Understanding Lorazepam and Its Illicit Use
Lorazepam, widely known by its brand name Ativan, is a potent, short-acting benzodiazepine prescribed to treat anxiety disorders, insomnia, and seizures [1.2.1, 1.4.5]. It functions by enhancing the effect of the neurotransmitter GABA (gamma-aminobutyric acid) in the brain, which slows down brain activity and produces a calming effect [1.4.1, 1.4.6]. While medically beneficial for short-term use (typically 2-4 weeks), its potential for abuse and addiction is significant [1.3.4, 1.3.6]. When sold illegally, lorazepam is known by various slang terms to conceal its identity. Common street names for lorazepam include Candy, Downers, Sleeping Pills, and Tranks [1.2.2]. It may also be referred to by more general benzodiazepine slang like Benzos, Blues, or Chill Pills [1.2.1, 1.2.3].
The Pharmacology of Lorazepam
Lorazepam is classified as a Schedule IV controlled substance by the Drug Enforcement Administration (DEA), indicating it has a recognized medical use but also a potential for abuse and dependence [1.3.1]. Its mechanism involves depressing the central nervous system (CNS) to reduce agitation and excitement [1.3.5]. The effects are relatively fast-acting, with users feeling the impact within hours, and it remains in the system for 10 to 20 hours [1.3.5]. This rapid onset and sedative, euphoric effect are what make it desirable for non-prescribed use [1.2.1]. However, even when taken as directed, users can quickly develop tolerance, meaning they need higher doses to achieve the same effect, which can lead to physical and psychological dependence [1.4.1, 1.3.3].
The Dangers of Street Lorazepam
Purchasing lorazepam on the street is incredibly dangerous for several reasons. First, illicitly sold pills often have unknown dosages, increasing the risk of accidental overdose [1.5.2]. Second, and more alarmingly, these counterfeit pills may be laced with other dangerous substances without the user's knowledge [1.5.3]. The DEA has warned that counterfeit prescription pills have been found containing highly potent substances like fentanyl [1.5.5]. Combining benzodiazepines with opioids like fentanyl is particularly deadly because both substances act as CNS depressants, dramatically increasing the risk of fatal respiratory depression [1.3.1, 1.5.1]. In the first half of 2020, 92.7% of deaths involving benzodiazepines also involved opioids [1.9.5].
Comparison: Lorazepam (Ativan) vs. Other Benzodiazepines
Lorazepam is often compared to other benzodiazepines like alprazolam (Xanax) and diazepam (Valium). Understanding their differences helps contextualize their abuse potential.
| Feature | Lorazepam (Ativan) | Alprazolam (Xanax) | Diazepam (Valium) |
|---|---|---|---|
| Primary Use | Anxiety, Seizures, Insomnia [1.2.1] | Panic Disorder, Anxiety [1.6.2] | Anxiety, Muscle Spasms, Alcohol Withdrawal [1.6.1] |
| Onset of Action | Intermediate (peaks ~2 hours) [1.6.2] | Fast (peaks ~1-2 hours) [1.6.5] | Fast (15-30 minutes) [1.6.1] |
| Duration of Action | Short-to-Intermediate (lasts ~8 hours) [1.6.2] | Short (lasts 4-6 hours) [1.6.5] | Long (lasts 12+ hours) [1.6.1] |
| Half-Life | ~12-18 hours [1.6.2] | ~11.2 hours [1.6.2] | Up to 48 hours [1.6.4] |
| Addiction Potential | High; shorter half-life can lead to more severe withdrawal [1.6.5] | High; rapid onset may reinforce drug-taking behavior [1.6.3, 1.6.5] | High; long-acting nature can lead to accumulation in the body [1.6.4] |
While 1mg of lorazepam is roughly equivalent to 0.5mg of alprazolam, these are loose estimates [1.6.3]. Xanax's rapid onset makes it particularly sought after for a quick high, but both it and Ativan have a high risk of abuse and are difficult to stop using [1.6.5].
Signs of Abuse and Addiction
Recognizing lorazepam addiction can be challenging, but there are distinct physical, behavioral, and psychological signs. Abuse is characterized by using the drug outside of a prescription's guidelines, while addiction is a compulsive use despite negative consequences [1.3.6].
Physical and Behavioral Signs:
- Tolerance: Needing more of the drug to feel the same effects [1.3.3].
- Doctor Shopping: Seeking prescriptions from multiple doctors [1.4.3].
- Neglecting Responsibilities: Failing to meet obligations at work, school, or home [1.3.1].
- Changes in Appearance: Poor hygiene and seeming overly tired or sedated [1.3.5, 1.4.4].
- Physical Symptoms: Slurred speech, poor coordination (ataxia), dizziness, and memory issues [1.4.3, 1.4.4].
Psychological Signs:
- Cravings: Strong urges to use the drug [1.3.1].
- Inability to Stop: Unsuccessful attempts to cut down or quit [1.3.4].
- Withdrawal Symptoms: Experiencing physical and psychological discomfort when not using the drug [1.4.3].
Withdrawal and Treatment
Withdrawal from lorazepam can be severe and even life-threatening, with risks including seizures, psychosis, and extreme anxiety [1.3.1, 1.7.2]. Symptoms can begin within a day after the last dose, peak around day two, and last for weeks or even months in a protracted phase [1.3.1, 1.7.2]. Because of these dangers, medical supervision is essential.
Treatment for lorazepam addiction typically involves:
- Medically Supervised Detox: This is the first and most critical step. A gradual tapering of the dosage is used to minimize withdrawal symptoms and prevent dangerous complications like seizures [1.8.2, 1.8.5].
- Behavioral Therapies: Cognitive Behavioral Therapy (CBT) is highly effective. It helps individuals identify and change harmful thought patterns and behaviors related to drug use, teaching them healthier coping skills [1.8.2, 1.8.4].
- Support Systems: Group therapy, family therapy, and support groups like Narcotics Anonymous (NA) or SMART Recovery provide a community and accountability to help maintain long-term sobriety [1.8.5].
Conclusion
While lorazepam is a medically important drug, its potential for misuse makes it a substance of concern. Known on the street as 'candy,' 'tranks,' and other names, its abuse is driven by its sedative effects but fraught with danger, especially the risk of overdose from counterfeit pills containing fentanyl. Recognizing the signs of addiction and understanding that safe recovery requires professional medical help are crucial first steps. Effective treatment, beginning with a medically supervised detox and followed by therapy, offers a path to overcoming dependence and reclaiming one's health.
For more information on substance abuse treatment, you can visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website: https://www.samhsa.gov/find-help/national-helpline.
