The recent suicide of musician Chris Cornell and the speculation about the prominent role that Ativan seems to have played has people asking questions about this popular antianxiety medication.
- Is Ativan REALLY safe?
- How do you know when someone is abusing Ativan?
- What do I do if I have an Ativan prescription?
These are valid concerns. After all, Cornell had a legitimate prescription. But he also had an extensive history of drug and alcohol abuse. This means that there was a fine line between treating his anxiety disorder and safely managing his substance abuse disorder. Unfortunately, that line was crossed, with tragic results. So, let’s examine these questions and more in an effort to prevent similar outcomes in the future.
First, the Basics – What Is Ativan?
Ativan is the brand name for lorazepam, a benzodiazepine-class medication that is prescribed for the treatment of a number of ailments, including:
- Anxiety disorders
- Insomnia and other sleeping problems
- Alcohol withdrawal
- Epileptic seizures
- Nausea and vomiting due to chemotherapy
- Memory formation during medical/surgical procedures
- To sedate patients who are mechanically ventilated
Because it can be a beneficial treatment for so many conditions, Ativan is an extremely popular medication. In 2011, there were 28 million Ativan prescriptions filled, making it the second-most-prescribed “benzo” in the country.
Is Ativan REALLY a Safe Medication to Use?
Ativan has been on sale in the United States for 40 years, and overall, it has an excellent reputation. The World Health Organization put Ativan on its List of Essential Medicine, signifying that it is one of the safest and most effective medicines that should be part of any society’s health care system. However, there is a caveat. Like all benzodiazepine lines, Ativan is only recommended for short-term use, no more than two to four weeks. The problem arises when it is taken for longer periods or when it is misused recreationally. With long-term use, there is a significant risk of psychological and physical dependence, misuse, and ultimately, addiction. Overdose is also possible, especially if Ativan is misused with other central nervous system depressants like alcohol, opioids, or other benzo drugs.
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What Formulations of Ativan are Available?
There are several different formulations of Ativan, and the prescribed dosage will depend upon the condition being treated:
- Adult dose –2-3 mg by mouth per day taken 2-3 times per day (initial) and 1-2 mg by mouth 2-3 times per day (maintenance)
- Child dose – Same as adult dose (age 12 or older ONLY)
- Geriatric – 1-2 mg by mouth per day, in divided doses
- Adult dose – 2-4 mg by mouth, taken at bedtime
- Child dose – Same as adult dose (age 12 or older ONLY)
- Geriatric – 1-2 mg by mouth per day, in divided doses
The medication comes in three dosages:
- Ativan or Lorazepam .5 mg
- Ativan or Lorazepam 1.0 mg
- Ativan or Lorazepam 2.0 mg
Ativan vs Xanax – How Do They Compare?
How do the two most popular benzodiazepine medications compare to each other? Because they are both benzodiazepines, Ativan and Xanax are very comparable medications, although Xanax (alprazolam) is prescribed far more often, 49 million to 27.6 million. There are many similarities. Both Ativan and Xanax:
- Are prescribed to treat anxiety disorders
- Have a high potential for misuse and addiction
- Have similar half-lives – Xanax half-life 10.7-15.8 hours, Ativan half-life 9-16 hours
- Have sedating effects – dizziness and drowsiness
- Are not recommended for pregnant women
But there are also important differences, the biggest of which is the fact that while both medications are prescribed to treat anxiety, Xanax is also given for panic disorders.
Why Do So Many People Use Benzodiazepines?
