Ativan (Lorazepam) withdrawal & detox

This Page was last reviewed and changed on June 7th, 2022

Content Overview

The withdrawal symptoms associated with Ativan detox can be severe, so it is important that this process is managed effectively. Most people who want to break free from Ativan will require a medically supervised detox where appropriate medication can be administered to lessen the impact of withdrawal. In a special detox clinic, your comfort and safety will be assured.

Overcoming an Ativan addiction permanently involves detox and its associated withdrawal. As a benzodiazepine, Ativan is a highly addictive drug that can easily trap a person who takes it for longer than the normally prescribed four to six weeks. And once addiction sets in, withdrawal is a normal part of trying to stop.

If you are currently misusing or abusing Ativan, it is important for you to understand withdrawal and detox before you begin treatment. Note that there is no way to fully stop using Ativan until you go through the detox and withdrawal processes. Also note that undergoing professional rehab at a private clinic offers you the safest and most comfortable detox and withdrawal possible.

As you will learn from this guide, it is not a wise idea to try Ativan detox and withdrawal outside of a doctor’s supervision. Too many things could go wrong to make it safe. If you need help with this drug, please contact us right away. We can help you identify the seriousness of your problem and connect you with a treatment centre capable of treating you.

Ativan Withdrawal Syndrome – An Overview

Withdrawing from the most addictive drugs creates physical and psychological withdrawal symptoms that range in length and intensity. The withdrawal symptoms associated with Ativan withdrawal constitute a condition known as ‘Ativan withdrawal syndrome’. It is typified by easily recognisable symptoms explained in the next section of this guide.

Patients can get through Ativan withdrawal syndrome with the help of medical and support personnel. Medically-assisted detox and withdrawal facilitate safe treatment by putting a patient’s care in the hands of trained professionals. In the absence of medical supervision, Ativan withdrawal syndrome can be a serious condition.

The unfortunate thing about Ativan withdrawal is that it tends to be more severe than withdrawing from other benzodiazepines. This is due to the drug’s relatively short half-life. Ativan is considered a short-acting benzodiazepine and, as such, can produce severe withdrawal symptoms.

Lastly, Ativan withdrawal syndrome can be characterised as acute or protracted depending on how long symptoms last. In the most severe cases, protracted withdrawal can lead to benzodiazepine withdrawal syndrome, a syndrome exhibiting more severe symptoms including rapid heart rate, high blood pressure, respiratory distress, and aggression.

Ativan Withdrawal Symptoms

Symptoms associated with Ativan withdrawal are many and varied. Below is a partial list of the most commonly experienced symptoms. Some patients experience just a few of them, others experience all of them.

The severity of the symptoms varies from one patient to another. In cases of either acute or protracted Ativan withdrawal syndrome, symptoms can be managed through prescription medications. Patients can be made more comfortable as well. There are occasions when symptoms are severe enough to lead to the previously mentioned benzodiazepine withdrawal syndrome, a potentially fatal syndrome that includes seizures and other severe symptoms.

Causes of Ativan Withdrawal

As for the causes of Ativan withdrawal, they are directly related to how the drug affects the body. All benzodiazepines work by interfering with brain neurotransmitters – chemicals that carry messages throughout various portions of the brain. In the case of Ativan, it interferes with the GABA neurotransmitter.

Ativan reduces the volume of GABA in the brain. It also interferes with GABA’s receptor, by making it less receptive to whatever GABA is present. The net effect of both influences is sedation. The drug relaxes the body and mind; it also produces feelings of euphoria. More importantly, the body attempts to produce more glutamate in order to counter the effects of Ativan. Glutamate is the most prevalent excitatory neurotransmitter in human beings.

Once a person has begun demonstrating tolerance of Ativan, it is because the body is producing enough glutamate to counteract the drug. At the point of addiction, the body is working overtime to make enough glutamate. This is where withdrawal symptoms begin showing themselves.

As the amount of Ativan in the system decreases, it takes some time for the body to respond by producing less glutamate. In the interim, a combination of excess levels of glutamate and the excitability of the GABA receptor are what produce withdrawal symptoms. This abnormal combination causes things like anxiety, insomnia, and seizures.

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How Long Do Ativan Withdrawal Symptoms Last?

