission, carry out and publish research into the prevalence of Xanax use and its effects. We do not know how big this problem is nationally, yet we know that young people are attending local A&E units suffering from the effects of Xanax.
Those three actions will go some way to help to alleviate some of the immediate problems caused by Xanax. They will not help Zoe, who has been robbed of six months of her life with potentially life-changing consequences, but they may help others, and that is something that we should all be striving to do.
I congratulate the hon. Member for Enfield, Southgate (Bambos Charalambous) on securing this important debate on the misuse of Xanax. His telling of Zoe’s story was an example of how we should bring some of our constituency casework to the Floor of the House, and I thought he did it very well. He has raised awareness of an issue that I do not think has previously been discussed in the House of Commons, so well done to him for that.
Last July, the Government published an ambitious new drug strategy. As the Home Secretary compellingly set out in her foreword, the harms caused by drug misuse are far-reaching and affect lives at almost every level. This includes crime committed to fuel drug dependence; the organised criminality, violence and exploitation that go hand in hand with production and supply; and, of course, the irreparable damage and loss to the families and individuals whose lives it destroys. As somebody who has young children, listening to Zoe’s story filled me with horror about what could be to come, with the parent’s sense of panic that we all know.
Concerns about the misuse of Xanax and its potential for harm have been very clearly expressed by the hon. Gentleman. I want to set out some of the facts. Xanax is an anti-anxiety drug in the benzodiazepine family, as he rightly said. It is similar to, but—I am told—20 times stronger than Valium, and it has a quicker, shorter-acting effect. It is not licensed for use in the UK and it is not prescribable on the national health service, but doctors can prescribe it privately and, as he said, it can of course be obtained from internet pharmacies or bought illicitly online.
In the United States Xanax is widely used to treat anxiety disorders, panic disorders and anxiety caused by depression. Its increased use in the UK is related in part to its use being associated with or written about by some celebrities—the hon. Gentleman and the hon. Member for Leeds North West (Alex Sobel) both mentioned Future and “Dr.K”. Rappers have great power and bring great pleasure to many, but they have a great responsibility in the position they hold. However, the hon. Member for Enfield, Southgate also rightly mentioned a rapper with whose work I am sure you are familiar, Madam Deputy Speaker: Lil Pump, who took that responsibility seriously and tweeted just after new year that he will not be taking Xanax in 2018. The cockpit of the nation, the House of Commons, might possibly have less impact on the behaviour of young people than what Lil Pump says on his Twitter feed.
There is a serious risk of harm from the misuse of Xanax. Its long-term use can lead to dependence and severe withdrawal symptoms if use is stopped suddenly. There have been reports in the UK of recreational misuse of Xanax among young people. The hon. Gentleman said that people have been bringing such reports to him since he secured the debate. They include accounts of hospitalisation of young people, particularly where they have combined use of the drug with drinking large amounts of alcohol. Young people’s substance misuse services have reported an increase in misuse of Xanax among the young people accessing their support services. There was a story in The Guardian about activity in Sussex on new year’s eve.
Prescription-only medicines such as Xanax are, by their very nature, potent and should be prescribed—and indeed “unprescribed”—only by a doctor or appropriate healthcare professional. Prescribers can assess an individual’s condition and medical history, consider possible risks associated with taking a particular medicine, and monitor recovery.
The regulation of human medicines in our country is the responsibility of the Medicines and Healthcare Regulatory Agency, for which I have ministerial responsibility in this House. The MHRA has identified an issue relating to the large-scale diversion of benzodiazepines and other hypnotics from the regulated supply chain to the criminal market. The latest information, which I obtained before coming to the House tonight, is that around 130 million tablets have been so diverted since January 2014. There is evidence of extensive criminality involving a number of businesses. The MHRA is working with regulatory and law enforcement colleagues, including the Home Office, the General Pharmaceutical Council and the Care Quality Commission, to identify how that has occurred, to prosecute those involved in criminal activity—rightly so—and to implement preventive measures.