In 2011, over 127 million benzodiazepine prescriptions were filled in the United States. Benzodiazepine medications like Ativan are so popular in America because the need is so prevalent. Consider just two conditions that typically call for a benzo prescription—anxiety and insomnia. According to the Anxiety and Depression Association of America, 40 million American adults struggle with an anxiety disorder – approximately 18% of the entire US population. This makes anxiety disorders the most common type of mental illness in the country. The National Institutes of Health reports that roughly 30% of the general population in America struggles with sleep disruption. Interestingly, there are significant differences in how common insomnia is among the various age demographics:
- 18-29: 68%
- 30-64: 59%
- 65 and older: 44%
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The Use and Abuse of Benzodiazepines in the United States
With those kinds of numbers, it is no wonder that 1 out of every 20 American adults has filled a benzodiazepine prescription within the last year. Other relevant statistics:
- In 1996, there were just over 8 million American adults with a benzodiazepine prescription.
- By 2016, that number had risen to 13.5 million – an increase of 67%.
- Use of benzos like Ativan and Xanax increases as people get older:
- 18-35: 2.6%
- 36-50: Use doubles, to 5.4%
- 51-64: 7.4%
- 65 and older: 8.7%, more than triple the youngest adult demographic
- Likewise, long-term use among those with a prescription also rises sharply with age:
- 18-35: 14.7%
- 65-80: 31.4%
- Significantly, the percentage of people who receive their benzodiazepine prescription from a psychiatrist DECREASES with age:
- 18-35: 15%
- 65-80: 5.7%
- The highest rate of benzodiazepine use is among women, and it increases with age.
- 10.8% of women age 65-80 use benzos, and among 80-year-old women, the rate is 11.9%.
- Between 1996 and 2016, the amount of medicine contained in an average benzodiazepine prescription DOUBLED.
- 1999-2013, the rate of benzodiazepine-related deaths more than QUINTUPLED.
- Approximately one-third of all prescription overdose deaths involve benzodiazepines.
- In 2016, that equated to over 8600 deaths.
- In 2012, more than 17,000 people were admitted to substance-abuse treatment citing Ativan or another benzodiazepine as their primary drug of choice.
- According to the Royal College of Psychiatrists, the use of benzodiazepines for more than 6 weeks results in dependency for 4 out of 10 patients.
- This dovetails with a report in the Journal of Addictive Behaviors stating that 44% of chronic benzodiazepine users eventually become dependent.
Are YOU Addicted to Ativan?
Because benzodiazepine use is so widespread, and dependence is so likely, knowing how to identify the risk factors and recognize early warning signs of a growing benzo dependency or addiction in yourself or someone you care about can be critical to avoiding a tragedy. Let’s take a look at some of those risk factors and warning signs.
Sign #1 – You Have Been Taking Your Medication for Months
Ativan and other benzodiazepines are only considered to be safe when they are taken short-term as a temporary solution, while other therapies are attempted. If you have used Ativan for more than one month, it is highly probable that you have become dependent.
Sign #2 – You Take More of Your Medication Sooner than Prescribed
If you take your Ativan because of “how it makes you feel”, rather than as prescribed, you are setting yourself up for dependency. When you base your medication regimen on how you “feel”, rather than your doctor’s orders, that is a definite red flag.
Sign #3 – You Have to Take More of Your Medication to Get the Same Effect
Needing ever-increasing dosages of your Ativan in order to achieve the same results is a sign that you have built a tolerance. This warning sign shows that the drug is beginning to change your brain. This is what happened to Chris Cornell. When his wife noticed that he was slurring his words during their phone conversation the night he died, he admitted that he might have taken “an extra Ativan or two.”
Sign #4 – You Run Out of Your Medication Early
When you take more of your Ativan than prescribed, you will definitely run out before it’s time to fill your prescription.
Sign #5 – You Are Unable to Function Without your Ativan
Your medication is supposed to make your life easier. But when it is the only thing that brings you any pleasure whatsoever or allows you to feel normal, that is evidence of drug dependence. Where once you took your medication to feel better, now you are taking the medication to keep from feeling bad.
