Benzodiazepines are one of the most prescribed groups of medicines in the United States. According to estimates released by the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 7.3 million people admitted to using lorazepam products at least once during 2016.Benzodiazepines were developed as alternatives to the addictive barbiturates that were once widely prescribed for the treatment of anxiety and for seizure control. The overprescription of barbiturates led to numerous substance abuse issues and well-publicized overdoses. The famous singer and actress Judy Garland overdosed on barbiturates and passed away as a result. It was hoped that benzodiazepines would have less potential for abuse; however, these drugs are also widely abused. For instance, according to the data provided by SAMHSA, 786,000 individuals admitted to at least one misuse of lorazepam in 2016.
All of the benzodiazepines are designated as controlled substances by the Drug Enforcement Administration (DEA), and most of them are listed in the Schedule IV (C IV) categorization. This means that these drugs have a moderate potential to be abused and may result in physical dependence if they are used consistently.
Using benzodiazepines for the treatment of anxiety or as a sleep aid should not be a long-term solution to the problem. Instead, benzodiazepines should be used to help individuals cope with their anxiety or issues with sleep while they learn behavioral methods to control their situation (e.g., with various types of psychotherapy or other interventions). Using benzodiazepines to address common issues with normal nervousness and frustration is a potential misuse of the medication.
Physicians should not prescribe benzodiazepines to address issues with anxiety unless the individual has a specific mental health disorder or some other neurological condition that results in clinically significant anxiety. The continued use of benzodiazepines as sleep aids can foster abuse because individuals will typically develop tolerance rapidly and require more of the drug to produce the effects they seek. This can lead to issues with misuse and abuse.
All benzodiazepines are considered to be minor tranquilizers or central nervous system depressant drugs, and they are sometimes listed as sedative drugs. Benzodiazepines all have a similar chemical structure and affect the neurotransmitter gamma-aminobutyric acid (GABA). Neurotransmitters are chemicals used by the nerve cells in the brain (neurons) to communicate with each other and to initiate the vast majority of human actions. GABA is an inhibitory neurotransmitter, meaning that when it is released, it slows down the functioning of other neurons in the brain. This accounts for its ability to address issues with anxiety, act as a sleep aid, and treat seizures.
There are risks to long-term use of benzodiazepines, such as the development of physical dependence. Long-term use of Ativan and other benzodiazepines carries the risk of significant potential side effects that can include issues with memory and the possible development of dementia in elderly individuals. Benzodiazepines like Ativan are also potentially fatal when combined with other central nervous system depressants, such as alcohol, other benzodiazepines, and opiate drugs.
The half-life of Ativan, the amount of time it takes an individual’s system to metabolize the drug to half its original concentration in the bloodstream, is often stated to be about 12 hours; however, a better estimate is between 10 and 20 hours for most individuals. In most cases, it takes about five to six half-lives for the medicinal dose of a drug to be eliminated from an individual’s system. Abusers with significant tolerance may take amounts that are extremely high, and it might take longer for the drug to be eliminated.
Research indicates that the majority of the drug is metabolized in the liver and then eliminated through the kidneys (through urine). For most individuals, the majority of Ativan is eliminated within five days of taking it; however, there are some metabolites of lorazepam (substances that are produced as a result of breaking down the drug) that may remain in a person’s system for longer than a week.
Depending on the situation, individuals being tested for drug use may not be screened for benzodiazepines. Many of the traditional drug screens (e.g., SAMHSA 5 Panel Test) may not screen for benzodiazepines, whereas more extensive screens (e.g., SAMHSA 10 Panel Test) will detect them.Based on the available research, there are estimated detection windows for how long Ativan will show up on a drug test.
The most common method to test for the presence of Ativan is urinalysis. Blood tests are considered too invasive, and hair samples are typically considered to be too expensive in most cases.
There are several factors that can influence the detection time for any drug, including Ativan.