Ativan withdrawal symptoms range in length. There are some people who peak somewhere around the fourth or fifth day before gradually starting to feel better. There are others who suffer from protracted withdrawal symptoms that can last anywhere from 10 to 15 days. There is no way to know for certain prior to beginning withdrawal.

Regardless of how long symptoms last, please note that their intensity is not consistent through the entire period of detox. Withdrawal symptoms start out rather mild, then gradually increase in intensity until they peak. Then they began to gradually subside.

Should you undergo Ativan withdrawal in the future, be prepared to experience withdrawal symptoms. Your withdrawal will hopefully be on the lower side of the scale. Regardless of the length of your symptoms though, know that treatment in a residential rehab centre is accompanied by medical assistance in an environment that seeks to make patients as comfortable as possible.

Managing Withdrawal Symptoms

Withdrawing from Ativan can be dangerous. Thus, it is crucial to manage withdrawal symptoms in order to prevent an already dangerous situation from becoming critical. This is why we recommend withdrawing from Ativan only under the care of doctors and nurses. Professionals are the most capable of safely managing withdrawal symptoms.

So, how are those symptoms managed? The first line of defence is a prescription medication. The safest way to withdraw from Ativan is to do so gradually. So in a residential rehab setting, a doctor prescribes a maintenance dose of Ativan (or another drug) that is slowly reduced over time. This gradual reduction gives the body ample opportunity to adapt to having less Ativan in the system.

During this gradual withdrawal, nurses and support staff enhance symptom management by making the patient as comfortable as possible. If necessary, other prescription medications may be used to counteract some of the effects of Ativan withdrawal. At any rate, medical and support staff are on hand to help patients get through the most uncomfortable hours and days of withdrawal.

Psychotherapeutic treatments can be delivered during detox and withdrawal if necessary. In some patients, the anxiety and panic attacks are severe enough to cause concern. This would trigger a psychotherapeutic response to calm the patient.

Contributing Factors to Ativan Withdrawal

As with any drug, there are a number of contributing factors that affect the severity and length of Ativan withdrawal. The first of those factors is the amount of time a person has been using the drug. A general rule states that a longer length of time makes withdrawing more difficult and uncomfortable. So if you were taking Ativan for six months as opposed to six weeks, you can expect a more difficult withdrawal.

Next is the amount of the drug being used. Lower doses tend to make for easier withdrawal while higher doses do just the opposite. The easiest withdrawal is generally experienced by people who have taken only low doses for a short amount of time. People who have taken large doses for longer periods of time can expect a more difficult withdrawal.

Finally, there are individual variables that apply to different people. For example, you might be suffering from a co-occurring disorder that would make withdrawing from Ativan more difficult. Your physiological make-up can be such that your withdrawal is less intense than someone else being treated at the same time. There is no way to account for individual differences until a person actually begins the withdrawal process.

Individual variables include the following:

Physical and Psychological Health

Recovering from any disease is influenced by a person’s overall health. In the case of drug withdrawal, people with underlying physical or mental health issues may find it more difficult to manage.

Other Drugs

The presence of other drugs can pose problems for Ativan withdrawal. As such doctors will ask patients about any other substances they are using. Doctors need to know about alcohol, OTC prescriptions, illicit drugs, etc.

Co-Occurring Disorders

Co-occurring disorders (e.g., Ativan addiction and clinical anxiety) require specialised treatment that accounts for both conditions simultaneously. Otherwise, focusing only on the addiction could make the other disorder worse.

Unusual Sensitivity to Medications

A person with an unusual sensitivity to medications, in general, may find withdrawal from Ativan very difficult. This is why doctors ask about medical history. They need to know if and how patients have reacted to medications in the past.

Family History

People with a family history of substance abuse and addiction may have a genetic predisposition that makes overcoming Ativan more difficult.

Patient History

Unlike some other drugs, a cycle of repetitive addiction and withdrawal seems to have a cumulative effect on Ativan users. Studies suggest that every quit attempt with Ativan gets progressively more difficult.

Addressing these individual variables is the impetus behind the initial physical and psychological assessments prior to the start of detox. Doctors, nurses, and therapists all want to know what they are up against before they begin.

Psychological Withdrawal from Ativan

Psychological withdrawal is distinctly different from physical withdrawal. The need for psychological withdrawal from Ativan is directly related to the feelings of euphoria the drug produces. Indeed, euphoric feelings are one of the most dangerous aspects of psychoactive drugs.