Sign #6 – Your Life Revolves around Your Ativan
If you constantly obsess over when and where you can get more Ativan or when you can take your next dose, it may be because you are hooked on the drug’s pleasurable – rather than therapeutic – effects. You may withdraw from family and friends and miss get-togethers because you have yet another “doctor’s appointment.” or another trip to the pharmacy. If you are obtaining your Ativan illicitly, you are spending even more time on your habit, because the supply and the source aren’t as reliable as your local drugstore. Sometimes, your whole day will be spent driving around to see which of your contacts is holding. And even when you have finally received your drug – legitimately or not – you still have to allow time to recover from its use. If you are taking high or excessive doses of any benzodiazepine medication, their sedating effects are going to put you out of commission for a while.
Sign #7 – You Hide Your Ativan Use
You don’t want your loved ones to know how much Ativan you are consuming, or how frequently, so you take your medication in secret. And, because you also need to recover, you spend even more time away from them.
Sign #8 – You Experience Painful Symptoms When Your Medication Isn’t Available
If you ARE drug dependent, then within just a few hours of your last dose, you will go into withdrawal if you don’t take more Ativan. Symptoms of benzodiazepine withdrawal include:
- Extreme restlessness and agitation
- Anxiety to the point of panic
- Severe depression
- Difficulty concentrating/confusion
- Muscle aches and cramps
- Fever and chills
- Accelerated heartbeat
- High blood pressure
- Dilated pupils
- Excessive perspiration
- Sensitivity to light, sound, smell, and touch
At its most severe, benzodiazepine withdrawal syndrome can cause your body temperature to rise drastically. You may even experience seizures or convulsions. These symptoms would qualify as a medical emergency because they are potentially fatal. This is why you should NEVER attempt to cut back or quit Ativan or other benzodiazepines unless you are under the close supervision of a doctor.
Sign #9 – You Have Multiple Prescriptions for Ativan
Knowing that the recommended dose won’t last, you visit multiple doctors in order to have enough drugs.
Sign #10 – Your Original Condition Is No Longer the Problem
At some point on the timeline of your descent into addiction, you stopped taking Ativan for your anxiety or insomnia and started taking it because you craved its effects. While you may still have those conditions, they have stopped being the reason why you take Ativan.
Sign #11 – You Fake Symptoms
There is no one test to measure the level of someone’s anxiety. Therefore, doctors must largely rely on what they are told by their patients. When you are dependent or addicted, you will exaggerate or even outright lie about your symptoms so you can obtain another prescription.
Sign #12 – Your Ativan Habit Is Costing You Too Much Money
Even if you have insurance, multiple trips to the doctor and co-pays can add up. And, because most insurance companies won’t pay for you to go to multiple doctors for the same problem, your extra visits are coming out of your own pocket – cash pay. While prescription Ativan or generic lorazepam is very affordable – 30-day supply of 1 mg pills can be as low as $10, the expenses mount when you have several prescriptions. It is even worse when you have to buy your drugs illicitly – 2-milligram lorazepam tablets go for between $4 and $8 apiece. At that price, the habit can be harder to disguise.
Sign #13 – You Do without Other Things Just to Have Your Ativan
To afford your Ativan addiction, you ignore other financial obligations – your bills, your mortgage or rent, your car payment, special occasions with your family, etc. You may even start supporting your addiction with credit cards or loans.
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Sign #14 – You Would Do ANYTHING to Obtain More Ativan
Because benzodiazepine withdrawal is so painful, your addiction will “hijack” your brain and cause you act in ways that you would never have imagined:
- Lying to your family and friends
- Stealing – from your loved ones or your job, writing hot checks, etc.
- Dangerous behaviors – driving high, going to unsafe neighborhoods, risky sexual behavior
- You ignore your appearance – lack of personal hygiene, dirty clothes, etc.
