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.”