It is those feelings of euphoria that make Ativan pleasant to use even though it creates some unpleasant side effects – like drowsiness and loss of motor function. Once a person begins cutting down, any euphoric feelings the drug produces are decreased proportionally. This can be tough for a person to take, psychologically speaking.

Psychological withdrawal is about the mind getting used to less intense euphoric feelings. Eventually those feelings go away altogether. For some individuals, this psychological withdrawal is the more difficult part of detoxing from Ativan. This is especially true for people who show a genetic predisposition to addictive behaviour. They are so dependent on those euphoric feelings that going without them is very difficult.

Physical Withdrawal from Ativan

Earlier you read a rather lengthy description of the causes of physical Ativan withdrawal. It is all tied to the GABA neurotransmitter and its associated receptor. Unfortunately, it takes just as much time for the body to compensate for less Ativan as it did to compensate for more. Physical withdrawal is a direct result of the body trying to compensate.

Physical withdrawal symptoms like increased heart rate and blood pressure are due to excess levels of glutamate in relation to the amount of Ativan in the system. If a person were to withdraw from the drug too quickly, some of these physical withdrawal symptoms could be dangerous. Again, we are talking about things like increased heart rate and seizures.

The fact that a person experiences withdrawal symptoms while taking a legitimate Ativan prescription is evidence that person has already begun to form a dependence on the drug. Does this sound familiar to you? Any physical withdrawal symptoms you experience is a call to action. Talk to your GP or contact us.

Substance Use Disorders and Detoxification

This is a good point to stop and talk about substance use disorders in detoxification in a general sense. Substances that create tolerance and dependence are the same substances that require detoxification. Their associated disorders are recognised by the symptoms exhibited when people use them.

A substance use disorder is defined as a condition in which the use of one or more psychoactive substances produces a significant level of impairment or distress. A substance use disorder does not have to involve addiction or dependence, though it quite often does. Even substance misuse could qualify as a disorder if it impairs or distresses the user enough.

Clinicians begin to consider substance use disorder when a patient’s use of substances either begins to negatively affect that person’s physical and mental health or presents potential harm to others. Once a substance use disorder is identified, treatment is the appropriate action.

Treatments vary between substance abuse and full-blown addiction. In an abuse scenario, treatment centres around addressing the social and physical consequences of continued abuse. Treatments for addiction must focus on detox, withdrawal, and psychotherapy, with permanent abstinence being the ultimate goal.

The question of detox also varies between abusers and addicts. Even a substance abuser may need detox if he or she is beginning to show signs of tolerance. In the case of Ativan use, this is actually quite common. Ativan is an especially powerful benzodiazepine because of its short half-life. It is quite possible that you would need a detox to stop using the drug even if you are not clinically addicted.

As for Ativan addicts, detox is a necessary requirement for coming clean. Detox is required to accomplish physical wellness and is a precursor to rehab therapy.

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Ativan Detox

A person addicted to Ativan is both physically and psychologically dependent on the drug. Physically speaking, the body is used to having Ativan in the system more often than not. The body is so accustomed to the drug that it begins exhibiting withdrawal symptoms as soon as the effects of Ativan start wearing off. If this sounds like your experience, you are in need of Ativan detox.

The point of detox is to eventually get to a place where the body and mind no longer need the substance being used. Some drugs are such that it is much easier to make a clean break and stop using altogether. That is not the case with Ativan. Experts say that stopping Ativan suddenly can lead to a dangerous situation. It is far better to gradually withdraw until detox is complete.

One of the unfortunate aspects of gradual withdrawal is the fact that it can take much longer. Whereas detoxing from some other substances can be completed in as few as five days, people withdrawing from Ativan can be subject to a 10-to-15-day detox period. The actual length of time depends on a patient’s progress and the severity of withdrawal symptoms.

We take the position that medically supervised detox is the best option. In the case of Ativan, medically supervised also means medication-assistant. Doctors prescribe medications to facilitate gradual withdrawal and control withdrawal symptoms. This is the safest and most effective way to detox from Ativan.

How to Detox Safely?

The safest way to detox from Ativan is with medical assistance. As previously stated, medically supervised detox is based on a philosophy of gradual withdrawal. This can be accomplished in either an outpatient or inpatient setting. The inpatient setting is more desirable because it is safer. When outpatient detox is chosen, patients must be extra diligent about following instructions.