Sign #15 – You Abuse Other Substances
Polydrug abuse among people with a benzodiazepine dependency or addiction is very common. Alcohol and opioids such as prescription painkillers or heroin are often co-abused with Ativan and other benzos. All substances of abuse affect the regions of the brain associated with pleasure, reward, and motivation – this is what drives addiction. But this also makes a person who is dependent on or addicted to one substance vulnerable to cross-addiction. In other words, when your primary drug of choice is not available, you may turn to other substances just to get some measure of relief. How prevalent is polydrug abuse? According to the Substance Abuse and Mental Health Services Administration, between 2000 and 2010, the rate of substance abuse treatment admissions for benzodiazepine abuse in combination with other substances skyrocketed almost 570%.
Sign #16 – It’s Affecting Your Personal Relationships
Try as you might, you cannot completely disguise your problematic Ativan use from the people closest to you. They are in an unfortunate position to see firsthand the consequences of your addiction – the lies, broken promises, manipulation, excuses, and denial. What kind of problems might you be experiencing?
- A friend, family member, or coworker expresses concern or repeatedly asks you “Are you all right?”
- Increased arguments
- Domestic violence
- Child abuse or neglect
- You stop getting invited to family or social gatherings
- Friends are distancing themselves from you
- Divorce or breakups
- The codependent or enabling behaviors of others
Sign #17 – You’re Having Problems at Work
Although 75% of people with substance abuse disorders work, having an active addiction can make it hard to find, keep, or advance in a job. The abuse of Ativan or other benzo medications can cause you to:
- Falsely call in sick (or have others do it for you)
- Have excessive absences
- Constantly get to work late or leave early
- Miss deadlines
- Have poor production or performance
- Suffer a workplace accident or injury
- Fail a mandatory or random drug test
- Interfere with company morale
- Rate poorly on reviews
- Receive disciplinary warnings and actions
- Get passed over for advancement and promotions
- Get demoted
- Receive a suspension
- Be terminated with cause
Sign #18 – You Are Experiencing Health Issues
Long-term or heavy benzodiazepine use can result in serious physical and mental health problems – the most obvious of which are overdoses and other adverse reactions. According to the drug enforcement agency, in 2010, there were over 345,000 benzodiazepine-related emergency room visits. But benzodiazepine misuse can cause other problems as well:
- Cognitive decline
- Sexual dysfunction
- Irritable Bowel Syndrome
- Mood disorders – depression, anxiety, PTSD
- Sleep disturbances
- Increased risk of suicide
Sign #19 – You’re Dealing with Legal Difficulties
The abuse of benzodiazepines can get you in trouble with the law in a number of ways:
- Driving Under the Influence
- Public Intoxication
- Disorderly Conduct
- Vehicular Accidents
- Identity Theft
Sign #20 – Your Life Has Become Unmanageable
At some point, even you will be unable to ignore the fact that your Ativan/lorazepam addiction is wrecking your life. You will look around and see the broken relationships, consequences at work, health issues, legal problems, and emotional pain and not like what you see. In other words, you will be sick and tired of being tired and sick. This is your rock bottom—the point at which you are ready for something better.
What to Do If You Are Addicted to Ativan
Once you have reached this point, there is good news – admitting that you have a problem is the very first step in getting help for that problem. Problematic substance abuse in ANY form is usually too big a problem for you to deal with on your own, but this is especially true in the case of benzodiazepine addiction. Since benzo withdrawal is so dangerous, you will first need to undergo a medically-supervised and medication assisted drug detoxification in order to assure your safety. This also helps your actual recovery and return to healthy sobriety get off to a proper start. If you have reached the point where even YOU are concerned about your use of Ativan or other benzodiazepine medication, then your next step should be to contact a reputable rehab program for a professional evaluation and to discuss your treatment options.
https://www.adaa.org/about-adaa/press-room/facts-statistics https://sleepfoundation.org/insomnia/content/what-is-insomnia/page/0/1 https://www.deadiversion.usdoj.gov/drug_chem_info/benzo.pdf https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2019955 https://www.aafp.org/Afp/2000/0401/p2121.html https://www.ncbi.nlm.nih.gov/pubmed/21481543?dopt=Abstract https://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/benzodiazepines.aspx
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