From the Research
Neither Ativan (lorazepam) nor clonazepam is preferred for treating drug addiction, as benzodiazepines themselves carry significant addiction potential. For individuals with substance use disorders, these medications should generally be avoided except in specific medical circumstances such as acute alcohol withdrawal management. When benzodiazepines are necessary for short-term use in patients with addiction history, the choice between lorazepam and clonazepam depends on the clinical situation. Lorazepam has a shorter half-life (10-20 hours) making it useful for acute situations, while clonazepam's longer half-life (30-40 hours) provides more stable blood levels with less frequent dosing 1.
Some key points to consider:
- Benzodiazepines have a high potential for addiction and should be used with caution in patients with a history of substance use disorders 2.
- The use of benzodiazepines in patients with addiction history should be carefully monitored, time-limited, and prescribed at the lowest effective dose under close medical supervision.
- Treatment for substance use disorders typically involves medications specifically approved for addiction (like buprenorphine, methadone, naltrexone, or acamprosate depending on the substance), combined with behavioral therapy and counseling.
- Clonazepam has been shown to be effective in the treatment of panic disorder and social phobia, but its use should be carefully considered in patients with a history of substance use disorders 1.
- The detection times of benzodiazepines in oral fluid can be extended in patients who have taken high doses, which can be relevant in the context of drug abuse and detoxification 3.
In terms of pharmacokinetics, benzodiazepines enter cerebral tissue rapidly, but the duration of action varies between different benzodiazepines, with clonazepam and lorazepam having longer durations of action compared to diazepam and midazolam 4. However, the clinical relevance of these pharmacokinetic properties in the context of substance use disorders is not well established.
Overall, the use of benzodiazepines in patients with substance use disorders should be approached with caution, and alternative treatments should be considered whenever possible.