New Guideline on Benzodiazepine Tapering

The social and economic consequences of chronic benzodiazepine use are summarised in Table 3 (Chapter 1). At the start of my Benzodiazepine Withdrawal Clinic in 1982, no-one had much experience in benzodiazepine withdrawal. Yet, as explained in Chapter 1, there was strong pressure from the patients themselves for help and advice on how to withdraw.

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• This post delves into the relationship between ketamine, tapering off medications, and the growing role of psychedelics in mental health care.
• When seeking customized medications like ketamine treatment, compounding pharmacies offer….
• The five included studies suggest some potential benefits, although the evidence is not as robust as that for opioid agonist treatments 33 or as extensively explored as potential methamphetamine agonist treatment options 80.

This guideline was developed to help clinicians determine when the risks of continued BZD prescribing outweigh the benefits for a given patient and how to safely taper the medication when indicated. The development of this Guideline was generously funded by grant U01FD from the US Food and Drug Administration, US Department of Health and Human Services. The contents are those of the authors and do not necessarily represent the official views of nor an endorsement by the FDA and Department of Health and Human Services or the US Government.

Nearly all patients who take BZD regularly for more than a month will develop physical dependence, while only 1.5% will develop a BZD use disorder. In performing a rigorous, systematic review of the evidence around tapering BZD, the guideline development committee was surprised by the paucity of research given that the need for BZD tapering is a relatively common clinical situation. Examples of slow withdrawal schedules are given at the end of this chapter. As a very rough guide, a person taking 40mg diazepam a day (or its equivalent) might be able to reduce the daily dosage by 2mg every 1-2 weeks until a dose of 20mg diazepam a day is reached. From 20mg diazepam a day, reductions of 1 mg in daily dosage every week or two might be preferable.

Agonist treatment

Psychedelic therapy has gained much attention recently for its potential to treat mental health disorders such as depression, anxiety, PTSD, addiction, and more… The UK Parliament’s research briefing examines the growing body of evidence supporting psychedelics such as psilocybin and ketamine for treating depression, PTSD, and other mental health conditions. While promising, regulatory barriers and the need for further research remain key challenges.

This review notes limitations both in methodology and in the evidence found. The search strategy’s focus on the term ‘harm reduction’ may have excluded studies that employed approaches aimed at reducing harm without explicitly naming this term. Furthermore, the wide variety of terms used to describe novel benzodiazepines made it challenging to create an exhaustive search strategy. The inclusion of any studies that used the term ‘harm reduction’ has led to the inclusion of some approaches, such as abstinence-focused treatment, that may not align with most conceptualisations of harm reduction. Finally, as this review focused on the academic literature available, it omits benzodiazepine-related harm reduction approaches by individual organisations, particularly peer-led organisations, such as peer-to-peer advice and related resources. A complicating factor in benzodiazepine consumption is the proliferation of counterfeit products on the illicit drug market.

Patient Handouts

‍Tapering off benzodiazepines and ketamine can be challenging but achievable with the right approach. Benzodiazepines and ketamine are widely used in clinical practice for their sedative, anxiolytic, and antidepressant effects. However, both substances carry risks of dependence and withdrawal, making proper tapering strategies essential for safe discontinuation.

• 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.
• The growing presence and easy availability of novel benzodiazepines only add complexity to efforts aimed at reducing benzodiazepine-related harm.
• This temporary rule allows providers to prescribe Schedule II-V substances without requiring in-person evaluations, ensuring uninterrupted care for patients.

Is Ketamine a Horse Tranquilizer?

Careful implementation of the Guideline, including avoiding patient abandonment, will be critical for preventing harm. Health care systems, which are already overburdened, are likely to identify a large population of patients who would benefit from BZD tapering. It will be important for health care systems and policymakers to consider how to triage those at highest risk and leverage existing health care resources to meet the needs of the population. When measuring success it will be critical to measure patient-centered outcomes (eg, functionality, patient experience) as well as adverse events (eg, protracted withdrawal) instead of using reductions in BZD prescribing as the sole measure of success. Many providers across disciplines struggle with helping patients taper or even broaching the subject.

