Lorazepam (Ativan) belongs to the benzodiazepine class of drugs. These drugs are useful medications when taken for their intended purpose; however, they should be taken with caution due to their potential for physical dependence and addiction.
Even among individuals who use benzos like Ativan as directed, tolerance may develop (a need for increasing doses to achieve a drug’s therapeutic or desired effect) and users may eventually become physically reliant on them just to feel normal (dependence).
For those who abuse lorazepam, the dual phenomena of tolerance and dependence may develop quickly and could contribute to escalating, compulsive misuse of the drug and addiction. For example, someone taking the drug recreationally or taking larger amounts than prescribed may need to continually increase their dose or the number of doses they take in a day. Doing so could result in even more rapidly growing tolerance and place them on a path to severe physiological dependence.
In the United States, benzodiazepines are the third most abused drug behind marijuana and prescription opioids. Lorazepam is a desirable drug of abuse for many people because it can cause a feeling of euphoria in high doses in addition to its calming and sedating properties that may be pleasurable to many.
Like other addictive drugs such as opioids lorazepam is associated with an increase in dopamine release in certain brain regions (although via a different mechanism). Dopamine is the neurotransmitter commonly associated with feelings of reward and plays a role in the development of addiction.
Myth: If It Was Prescribed, It Must be Safe
Those who are prescribed lorazepam may find it to be a lifesaver in many cases. They certainly don’t see any reason why they shouldn’t take it. After all, if a doctor is prescribing it, then they assume it’s safe. However, as noted above, Ativan is only for short-term use, and any misuse of the drug can be dangerous. Even when used as directed, certain side effects are possible, and the risks increase with abuse.
It is impossible for practitioners to monitor exactly how prescribed medications are being used once a patient leaves the office. For instance, though a medication regimen will be detailed clearly in prescription instructions, doctors ultimately are limited in knowing how frequently the medication is used, and in some cases, it may not be clear how long someone has been using lorazepam before receiving a new prescription. In some cases, the issue is perpetuated by a lack of thorough medical oversight. For example, in Oregon in 2013, 1.9 million prescriptions were written for benzos like lorazepam, and 45% of people using them had been refilling the prescription for at least 3 months in a row.
The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that more than half of all individuals who misused prescription drugs during 2012 and 2013 obtained them from a friend or relative for free. These individuals may see getting prescription drugs from a friend or relative as less risky than buying street drugs, but benzodiazepine abuse can just as dangerous as many illegal drugs.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) notes that while the more common scenario involves teens and people in their 20s escalating their occasional use of sedative drugs to the point where it is no longer manageable, in some cases, people who are prescribed the drug for legitimate medical purposes develop a problem. Often what happens is that the person receives a prescription to help manage anxiety or another medical purpose and then find that due to a growing tolerance they need to up their dose or how often they take it and do so without consulting their doctor. This may lead to a growing pattern of misuse that they continue to justify based on the persistence of their original symptoms and their perceived medical needs.
It is unfortunately all-too-common for people to abuse benzodiazepines such as lorazepam in combination with opioids such as oxycodone or heroin. Around 90% of people who abuse opiates also abuse benzos like lorazepam.
Polydrug abuse involving benzodiazepines is common among young adults between 18 and 25. Research conducted with participants of club scenes found that benzodiazepines such as Ativan are often combined with alcohol or other drugs to 1) increase the high 2) mimic the effects of other drugs and 3) ease the comedown from stimulants such as cocaine.
The risks that come with abusing more than one drug surpass the already serious risks of abusing one substance. SAMHSA notes there is a 24-55% heightened risk of serious outcomes when benzodiazepines are used along with an opioid painkiller or alcohol than when used alone. The most severe consequence is significant respiratory depression, which can lead those who abuse these drugs to fall into a coma or die. In 2015, nearly a quarter of all individuals who died from an opioid overdose were found to also have benzodiazepines in their systems.
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As a group of drugs, benzodiazepines have a significant side effect profile, and lorazepam is no exception. Potential side effects of this drug include the following:
- Feelings of weakness.
- Blurry vision.
- Diarrhea or constipation.
- Problems with urination.
- Reduced sexual drive or ability to perform sexually.
Other acute effects of Ativan intoxication include:
- Lack of coordination.
- Difficulty walking
- Abnormal eye movements.
- Slurred speech.
- Impaired cognitive ability.
- Anterograde amnesia (blackouts).
Benzodiazepine intoxication may also lead to serious accidents, such as vehicle collisions or falls. You might also be more likely to engage in inappropriate sexual or aggressive behavior while abusing Ativan. Additionally, you might experience rapid mood changes and impaired judgment that may cause you to engage in dangerous behaviors.
