Fewer Xanax Scripts for Twentysomethings Is Not the Same as Fewer Xanax

If you are under thirty and you have ever wondered why a Xanax script got so much harder to land than it was a decade ago, there is now a number for it. Between 2013 and 2024, benzodiazepine prescriptions in the United States fell 26.7%, according to a Rutgers and Columbia team that went through more than 1.1 billion filled prescriptions. Adults 18 to 29 saw the steepest drop of any group.

A smaller prescription pad does not make a smaller appetite for relief.

That is the whole take. The paper, led by Naomi Cruz and including Columbia’s Mark Olfson, is a good-news study on its face: the average dose per prescription also fell 18.3%, fewer scripts are coming from primary care doctors and psychiatrists, and the authors credit prescribers for getting more careful after FDA warnings in 2016 and 2020 about mixing these drugs with opioids. Fewer young people being started on a sedative they may not be able to stop is a real win. Say it plainly and move on.

Now ask where a 22-year-old with panic attacks and no script goes. The paper does not study that, and says nothing about the illicit market. The DEA does. When it placed bromazolam in Schedule I in March, it described a designer benzodiazepine with no approved medical use that is among the most frequently identified benzodiazepines in drug seizures and a common ingredient in counterfeit Xanax tablets. A pill that looks like the one the pharmacy used to fill can now be something else entirely, and what it is cannot be known from looking at it.

Two things can both be true: prescribers got more careful, and the people they stopped serving did not vanish. Nobody has yet shown how many of them moved to the counterfeit market, and we should say so. What we can say is that the supply those people would reach has changed under them.

For anyone who works with young adults: add one question to intake this week. Not “do you use,” which gets you a no. Ask, “Has anything you take to sleep or calm down ever come from somewhere other than a pharmacy?” Then follow it with the thing that earns a real answer, which is what you will do with it: a safer plan, not a lecture or a discharge.

Naloxone is still available over the counter and still works on the opioid in a mixed pill. Poison control, 1-800-222-1222, answers at any hour.

The curve went down because someone finally did the careful thing. The people it left standing still need somebody to do the careful thing for them.