Ketamine-assisted psychotherapy (KAP) is at the forefront of innovative treatments for mental health conditions, particularly for individuals… Chinese New Year 2025, also known as the Spring Festival, is a time of joy, reunion, and renewal. Families gather, traditions are honored, and the new year is welcomed with hope and excitement. However, beneath the festive atmosphere, many people experience stress and anxiety due to family expectations, social gatherings, and cultural obligations. The pressure to meet societal and familial expectations can sometimes overshadow the joy of the occasion.

The must-read information brochure on Ativan and older adults

They reported adopting other harm reduction practices, such as using smaller doses, avoiding solitary use, and carrying naloxone 44, 51. Most participants who used FTS incorporated it into their daily routines because of their convenience 52. A separate study revealed that, after using FTS, participants reduced their injection frequency, avoided solitary drug use, and decreased benzodiazepine use 51.

The second study, as part of the EDNAV project, examined 1112 emergency department presentations (2020–2022), identifying 183 cases (16.5%) involving novel benzodiazepines, predominantly in young males (median age 24) 66. Twelve different novel benzodiazepines were detected, with clonazolam and etizolam most common. Nearly half of the cases involved multiple novel benzodiazepines, often combined with psychostimulants like methylamphetamine. Prescription benzodiazepines and psychotropic medications were also frequently co-detected, often without patient disclosure. The third study from EDNAV focused on drug toxicity at music festivals 67, reviewing 1603 medical presentations, of which 228 involved illicit drug toxicity.

For this reason, triazolam can be stopped abruptly without substitution of a long-acting benzodiazepine. If withdrawal symptoms occur, you could take a short course of diazepam starting at about 10mg, decreasing the dosage as shown on Schedule 2. The same approach applies to the non-benzodiazepines zolpidem and zaleplon which both have half-lives of 2 hours. Older people can withdraw from benzodiazepines as successfully as younger people, even if they have taken the drugs for years. These findings have been repeated in several other studies of elderly patients taking benzodiazepines long-term.

Some policies emphasise discontinuation, recommending rapid cessation in cases of misuse, which the authors defined as behaviours such as doctor shopping, early refills, or reports of lost prescriptions, even if this goes against the patient’s wishes 64. A “no benzodiazepine” policy implemented in outpatient mental health settings incorporated individualised treatment plans but enforced cessation as a non-negotiable outcome 62. While some approaches are framed as harm reduction, they may differ from core harm reduction principles commonly described in the literature, such as supporting patient autonomy, incremental progress, and continuity of care without punitive measures 85. This highlights the variability in the operational definition of harm reduction and its application in clinical policies. Some policies may adopt the term “harm reduction” without fully embodying its foundational principles, reflecting a broader lack of consensus.

One study found that positive FTS results were linked to safer drug use behaviours over a 28-day period, including using smaller amounts, and having naloxone on hand. Particularly when FTS were used on benzodiazepines, which resulted in a 20-fold reduction in use after a positive FTS result 54. Although some patients may prefer a quicker taper, this must be balanced with the severity of potential withdrawal symptoms. In my experience, the only exception to the general rule of slow reduction is triazolam (Halcion). This benzodiazepine is eliminated so quickly (half-life 2 hours) that you are practically withdrawn each day, after a dose the night before.

The service reached 6635 individuals potentially at risk from nonmedical use of prescription medications. The intervention was found to be practical, feasible, and quickly implementable. As described in Chapter 1, long-term use of benzodiazepines can give rise to many unwanted effects, including poor memory and cognition, emotional blunting, depression, increasing anxiety, physical symptoms and dependence. All benzodiazepines can stopping benzodiazepines safely produce these effects whether taken as sleeping pills or anti-anxiety drugs.

The growing presence and easy availability of novel benzodiazepines only add complexity to efforts aimed at reducing benzodiazepine-related harm. Addiction specialists, psychiatrists, and medical toxicologists have the specialty expertise to help our colleagues in primary care and other disciplines effectively support their patients through BZD tapering. As this Guideline is released and implemented, we hope that you will explore ways to help other clinicians in your community rise to this challenge. This week ASAM released the new Joint Clinical Practice Guideline on Benzodiazepine Tapering.