Given the potential for harm presented by the misuse of prescription drugs, including Xanax, the MHRA is taking a range of measures to tackle the illegal online sale and supply of medicines, including public awareness campaigns to deter people from buying medicines from unregulated sources. In addition, the CQC will continue to monitor how controlled drugs are managed within health and care services as part of its inspection processes, taking account of the latest guidelines from the National Institute for Health and Care Excellence.
The hon. Gentleman talked about education. Patterns of drug use in the UK and beyond change over time, particularly amongst young people, where fashions move fast. Public Health England continually updates Frank, the Government’s very successful drug information and advisory website, to reflect new and emerging patterns of drug use, but I think PHE would admit that it is constantly chasing the next fad. That work has included revising the benzodiazepine pages to raise awareness of the dangers of Xanax misuse, and the pages on Xanax are the top-visited and top read news story on the home page right now, which tells its own story. The Frank service remains a key element in providing accurate factual advice on the risks and effects of a range of drugs and alcohol, as well as broader advice around substance abuse, including signposting to relevant local services for young people.
As part of the Government’s updated drug strategy, Public Health England is supporting programmes that have a positive impact on young people and adults, giving them the confidence, resilience and risk-management skills to resist drug use in the first place, which must be our aim if we are to prevent constituents such as Zoe, whom the hon. Gentleman represents, from being in the situation she was put in.
The Government’s drug strategy makes it clear that we are committed to reducing both the number of young people using drugs and under-age drinking. A recent report published by NHS Digital found that in 2016 24% of pupils—11 to 15-year-olds—reported that they had taken drugs. That is compared with 15% in 2014. There has been progress, but there is clearly a long, long way to go.
That is why drug education is a statutory part of the new national curriculum for science at key stage 2 and key stage 3, and rightly so. Pupils should be taught about the effects of recreational drugs, including substance misuse, on their behaviour, their health and their life chances. Provision in this area can be further strengthened through personal, social and health and economic education, and I know that it is.
Launched in April 2013, ADEPIS, the Alcohol and Drug Education and Prevention Information Service—we do like our acronyms in the health service—is a drug and alcohol information and advice service for teachers and practitioners, providing accurate and up-to-date evidence-based information and resources for alcohol and drug education and prevention in schools. This service is delivered by Mentor UK.
Since the 2010 strategy was published, we have made progress. Drug use in England and Wales is lower than it was a decade ago. In 2016-17, 8.5% of adults had used a drug in the last year, compared with 10.1 % of adults in 2006-07. More adults are leaving treatment successfully than in 2009-10, and the average waiting time to access treatment is just two days.
Obviously, funding decisions on drug and alcohol treatment budgets for adults and young people have been devolved to local authorities through the Health and Social Care Act 2012. We think local authorities are best placed to understand the support and treatment needs of their specific populations. Of course I recognise that there are concerns about funding and that there are pressures on local authority budgets, and authorities need to make difficult choices about how they spend their resources. This is why we are extending the ring-fenced public health grant until at least April 2019 and retaining the specific condition to improve drug and alcohol treatment uptake and outcomes as part of that.
While the intention remains to give local authorities more control over the money they raise, such as business rates, we are actively considering the options for 2019 onwards with my colleagues in the Department for Housing, Communities and Local Government. We remain committed to protecting and improving the outcomes from core services such as those dealing with substance misuse, and we will involve the key stakeholders I work with in discussions about how we achieve that
While we have made strong progress in tackling the misuse of drugs, we are not complacent, and we know there is a huge amount more to do. There are new fashions being invented all the time. There are fundamental challenges, such as drug-related deaths, which we need to tackle, as well as newer issues, such as the misuse of Xanax, which the hon. Gentleman has raised so successfully in the House this evening. We will tackle those challenges with the full range of partners, who are essential to making the strategy a success and enabling us to maintain and build on what we have already achieved. I thank the hon. Gentleman for bringing the issue to the House this evening and especially for the way he has done so.
Question put and agreed to.
Motion made, and Question proposed, That this House do now adjourn.—(Chris Heaton-Harris.)