Lorazepam is a prescription benzodiazepine drug that was approved in 1977 for the treatment of anxiety, insomnia, and, in some cases, depression alongside anxiety. Sometimes, it is also used off label to treat partial seizures, psychosis, and the symptoms of epilepsy.

This Schedule IV controlled substance is highly addictive and should not be used for longer than four weeks. Despite this distinct warning, prescriptions are regularly churned out and refilled for the potent benzo. Branded as Ativan, the drug was prescribed 27,172,000 times in 2011, according to Psych Central.

Addiction Risk

With persistent use of any benzodiazepine, addiction can form easily. Initially, people using the medication may be taking it on a regular basis, so they don’t even have the opportunity to notice that they don’t feel quite right without it anymore. Evidence-Based Diagnosis in Primary Care: Practical Solutions to Common Problems states approximately 40 percent of people who are dependent on benzodiazepines like lorazepam don’t even know it.

Many will start out using the drug as prescribed only to find it soon loses its efficacy. In a desperate attempt to find relief from anxiety or sleepless nights once again, these people up their dose of the drug. When it starts working again, they assume the increase was the right choice and thereby reinforce the behavior of taking more of the drug to achieve the same effect they were accustomed to. In the world of addiction, this is known as tolerance. With regular use, tolerance usually develops after someone has used lorazepam for six months or so, the Center for Substance Abuse Research reports. However, abuse of the drug can cause tolerance to form much sooner.

Most people who abuse lorazepam are hooked on the relief it provides them from everyday stressors of life. While it certainly will induce a calming effect in anyone who abuses it, the potent prescription drug has far more impact than that, much to the individual’s detriment.

Others abuse lorazepam because it boosts the intensity of the high they receive from abusing opiates. In fact, simultaneous abuse of these two substances is quite common. Around 90 percent of people who abuse opiates also abuse benzos like lorazepam, according to the Examination Notes in Psychiatry 4th Edition.

The risks that come with abusing both of these drugs are further compounded, too. The Substance Abuse and Mental Health Services Administration notes there is a 24-55 percent heightened risk of serious outcomes when lorazepam is used along with an opioid painkiller or alcohol than when it is used alone. The most severe is likely respiratory distress, which can lead those who abuse these drugs to fall into a coma or die. Most of the time, people are abusing prescription opioid painkillers along with lorazepam, not heroin, but that does happen, too.

Of course, some people never set out with any intention to abuse lorazepam.

The American Psychiatric Association accounts for around 25 million people suffering from anxiety each year in America alone.

Around 20 percent of them have or will develop a co-occurring substance use disorder, per the Anxiety and Depression Association of America. Those who are prescribed lorazepam as a means to relief 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. This is very common among young people, who are one of the biggest demographics for benzodiazepine abuse. The Georgia Department of Education reports 41 percent of teens believe prescription drug abuse is safer than illicit drug abuse.

The truth is doctors don’t go home with the people they treat. They don’t see how frequently the medication is used, and they may not know how long someone has been using lorazepam before refilling a prescription. For example, the Bend Bulletin notes 1.9 million prescriptions were written for benzos like lorazepam in 2013, and 45 percent of people using them refilled the prescriptions for three months or more.

SAMHSA notes over half of individuals who misused prescription drugs during 2012 and 2013 obtained them from a friend or relative for free. Every time people use lorazepam for an illegitimate or nonmedical reason, they are opening the door to the potential for misuse to turn into abuse. When the drug helps them feel less stressed, tense, or paranoid, they will remember that and reach for it next time, too. Thus, the cycle continues.

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Side Effects

The side effects of benzodiazepines are strong, and lorazepam bears no exception. With regular use, lorazepam affects the brain by ramping up the production of GABA, a neurotransmitter responsible for calming the mind and body via chemicals like dopamine. When abused, GABA goes into overdrive. As a result, the brain is flooded with dopamine, resulting in a state of euphoria. Those with low dopamine may be more likely to grow dependent on this drug.

Lorazepam binds to receptors so that dopamine recycling is inhibited, and the chemical sticks around for a longer period of time than it normally would to maintain the high. Over time, the receptors in the brain eventually lose functionality. They stop responding to natural cues for dopamine, and individual will begin to lose the ability to feel pleasure and happiness. Some suffer from this condition, known as anhedonia, for many years. The solution for this is generally a long-term treatment plan inclusive of antidepressants.

Negative Neurological Impact

Lorazepam can also cause brain damage. Loss of brain mass caused by atrophy, cerebral ventricular enlargement, and damage to the cerebral cortex are all commonly seen in individuals who abuse lorazepam and other benzodiazepines, according to Psychology Today.

Newer research has come to light that suggests abuse of benzodiazepines like lorazepam could be a strong factor in the development of dementia. Though it isn’t really a disease or disorder in and of itself, the condition is marked by severe memory loss, so much so that everyday tasks most people take for granted are difficult for affected individuals to complete. The condition is progressive. It often becomes so severe that individuals who suffer from it can’t manage life on their own anymore. They forget to pay bills, get lost easily, and may even forget to feed themselves. They frequently require hospitalized care throughout the rest of their lives once dementia progresses this far.