Although not advised, some people do try to detox from Ativan on their own. Any such efforts should be done gradually, by stepping down the amount of the drug being used. It should also be done with the help of family members or friends who stand by to offer comfort and contact emergency services if necessary.

The key to safe detox – regardless of whether it is done in a clinic or at home – can be described in a single phrase: slow and controlled. By taking it slow, the body is given time to gradually adapt to the changes it is undergoing. The body will gradually purge itself of the toxins within and address the stress put on it as a result of lower Ativan exposure.

Certain behavioural therapies can make the detox process even safer. In cases of protracted withdrawal symptoms, behavioural therapies can mean the difference between getting through safely and being at risk of self-destructive behaviour.

Withdrawal Timeline and Length of Detoxification

It is not possible to put an exact length of time on every case of Ativan withdrawal. As previously mentioned, some people withdraw completely in 5 to 7 days while others take a couple of weeks. However, we can establish a timeline as a general guide. The timeline is divided into three stages: early stage, acute withdrawal, and protracted withdrawal.

Early-stage withdrawal begins within 6 to 12 hours of the patient’s last dose. During this early stage the patient will start feeling some of the psychological effects of withdrawal. These include panic attacks, anxiety, and the readability. They will start out fairly mild but increase over time.

Acute withdrawal usually begins on the second or third day as withdrawal symptoms gradually increase toward their peak. When they peak depends on how the patient responds. In most cases, a peak is reached somewhere between the fifth and tenth day. At that point withdrawal symptoms should begin to subside. They should be completely gone with a couple of weeks.

If they do not subside, the patient is considered to be in the protracted withdrawal stage. Protracted withdrawal symptoms can linger for as long as 10 to 15 days. In some cases, they can linger for up to 4 weeks. They will eventually subside by themselves, but when that will happen in any one case is impossible for doctors to say.

Unfortunately, a person who experiences protracted withdrawal might also experience what is known as the ‘rebound effect’. This is a situation in which some of the original symptoms for which the person began taking Ativan suddenly return. Rebound symptoms can continue through the end of detox and into rehab.

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Ativan Detox Protocol

Doctors follow a very strict protocol for Ativan detox. That protocol begins with individualised assessments. In other words, each patient is assessed as an individual case rather than lumping him or her in with every other Ativan user. An individual assessment establishes the psychological and physical condition of the patient.

Next is an assessment of the kind of treatment that would be most effective for the patient. A doctor might recommend an outpatient treatment through his/her own practice to one patient but a residential treatment programme for another. It is obviously advisable to heed the doctor’s treatment advice.

Third, Ativan detox protocol dictates determining what prescription medications will be used during withdrawal. The doctor may choose to continue using Ativan on a gradually reduced scale in order to facilitate safe withdrawal. On the other hand, a doctor may choose to use another benzodiazepine with a longer half-life, like diazepam for example. Even SSRI antidepressants are on the table.

Finally, Ativan detox protocol dictates continual monitoring of patient health throughout the withdrawal period. Patients must be monitored for the most severe withdrawal symptoms that could lead to injury or death. They must also be monitored for the onset of benzodiazepine withdrawal syndrome, the most severe condition that could result from withdrawal.

Medical Detox for Ativan Use

The short half-life of Ativan makes it one of the most powerful benzodiazepines on the market. Unfortunately, this is the same reason that withdrawal from the drug can be so extreme for some people. Medical detox is conducted with this in mind. Doctors and nurses are tasked with finding the safest way to conduct detox and simultaneously reduce the risk of complications.

The need for medical detox is even more profound in patients suffering from co-occurring disorders. Treating Ativan addiction without treating an underlying condition, like anxiety for example, could create a more serious problem for the patient. It takes skilled clinicians to properly address co-occurring disorders correctly.

Another issue with medical detox is dealing with rebound symptoms. How does a doctor treat those rebound symptoms without giving the patient more of the drug that he or she is trying to eliminate? The doctor will have to turn to alternative treatments or just instruct the patient to wait it out.

Ativan Detox Medications

Doctors have a number of medications at their disposal for Ativan detox. At the top of the list are other benzodiazepines with a longer half-life. These are drugs similar to Ativan but with longer lasting effects. They include diazepam, clonazepam, and chlordiazepoxide.

