Guideline Outlines How to Taper Benzodiazepines Safely

14 Oct Guideline Outlines How to Taper Benzodiazepines Safely

Diazepam, a long-acting benzodiazepine, is the most common choice for dose tapering. One study examined the gendered impacts of drug supply contamination in British Colombia during the COVID-19 pandemic. In response to increased overdose risk and gendered violence, with particularly attention paid to the risk of sexual assault in the context of benzodiazepine use, women developed informal peer networks to support and check on each other stopping benzodiazepines safely during this time 76. These criteria were refined during the screening calibration process to prioritise studies where benzodiazepines were central to the intervention or findings. Studies focusing primarily on other substances were excluded to maintain relevance and specificity. Formal exclusion based on study quality was not performed, consistent with scoping review methodology.

The authors provided recommendations for healthcare practitioners, including educating adolescents and caregivers about counterfeit pills, securing medication storage, and distributing naloxone and FTS. Three linked studies from Victoria, Australia, form a comprehensive toxicosurveillance project monitoring illicit drug signals among patients with drug-related toxicity 66,67,68. The first study detailed the Emerging Drugs Network of Australia—Victoria (EDNAV) 68, a coordinated toxicosurveillance system integrating clinical and toxicological data across emergency departments, laboratories, and public health agencies. Using a risk-based framework, EDNAV facilitates timely detection of concerning drug signals and supports rapid harm reduction responses, including dissemination of alerts to the community.

• Although rare, these complications can become life-threatening if withdrawal occurs abruptly after prolonged or high-dose use.
• Ideally, your mentor should be someone who understands about benzodiazepine withdrawal or is prepared to read about it and learn.
• People who have been on low doses of benzodiazepine for a relatively short time (less than a year) can usually withdraw fairly rapidly.
• Tapering schedules vary depending on dosage, duration of use, and individual factors.

Prioritize Those at Highest Risk of Harm

• A slow tapering regimen, in my experience, is easily tolerated, even by people in their 80s who have taken benzodiazepines for 20 or more years.
• A reduction plan often includes replacing short-acting, more potent benzodiazepines (e.g., alprazolam) with longer-acting options (e.g., diazepam) guided by standardised dose equivalence protocols 37.
• At the start of my Benzodiazepine Withdrawal Clinic in 1982, no-one had much experience in benzodiazepine withdrawal.
• Inclusion of an approach with this framing of harm reduction points to the range of perspectives and practices in the field.
• Research shows that psychotherapy makes ketamine treatment more effective for depression.

This scoping review aims to identify literature referencing harm reduction approaches related to benzodiazepine use. A secondary objective is to thematically categorise the included studies and provide a narrative synthesis summary of current approaches in this area. Long-term, regular use of benzodiazepines is common and can lead to physical dependence and withdrawal when the dose is reduced or the medication is abruptly stopped. However, evidence has been lacking on the best tapering methods for the medications commonly prescribed for uses including sleep disorders and anxiety. Three studies examined approaches to benzodiazepine prescription 62,63,64.

One involved 100 people with long-term polydrug use in the UK, 61 where participants reported reduced injection of gel capsules but continued intravenous use with temazepam tablet formulations. The participants also reported increased criminal activity, higher drug prices, and substitution with riskier drugs such as flunitrazepam. Changes in the illicit drug market, such as the appearance of unfamiliar tablets and increased suspicion, desperation, and aggression, have been reported 61. The presence of these drugs has increased significantly since they first appeared on online drug markets in 2007, with 36 novel benzodiazepines reported to the EU early warning system between 2007 and 2023 24. These substances pose additional risks due to their largely unknown safety profiles and potency and are frequently detected in counterfeit pills 22.

BEFORE STARTING BENZODIAZEPINE WITHDRAWAL

The plethora of available options and varying advice can leave you feeling lost and unsure about what would work best for you. Get the latest insights on psychedelic therapy, mental health, and innovative treatments—straight to your inbox. A number of resources have been developed to help clinicians implement the recommendations in the guideline, including continuing medical education, pocket guides, and handouts, and downloadable tools such as benzodiazepine dose equivalents and decision flow charts.

One patient who has been taking BZDs for years may have little trouble tapering at a rate of 25% every 2-4 weeks. Another patient who has been taking BZD for less time may experience significant and persistent withdrawal symptoms even with a much slower taper. The Guideline emphasizes the importance of a patient-centered approach to tapering, starting slowly and adjusting the pace of the taper based on the patient’s response.

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The first study found participants preferred prescribed benzodiazepines over illicit use, citing benefits such as reduced costs, criminal activity, and the risk of contaminated pills 57. Notably, some participants in this study reported treatment termination from their prescriber if nonmedical benzodiazepine use was suspected or disclosed. The second study found most participants saw the benefits of agonist treatment, such as reduced criminal behaviour and greater stability 58. However, a subset of participants, particularly those with a history of hospitalisations and withdrawal attempts, felt that discontinuation was preferable to a maintenance approach, fearing that continued dependence would hinder their treatment decisions. For short-acting benzodiazepines, such as alprazolam, rebound symptoms may appear between doses,1 which typically leads to dose escalation with temporary relief of these symptoms,4 as in this case scenario.

Women who use drugs

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It is necessary to take the tablets several times a day and many people experience a “mini-withdrawal”, sometimes a craving, between each dose. Drug checking has emerged as a critical and adaptive harm reduction response to the growing challenges posed by novel benzodiazepines. The shift of drug use discussions and transactions to online spaces 66,67,68,69 highlights how use of unknown compounds when alone at home can render some traditional harm reduction advice insufficient. In this context, drug checking offers essential information about the substances people intend to use, further informing their decision-making and use of harm reduction strategies 44. Two qualitative studies explored the rescheduling of temazepam gel capsules.

The main manuscript text was written by CM and IN; all authors reviewed the manuscript. Join us in making a difference today by supporting BIC with a tax-deductible donation. At Isha Health, we are committed to providing the best possible care for individuals….

This temporary rule allows providers to prescribe Schedule II-V substances without requiring in-person evaluations, ensuring uninterrupted care for patients. The extension benefits mental health providers and patients, particularly those relying on telehealth for conditions like depression, anxiety, PTSD, and opioid use disorder. It also supports Ketamine-Assisted Psychotherapy (KAP) by maintaining remote accessibility to Schedule III medications like ketamine. While this extension offers relief, it underscores the need for permanent regulatory frameworks and proactive compliance monitoring. Behavioural changes were evident, consistent with research on the impact of drug checking results on behaviour modification 79. Behavioural modifications following drug checking intervention included disposal of adulterated samples, reduced benzodiazepine use, reduced injection frequency, and reduced solitary drug use 44, 51, 54.

There may even be circumstances when you need to stop for a while at a certain stage. A continuation schedule can follow later depending upon how you get on, and the doctor can continue prescribing in accordance with the new schedule. Your doctor’s agreement and co-operation is necessary since he/she will be prescribing the medication. Many doctors are uncertain how to manage benzodiazepine withdrawal and hesitate to undertake it. But you can reassure your doctor that you intend to be in charge of your own program and will proceed at whatever pace you find comfortable, although you may value his advice from time to time.