The chilling effects of the “addictive” label
But the main point is that in the U.S. and Britain this drug class became demonized as addictive. In 1975 the US Department of Justice placed Librium and Valium on schedule IV of its list of controlled substances. Being listed as potential drugs of abuse had a chilling effect on prescribing. In New York State a further drop in use followed the 1989 imposition of restrictive triplicate prescription regulations which mandated state monitoring. A 1991 study reported in JAMA that these regulations led to a 44% decrease in benzodiazepine prescribing between 1987 and 1990 – but also an increase in the use of “less acceptable medications” (barbiturates and other traditional tranquilizers) – as well as the emerging, “more expensive” antidepressants buspirone and Prozac.
The anti-benzo backlash was particularly strong in the U.K. Prescribing there peaked in 1979, with 31 million prescriptions, then began a steady decline in response to government warnings. In 1988, the Committee on Safety of Medicines warned of withdrawal symptoms and dependence “following therapeutic doses given for SHORT periods of time” (its emphasis) and recommended limiting their use for a maximum of 2-4 weeks for “disabling” anxiety or insomnia. These restrictions remain in effect, forcing British doctors to “write fraudulent prescriptions” in order to adequately treat catatonia patients. (Healy, 2013)
The effectiveness of ibuprofen and lorazepam combination therapy in treating the symptoms of acute Migraine: A randomized clinical trial.
CONCLUSIONS: Given the greater effectiveness of combination therapy with Ibuprofen and Lorazepam in alleviating the symptoms of acute migraine compared to single-drug treatments with Ibuprofen, Lorazepam is recommended to be used as a first line treatment for acute migraine.
Ativan (and its generic version, lorazepam) is an extremely common drug, prescribed to millions of people every year, says Asher Simon, MD, assistant professor of psychiatry at The Mount Sinai Hospital in New York City. And overall, he says, “it can be an incredibly effective and very safe medication.”
It’s in a class of drugs called benzodiazepines, which work by slowing down the central nervous system and enhancing certain chemicals in the brain to produce a calming effect. (Other well-known benzodiazepines include Valium and Xanax.) The drug is usually prescribed on a short-term basis for the treatment of anxiety, and is often helpful for people with depression.
“It lasts about four to six hours, and a lot of times it’s prescribed on an as-needed basis,” says Dr. Simon. “We might say, ‘Take one or two pills three times a day, as needed.’” The drug starts working right away, he says; that’s why they’re sometimes recommended for people who are anxious about flying on airplanes or visiting the dentist, for example.
Ativan might also be prescribed for short-term use alongside antidepressant medications. “A lot of times when someone comes in with anxiety and you start them on an antidepressant, their anxiety can get worse before it gets better,” says Dr. Simon. “So sometimes they need a couple weeks of an anti-anxiety medication to provide immediate relief, until the antidepressant kicks in.”
Because it’s a sedative, Ativan can make people dizzy and tired when they first start taking it. It can increase the risk of falls, especially in older people, and patients are warned about driving or operating heavy machinery until they know how the drug will affect them.
But Dr. Simon says that taking an extra Ativan or two would not cause slurring or serious impairment, especially for people who have been on the drug long-term and developed a tolerance to its sedating side effects. “Yes, of course you should never take more than prescribed,” he says. “But one or two additional pills is usually not a huge deal.”
Combining Ativan with alcohol or other drugs, is much more dangerous, he says—mostly because of the potential for impaired judgment and slowed breathing and heart rate. There’s less of a chance that Ativan would cause a non-suicidal person to take their own life, says Dr. Simon. “A lot of suicide comes at a time of acute anxiety, and if it treats the anxiety it can actually prevent those suicides,” he says. “It is extremely unlikely to cause suicidal thinking in and of itself.”
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Diazepam is mainly used to treat anxiety, insomnia, panic attacks and symptoms of acute alcohol withdrawal. It is also used as a premedication for inducing sedation, anxiolysis, or amnesia before certain medical procedures (e.g., endoscopy). Diazepam is the drug of choice for treating benzodiazepine dependence with its long half-life allowing easier dose reduction. Benzodiazepines have a relatively low toxicity in overdose.
Diazepam has a number of uses including:
- Treatment of anxiety, panic attacks, and states of agitation
- Treatment of neurovegetative symptoms associated with vertigo
- Treatment of the symptoms of alcohol, opiate, and benzodiazepine withdrawal
- Short-term treatment of insomnia
- Treatment of tetanus, together with other measures of intensive treatment
- Adjunctive treatment of spastic muscular paresis (paraplegia/tetraplegia) caused by cerebral or spinal cord conditions such as stroke, multiple sclerosis, or spinal cord injury (long-term treatment is coupled with other rehabilitative measures)
- Palliative treatment of stiff person syndrome
- Pre- or postoperative sedation, anxiolysis and/or amnesia (e.g., before endoscopic or surgical procedures)
- Treatment of complications with a hallucinogen crisis and stimulant overdoses and psychosis, such as LSD, cocaine, or methamphetamine
- Preventative treatment of oxygen toxicity during hyperbaric oxygen therapy
Dosages should be determined on an individual basis, depending on the condition being treated, severity of symptoms, patient body weight, and any other conditions the person may have.
Intravenous diazepam or lorazepam are first-line treatments for status epilepticus. However, intravenous lorazepam has advantages over intravenous diazepam, including a higher rate of terminating seizures and a more prolonged anticonvulsant effect. Diazepam gel was better than placebo gel in reducing the risk of non-cessation of seizures. Diazepam is rarely used for the long-term treatment of epilepsy because tolerance to its anticonvulsant effects usually develops within six to 12 months of treatment, effectively rendering it useless for that purpose.
The anticonvulsant effects of diazepam can help in the treatment of seizures due to a drug overdose or chemical toxicity as a result of exposure to sarin, VX, or soman (or other organophosphatepoisons), lindane, chloroquine, physostigmine, or pyrethroids.
It is sometimes used intermittently for the prevention of febrile seizures that may occur in children under five years of age. This use, however, is not typically recommended as the benefits are small and side effects are common. Long-term use of diazepam for the management of epilepsy is not recommended; however, a subgroup of individuals with treatment-resistant epilepsy benefit from long-term benzodiazepines, and for such individuals, clorazepate has been recommended due to its slower onset of tolerance to the anticonvulsant effects.
Diazepam is used for the emergency treatment of eclampsia, when IV magnesium sulfate and blood-pressure control measures have failed. Benzodiazepines do not have any pain-relieving properties themselves, and are generally recommended to avoid in individuals with pain. However, benzodiazepines such as diazepam can be used for their muscle-relaxant properties to alleviate pain caused by muscle spasms and various dystonias, including blepharospasm. Tolerance often develops to the muscle relaxant effects of benzodiazepines such as diazepam.Baclofen or tizanidine is sometimes used as an alternative to diazepam.
The United States military employs a specialized diazepam preparation known as Convulsive Antidote, Nerve Agent (CANA), which contains diazepam. One CANA kit is typically issued to service members, along with three Mark I NAAK kits, when operating in circumstances where chemical weapons in the form of nerve agents are considered a potential hazard. Both of these kits deliver drugs using autoinjectors. They are intended for use in “buddy aid” or “self aid” administration of the drugs in the field prior to decontamination and delivery of the patient to definitive medical care.