Masking Symptoms with Medication: A Cautionary Tale

Many medications are typically prescribed for much longer than recommended by the manufacturers. Stomach acid-lowering drugs (H2 blockers like Nexium) and benzodiazepines like Xanax and Ativan are two of the leading ones. The overuse of Nexium will actually cause reflux! In my circle of patients, friends, and loved ones, I have two senior members who have been prescribed Ativan for sleep issues stemming from poor sleep. Remarkably, they've been taking this medication for decades despite guidelines warning against use beyond four months. Both were placed at high risk for falls, which became much worse due to the drug-induced dizziness and weakness. One relative has osteoporosis, making any fall potentially catastrophic. Strangely, they are bedridden and sleep most of the day. It seems they don't need any help sleeping anymore.

Ativan, or lorazepam, is FDA-approved for managing anxiety and certain seizures and as a preoperative sedative. It's available in oral tablets and injections, but its use must be carefully monitored to avoid dependency. The drug's label clearly warns of the risks of addiction, misuse, and the severe withdrawal symptoms that can occur if abruptly discontinued.

Yet, in two cases of people close to me, the prescribing doctors did not monitor usage closely. There was a single instance where another doctor raised concerns and called the prescriber, but no action followed. This scenario underscores a significant gap in healthcare oversight regarding benzodiazepine prescriptions. In neither case did the prescriber care that four months is the longest recommended course.

Another close individual in my life was on a similar medication, Xanax (Alprazolam), for anxiety, which they overcame. When they tried to stop their medication because they believed they no longer needed it, they faced severe withdrawal symptoms mistaken for returning anxiety, revealing an addiction they were never warned about. Now, they're undergoing a medically supervised withdrawal, which is challenging but necessary.

This experience raises questions about the practice of symptom management in medicine. Continually masking symptoms with medications like Ativan ignores underlying issues such as poor sleep hygiene, dietary deficiencies, chronic stress, lack of physical activity, insufficient sunlight exposure, or toxic interpersonal relationships. Addressing these root causes could potentially reduce the need for such medications, preventing the dependency cycle.

In conclusion, the overuse of Ativan and other medications in many instances serves as a cautionary tale about the near-absurdity of managing symptoms without tackling underlying issues. It's a reminder for medical practitioners and patients alike to consider the long-term implications of drug dependency and to prioritize lifestyle and psychological interventions where possible.