The actual cause of dementia is still being studied, but it is known that it is a result of neurological cell damage. Alzheimer’s is the most common form of dementia. It affects 5.3 million Americans every day, per the Alzheimer’s Association.

In milder cases of memory loss, benzodiazepines can cause blackouts. Sometimes the abuse of benzos like lorazepam for anxiety relief can backfire. While the intent is to achieve a relaxing high or freedom from anxiousness and paranoia, some people will experience just the opposite –an intensification of their symptoms. A person may have vivid nightmares, extreme worry and paranoid thoughts, hostile behavior, and even hallucinations. This is far more likely to occur with abuse of lorazepam than regular use as prescribed.

Cardiac Complications

The American Family Physician reports benzodiazepines can cause an increase in both blood pressure and heart rate. While these seem like fairly harmless side effects in moderation, the cumulative effects on those who abuse lorazepam can be substantial over time. The stress these side effects regularly put on the heart is pretty severe and can lead to more dire circumstances, like cardiac arrest.

Co-Occurring Illnesses

For older individuals with specific health ailments, like those with chronic obstructive pulmonary disease (COPD), lorazepam may actually make breathing harder and increase the risk of developing pneumonia. The results of one study were relayed by Science Direct and concluded that people with COPD who were prescribed a benzodiazepine drug had a 45 percent increased risk of intensified symptoms and a 92 percent increased risk of making a trip to the emergency room for such. Otherwise, it is unlikely lorazepam would cause breathing problems unless the problems were related to panic or anxiety that were heightened by the drug’s effects.

Renal Repercussions

For individuals who abuse other substances that may affect the liver, such as alcohol or acetaminophen-containing drugs like Percocet, liver disease may be a problem. Fatty liver, the beginning stage of alcoholic liver disease, is a problem for 90-100 percent of all people who drink heavily, Johns Hopkins reports. In those affected by liver disease, the abuse of lorazepam can cause oversedation since the liver is unable to fully process and rid the body of toxins.

Signs of Abuse

When concerned if use of lorazepam has crossed the threshold from typical use to misuse or abuse, there are signs to look for, including:

  • Irritability
  • A defensive attitude when confronted about use of the drug
  • Needing to use more than previously used to in order to still get high
  • Seeming as though nothing but abusing lorazepam is important
  • Using when withdrawal sets in to avoid those symptoms
  • Hiding use of the substance
  • Failed attempts to restrict use or quit altogether
  • Avoiding friends and family
  • Habitual use or abuse of lorazepam even though it has been detrimental
  • Sluggish behavior
  • Extreme bouts of insomnia coupled with the need to sleep during the daytime
  • Sloppy physical appearance
  • Careless or reckless behavior that is out of the ordinary for the individual

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Coming off Lorazepam

Withdrawal from lorazepam ranges from fairly mild to very severe, depending on the amount of the drug that is being abused and if any other substances are being abused as well. In cases where high doses are being abused, abruptly stopping can cause severe side effects, including seizures and episodes of psychosis. Many who come down off lorazepam can expect bouts of depression, tension, depersonalization, trouble sleeping, restless behavior, sensitivity to light, dizziness, confusion, and many more psychosomatic effects.

Withdrawal typically sets in within 48 hours of the last dose of lorazepam.

In some cases, individuals will suffer from prolonged withdrawal periods in which they must cope with depression, anxiety, tinnitus, paresthesia, and neuromuscular problems. According to Benzo.org, among people who use benzodiazepines for medical reasons and as prescribed for at least a few months, 30-45 percent incur a withdrawal syndrome when trying to stop using. Resolution of it can take as long as six months, per Psychology Today.

The standard treatment approach for an addiction to lorazepam is to slowly taper the individual’s dose down until the person is completely weaned off the drug. For this to work, there must be transparency about one’s drug use in the beginning of treatment. Generally, clients are started on the dose of lorazepam that has been abused. Within a few days, their initial dose may be decreased. The dose will generally be reduced by a quarter every two weeks. Therefore, how long it takes them to detox will depend on how large of a dose they have been abusing. For instance, someone who has been abusing 8 mg of the drug every day may take as long as 2-3 months to completely detox, whereas someone abusing only 3 mg daily might be done in less than a month.

Withdrawal may be a more intense experience for those who suffer from mental health ailments. Depression and anxiety are both commonly seen among individuals who abuse lorazepam. In addition, the co-occurrence of both depression and anxiety is high. The Depression and Bipolar Support Alliance attests to 85 percent or more of people affected by major depression also having symptoms of anxiety. As in all cases of dual diagnosis, treatment for co-occurring disorders should be sought, so the substance abuse issue can be treated alongside the mental health issue.