Certain antidepressants known as selective serotonin reuptake inhibitors (SSRIs) can be used in place of other benzodiazepines. These drugs might also be used in concert with benzodiazepines if a patient is being treated for a co-occurring disorder involving depression or anxiety. Examples of SSRI antidepressants include Prozac and Paxil.

Finally, doctors may prescribe additional medications to treat some of the symptoms of withdrawal. An analgesic might be prescribed for headaches, for example. An over-the-counter drug might be given to relieve nausea and vomiting; doctors might even order electrolytes to combat dehydration. The only thing is that they have to be very careful about what they prescribe due to interactions between medications.

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Gradual Dose Reduction for Ativan Withdrawal

The gradual dose reduction strategy for Ativan withdrawal has proved to be the safest and most effective way to help addicts get through detox. One of two strategies can be employed: a direct taper or a substitution taper. It is up to doctors to determine which strategy would be best on a case-by-case basis.

A direct taper method involves making steady reductions in the amount of Ativan administered without any substitute drugs being applied. The doctor would start with a maintenance dose that is based on what the patient is currently using. Over time, that amount would be gradually reduced until no more Ativan is being used.

The substitution taper method dictates switching from Ativan to a less powerful benzodiazepine first. For example, a doctor may substitute for diazepam given that the drug has a longer half-life compared to Ativan. Once the patient is stabilised on the substitute drug, gradual tapering can begin.

It is becoming increasingly more common for doctors to utilise the substitution taper method for Ativan withdrawal, especially using diazepam. The half-life of diazepam is between 20 and 100 hours, meaning the amount of the drug in the system is more consistent rather than the constant rise and fall of Ativan. Another benefit of diazepam is its low potency. This allows for very small dose reductions without extreme side effects.

The only disadvantage of using this drug in a substitute taper scenario is the fact that establishing equivalent doses is tricky. Some doctors make the switch from Ativan to diazepam gradually in order to ensure they get the dosage correct. Once they are sure, they complete the switch and then begin tapering down.

Psychological Interventions for Ativan Withdrawal

Withdrawing from Ativan and other benzodiazepines can be a bit more challenging because of the psychoactive effects of the drugs. You already know that Ativan withdrawal can produce symptoms including panic attacks and anxiety. In the most severe cases, they can combine with hallucinations to produce suicidal tendencies or other destructive behaviours. As such, psychological intervention is sometimes needed.

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Psychological interventions are comprised mainly of talking therapies that seek to calm the patient and help him or her embrace rational thinking. If the therapist can refocus the patient’s mind on other things, anxiety and panic can be reduced. In cases where panic attacks and anxiety are severe, psychological interventions may be necessary for weeks following the completion of detox.

There have been reports of anxiety and panic attacks lingering for weeks on end. The risk of lingering withdrawal symptoms is increased if the person being treated was originally prescribed Ativan to deal with anxiety or depression. In either case, psychological intervention may be necessary until those feelings subside.

You should know that rehab makes use of psychological interventions as well. Making the transition from detox to rehab can be as simple as continuing the psychotherapy treatments that began during detox.

Pharmacological Interventions for Ativan Withdrawal

The pharmacological interventions should be apparent based on what has been discussed thus far in this guide. Pharmacological interventions include the various medications that might be prescribed during the withdrawal process. These include other benzodiazepines, SSRI antidepressants, and over-the-counter medications to treat some of the less acute symptoms.

It has been mentioned numerous times in this guide that pharmacological intervention is necessary due to the danger associated with benzodiazepine withdrawal. Without it, patients could quickly find themselves at risk of injury or death during detox.

Once again, it is highly recommended that you do not attempt to withdraw from Ativan by yourself. If you are an Ativan addict or abuser, please get professional help. You need both pharmacological and psychological intervention to guarantee your safety.

Possible Complications from Ativan Withdrawal

The possible complications related to Ativan withdrawal are many. Furthermore, they range in severity. Beginning with the mild, dehydration is a very real complication. A combination of vomiting and diarrhoea can quickly dehydrate a patient to dangerous levels. When detox takes place in a clinical setting, medical staff are on hand to make sure the patient stays hydrated.