The intensity of the drug’s side effects will be heightened when the drug is used in combination with other CNS depressants. For example, using benzos with alcohol may give you a feeling of a stronger high, but you are far more likely to suffer life-threatening respiratory depression.
Negative Neurological Impact
Researchers have found evidence to support that benzodiazepines, including lorazepam, may contribute to the risk of Alzheimer’s dementia. They found that the more a person uses, the higher their risk of developing the condition.
Ativan and other benzodiazepines are commonly indicated for short-term use, and when used for less than 3 months, the risk for Alzheimer’s doesn’t appear to be any higher than if no benzodiazepines were taken at all. However, taking a benzo for an amount of time between 3 and 6 months may hike the risk of Alzheimer’s by 32%, and taking it for longer than 6 months boosted the risk by an alarming 84%. Fortunately, shorter-acting benzodiazepines such as Ativan were associated with a lower risk than some relatively longer-acting drugs such as Valium.
For older individuals with specific health ailments, such as chronic obstructive pulmonary disease (COPD), lorazepam may exacerbate respiratory problems and could even increase the risk of developing pneumonia. One study concluded that people with COPD who received a new prescription for a benzodiazepine drug had a 45% chance of their respiratory symptoms worsening to the point of requiring outpatient treatment.
Signs of Addiction
It can often be difficult to admit to yourself that you have a problem, especially if you’ve been prescribed your drug of abuse. The DSM-5 has several diagnostic criteria for a substance use disorder. If you meet 2 or more of these criteria, you may have already developed an addiction, and would benefit from some form of substance abuse treatment:
- Making unsuccessful attempts to stop using lorazepam
- Using more of the medication or using it for a longer period than you set out to
- Using lorazepam despite negative consequences to your health or other areas of your life
- Failing to fulfill personal obligations at home, school, or work due to using the drug
- Using lorazepam in hazardous situations, such as while operating machinery
- Needing increased doses to feel the effects (tolerance)
- Experiencing withdrawal symptoms when cutting down or quitting
- Expending a great deal of time in obtaining and using lorazepam
- Having cravings for lorazepam
- Having continued relationship or interpersonal problems because of your use
- Prioritizing lorazepam over important professional, social, or recreational activities
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Coming off Lorazepam
Abruptly quitting lorazepam can bring on withdrawal symptoms, some of which are relatively mild and some that may be serious enough to require emergency medical intervention. Reported symptoms of lorazepam withdrawal include:
- Dysphoric mood.
- Panic attacks.
- Rapid heart rate.
- Nausea and vomiting.
For shorter-acting benzodiazepines like Ativan, withdrawal symptoms will typically begin within 6 to 8 hours and peak on the second day. By day 4 or 5, symptom severity is often markedly decreased.
Due to the potential life-threatening complications of Ativan withdrawal, the safety and supervision of a medical detox environment may be required. Medical detox programs are staffed with doctors, nurses, and other treating professionals who will initiate a slow taper of the substance (or a replacement substance—often a longer-acting benzodiazepine such as diazepam or chlordiazepoxide) to minimize serious risks and reduce your discomfort.
Lorazepam abuse can cause serious problems, both physically and psychologically. If you are abusing it and need help, don’t hesitate to reach out. There’s no better time to ask for the help you need than today.
- U.S. National Library of Medicine. (2018). Lorazepam.
- Biovail. (2007). Ativan.
- Center for Substance Abuse Research. (n.d.). Benzodiazepines.
- Kurtz, S. P., Buttram, M. E., & Surratt, H. L. (2016). Benzodiazepine Dependence among Young Adult Participants in the Club Scene Who Use Drugs. Journal of psychoactive drugs, 49(1), 39-46.
- National Institute on Drug Abuse. (2012). Well-Known Mechanism Underlies Benzodiazepines’ Addictive Properties.
- Hawryluk, Markian. (2014). Benzodiazepines treat anxiety, cause long-term problems. The Bend Bulletin.
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
- Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (December 18, 2014). The DAWN Report: Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes. Rockville, MD.
- National Institute on Drug Abuse. (2018). Benzodiazepines and Opioids.
- Harvard Health Publishing. (2016). Benzodiazepine use may raise risk of Alzheimer’s disease.
- Science Daily. (2014). Study finds adverse respiratory outcomes for older people with COPD taking benzodiazepines.
- U.S. Food and Drug Administration. (n.d.). Ativan C-IV.