Ativan for Addiction and Substance Abuse - Is it a Safe Alcohol Addiction Withdrawal and Detox Option?
What is Ativan?
Ativan, otherwise known as Lorazepam or Temesta, is a drug in the benzodiazepine class of drugs which includes most tranquilizers. Ativan has many uses which include: sedative/hypnotic effects, muscle relaxant, anxiolytic (to reduce anxiety), amnesic and anticonvulsant (or to prevent seizures). It has also been used in conjunction with other drugs as an anti-emetic, which means it can stop vomiting.
How do you take this drug and how long does it take to work?
Ativan can be taken multiple ways. Lorazepam may be administered orally, by patch, sublingually or under the tongue, through muscular injection or by IV. If administered through IV, effects can begin within one minute. If given via injection, it can take up to an hour for the recipient to feel the results. When taking Ativan by mouth it can take up to two hours in order to work. Unlike other benzodiazepines, because Ativan has been found to have a high affinity for GABA receptors in the brain which may explain the strong amnesic effect it can have. Because of the strength associated with the drug, it is important that the dosing of Ativan not be all in one shot. Unless Ativan is prescribed just for night sedation, it’s best to split up the doses to several throughout the day.
Under what conditions is Ativan usually prescribed?
- Substance Abuse Withdrawal: Treatment and prevention of symptoms of alcohol withdrawal.
- Vomiting and Nausea: Often administered with chemotherapy treatment to treat nausea and vomiting. It’s usually combined with other medications to prevent vomiting.
- Anxiety: For severe anxiety disorders.
- Pre-medication: Often administered orally or IV before a general anesthetic which should help to reduce anxiety. Health staff must take precautions (chaperoning and avoiding ambiguous language and gestures) against patients later making unjustified allegations of sexual abuse during treatment, due to impaired memory and to drug-induced misinterpretations.
- Mania and Extreme Agitation: To quickly offer sedation to violent or agitated patients. It is usually given with haloperidol, another sedative.
- Seizures: Often administered for treatment of status epilepticus (refers to the brain being in a state of persistent seizure which can be life threatening).
- Insomnia: Short-term treatment of insomnia, particularly if associated with severe anxiety.
Is Ativan Addictive?
Like all benzodiazepines, Ativan has potential for being addictive. Since Ativan is utilized specifically to help inpiduals detox from alcohol, there is potential for dependence on this drug. If Ativan has been prescribed to help with detoxification, it should be done under supervision. Dependence isn’t the only reason Ativan can be a problem, since perhaps the most dangerous part of Ativan use, is mixing it with alcohol. Ativan itself is not usually fatal in overdose; however, it can cause respiratory depression, which means an inpidual’s breathing may slow, if taken in overdose with alcohol. This occurrence is mixed with the usual effects of alcohol which include disinhibition and anterograde amnesia or memory loss. All these factors together can lead to severe problems.
In addition, continuous Ativan use can lead to a slew of side effects that can cause immediate damage (respiratory depression, i.e. not breathing) to causing social problems (amnesia- not remembering you insulted your in-laws) to bring on serious long term damage (liver failure- which means drinking alcohol is truly no longer an option).
More side effects of Ativan are as follows:
- Cognitive Defects: Long term therapy can produce thinking problems, especially in the elderly. This may be reversible after a period of discontinuation.
- Liver failure: Though Ativan is safer than other benzodiazepines; it can still affect liver function if not monitored.
- Kidney failure: Possibility of kidney damage.
- Respiratory failure: Excessive use (especially when mixed with alcohol) can cause an inpidual to stop breathing.
- Pregnancy and breast feeding: If Ativan is used during the first trimester of pregnancy, it can cause harm to the unborn baby. This includes respiratory depression and neonatal jaundice. For mothers planning on breast feeding, Ativan is excreted in breast milk, so one must be careful.
- Reduced Responsiveness: After an Ativan injection, a patient should not be left alone due to residual effects like: vertigo, hypotension, sleepiness. Furthermore, driving a car is probably not a good idea for about 24 hours.
- Paradoxical effects: There are some instances in which, instead of calming the person down, Ativan use results in increased hostility and aggression. This is thought to be attributed to disinhibition and the incidence is higher in people with personality disorders. These side effects are dose related and usually subside when dose is reduced, or after a complete withdrawal.
- Suicidality: There is the chance that Ativan can bring out suicidal ideations in depressed patients. The thought behind this is again, disinhibition. This may cause one to be more willing to express suicidal thoughts. This is why Ativan should be prescribed with another antidepressant.
- Amnesia: After 2-3 days of regular use, Ativan probably won’t still be causing amnesia. To avoid amnesia/sedation from being an issue, patients should not be prescribed above 2 mg a day initially, including at night.
- Tolerance: This can occur with any benzodiazepine. With Ativan, after 4-6 months, the drug is not shown to continue working. Meaning after this period of time, chances are, continued use would not have the desired effect. This does not mean, however, that use should be stopped abruptly. Doing so can cause symptoms of withdrawal which include severe anxiety, which most cases, was what the drug was being used for to begin with.
Why Would Someone Abuse Ativan?
Most likely abusers started out using Ativan to decrease anxiety and became addicted to it. In all likelihood they did not start out using Ativan which intention of becoming addicted. However, whatever their reasons are, abuse of the drug can be deadly and does need to be treated.
Rachel Hayon, BSN, MPH
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