In patients who suffer from protracted withdrawal syndrome, additional complications are possible. For example, some patients exhibit long-term cognitive defects and/or psychosis. Others experience chronic muscle pain, weakness, and tingling and numbness in the extremities. When these complications linger after detox, they can have a profound impact on the rest of the patient’s life.

Increased heart rate and respiration can cause additional complications. If respiratory problems are significant enough, they can lead to an eventual respiratory arrest (the patient stops breathing). There is also the very real risk of convulsions, catatonia, delirium tremens, and mania.

Please note that these complications are less likely when Ativan withdrawal is managed by medical personnel. Experienced doctors and nurses know how to gradually taper patients in a safe and effective way. On the other hand, the risk of severe complications goes up the more drastic the withdrawal is. Trying to quit Ativan cold turkey increases the risk of complications considerably.

All the complications listed here are bad enough in and of themselves. But there are indirect consequences to consider as well. For example, if a patient were to start having seizures and fall, the fall could result in serious injury as well. Patients who begin to hallucinate and/or suffer from suicidal ideation can seriously injure themselves through destructive behaviours.

We cannot stress enough how important it is to get professional treatment for Ativan addiction. Do not try to stop using this drug on your own. Stopping is difficult enough without any complications. With complications though, your life could be dramatically changed – if not lost.

Ativan Addiction Treatment and Rehab

Treatment and rehab for Ativan addiction are available through the NHS and both outpatient and inpatient rehab clinics. A comprehensive treatment includes detox and rehab in a medically-assisted setting. Please note the importance of treatment as mentioned multiple times in this guide. If you are suffering from Ativan abuse or addiction, it is time for you to seek professional help.

Frequently Asked Questions

How will I know if I’m experiencing Ativan withdrawal?

If you are a regular Ativan user and you begin noticing withdrawal symptoms within 6 to 12 hours of taking your last dose, then it is likely you are experiencing withdrawal. Pay attention to any of the following: insomnia, anxiety, agitation, headaches, nausea and vomiting, blurred vision, and increased heart rate and respiration. The presence of withdrawal symptoms indicates a level of tolerance. If left untreated, tolerance can become an addiction in short order.

Can lorazepam withdrawal kill you?

Although fatalities during lorazepam withdrawal are rare in clinical settings, it is still very possible. Withdrawal symptoms can be severe enough to induce coma and eventual death. People who try to withdraw at home face an even bigger risk.

Can Ativan withdrawal cause seizures?

Ativan withdrawal can absolutely cause seizures. In fact, seizures are among the most common withdrawal symptoms related to this drug. They can be safely managed by medical personnel.

Does Ativan withdrawal cause depression?

Ativan withdrawal may result in certain long-term symptoms continuing for weeks after treatment. One of them is depression. However, becoming depressed after stopping the drug is not a guarantee. Your chances of not developing clinical depression are greater than your chances of developing it.

What does Ativan withdrawal feel like?

This is a very difficult question to answer if you have not experienced Ativan withdrawal yourself. Medical professionals observe that patients routinely feel anxious and panicky during withdrawal. Many also feel agitated as well. If you can imagine such feelings, throw in things like headaches, nausea, and diarrhoea. That is what withdrawal feels like.

What will help Ativan withdrawal?

Withdrawing from Ativan is made easier with the use of certain medications like diazepam and SSRI antidepressants. These other medications make it easier to gradually step down from the highest doses of Ativan, thereby reducing withdrawal symptoms to some degree. Over-the-counter medications can help with headaches, nausea, etc.

How do doctors ease Ativan withdrawal?

Withdrawal is eased by tapering down. Doctors can direct taper or substitute taper, depending on which method they believe is most appropriate. Substitute tapering with the use of diazepam is becoming more common. Note that tapering does not completely eliminate withdrawal symptoms. It only reduces their severity.

How do clinics minimise Ativan withdrawal?

Ativan withdrawal is minimised the same way it is eased: through the use of prescription and over-the-counter medications. Where necessary, psychotherapeutic interventions are also utilised. Therapists attempt to minimise the psychological effects of withdrawal through various talking therapies designed to calm and soothe the patient.

Is Ativan withdrawal dangerous?

In a word, absolutely. All benzodiazepines are difficult to withdraw from due to the way they interact with the GABA neurotransmitter. Ativan is especially dangerous because of its relatively short half-life. Patients should withdraw from Ativan only under the care of medical personnel.

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