Importantly, the Guideline emphasizes that residential or inpatient treatment may be necessary for patients with SUD who are unlikely to safely and effectively participate in outpatient tapering. It also emphasizes that BZD prescribing and tapering considerations should never be used as a reason to discontinue or disrupt a patient’s medications for SUD treatment, including buprenorphine and methadone. It is a good idea to make out a dosage reduction schedule for the initial stages (see below) and to give your doctor a copy. You may need to mention the importance of flexibility, so that the rate of dosage tapering can be amended at any time.
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During the first week, you can also expect physical symptoms like headaches and hand tremors. The brochure above covers Ativan along with other benzodiazepines, such as Valium, Xanax, Klonopin, and Restoril (generic names diazepam, alprazolam, clonazepam, and temazepam, respectively). It also covers commonly used sleeping pills such as zolpidem (brand name Ambien). A variety of withdrawal schedules from several benzodiazepines are illustrated on the following pages. Schedules such as these have worked on real people, but you may need to adapt them for your own needs.
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- While ketamine withdrawal is not typically life-threatening, it can lead to severe mood swings, cognitive fog, and increased depression, requiring close monitoring and support.
- Among people taking benzodiazepines for longer than six months, about 40% experience moderate to severe withdrawal symptoms when they quit suddenly.
- Initially, established in Europe, drug checking has expanded across North America in response to the opioid crisis and fentanyl contamination in the drug supply 79.
- These findings have been repeated in several other studies of elderly patients taking benzodiazepines long-term.
You should plan to stay in touch with your doctor regularly during the tapering process, either by phone or during office visits. There is a risk that people who quit benzodiazepines without a taper may experience a life-threatening grand mal seizure. If you go into withdrawal without tapering, you also risk experiencing delirium and hallucinations that cause you to lose touch with reality—a terrifying and dangerous experience. Your doctor will help make an individualized tapering schedule based on your current dose and particular circumstances. The best way to quit benzodiazepines is to avoid withdrawal by asking your doctor to taper down your dose.
- Voluntary tranquilliser support groups (self-help groups) can be extremely helpful.
- Changes in the illicit drug market, such as the appearance of unfamiliar tablets and increased suspicion, desperation, and aggression, have been reported 61.
- Lorazepam (brand name Ativan) is a fairly popular benzo, as the effect lasts for what is considered a “medium” length of time (the half-life is hours).
- Yet some people might prefer to reduce faster and some might go even slower.
The onset of benzodiazepine withdrawal depends on the specific medication you are taking. Short-acting drugs like Xanax (alprazolam) and Ativan (lorazepam) leave the system quicker, which means withdrawal symptoms can appear in as little as eight to 12 hours. Initially, established in Europe, drug checking has expanded across North America in response to the opioid crisis and fentanyl contamination in the drug supply 79.
One study evaluated the use of social workers in a telephone-based poison centre, where they assisted with tablet identification and overdose information 78. During the 20-month study, social workers answered 17,616 tablet identification calls. Overdose prevention and drug safety information was provided to 37.7% of callers.
Unlike benzodiazepines, ketamine is not a traditional sedative but can still lead to withdrawal symptoms and psychological dependence. While there is no FDA-approved medication to treat benzodiazepine withdrawal, your doctor may also prescribe other medications to help you manage withdrawal symptoms. The medication Romazicon (flumazenil) is sometimes used off-label for withdrawal symptoms. Benzodiazepine withdrawal can be risky, so it is best to work with a doctor. Depending on which benzodiazepine you are currently taking, your doctor may want to switch you to a different one before your taper begins. Short-acting benzodiazepines complicate withdrawal with too many ups and downs.
None of Dr. Kernisan’s website or group information should be considered a substitute for individualized medical assessment, diagnosis, or treatment. Any comments Dr. Kernisan may make regarding an individual’s story or comments should not be construed as establishing a physician-patient relationship between Dr. Kernisan and a caregiver, or care recipient. Lorazepam (brand name Ativan) is a fairly popular benzo, as the effect lasts for what is considered a “medium” length of time (the half-life is hours). A systematic search was conducted by RML, with articles reviewed by CH, IN, CM and RML.
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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. Notably, benzodiazepine agonist treatment during the COVID-19 pandemic has shown positive outcomes, such as successful isolation completion and improved health outcomes, with minimal adverse events 56. These results reflect the broader trend of flexible harm reduction approaches during the pandemic 81. The guideline is not meant for palliative care and end-of-life physicians, the authors noted. This review highlights drug checking as the most prevalent and pragmatic harm reduction strategy currently available for benzodiazepine use, particularly in the context of continuously emerging novel substances. Conversely, interventions related to prescribing and policy have shown mixed effects, often shaped by broader structural and systemic factors.
The third study explored harm reduction service provision across 34 cities during the pandemic, and highlighted the introduction and continuation of a prescribed benzodiazepine stabilisation protocol in Dublin 32. One study in New York City focused on young people (aged 18–30) engaged with harm reduction services 74. Young participants differed from older individuals in terms of sociodemographics, health and social risk factors, and drug use patterns.
Direct interventions
Slow withdrawal means tapering dosage gradually, usually over a period of some months. The aim is to obtain a smooth, steady and slow decline in blood and tissue concentrations of benzodiazepines so that the natural systems in the brain can recover their normal state. As explained in Chapter 1, long-term benzodiazepines take over many of the functions of the body’s natural tranquilliser system, mediated by the neurotransmitter GABA. As a result, GABA receptors in the brain reduce in numbers and GABA function decreases.
This post delves into the relationship between ketamine, tapering off medications, and the growing role of psychedelics in mental health care. It explores how ketamine is used therapeutically, the importance of careful medication tapering, and how psychedelics like psilocybin and MDMA are being integrated into treatment plans. The article provides insights into current research, safety considerations, and the potential benefits of combining these approaches in modern psychiatry.
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Inclusion of an approach with this framing of harm reduction points to the range of perspectives and practices in the field. These discussions are valuable for fostering critical reflection and advancing understanding among clinicians and researchers, especially considering the often limited formal training in harm reduction within medical education 86. Two qualitative studies explored individuals’ perceptions of benzodiazepine use and treatment 57, 58.
Other Medical Society Support
Along with the dose of the tablet, it’s also important to consider the schedule that is prescribed. It could be prescribed just at bedtime, or sometimes it’s prescribed “as needed” two or three times per day, for anxiety (or even agitation, especially in people who have Alzheimer’s or a related dementia). Finally, your doctor may appreciate receiving some literature on benzodiazepine withdrawal, for example the articles mentioned under Further Reading at the end of Chapters 1 & 3 and of this chapter. Poster with engaging graphics and stopping benzodiazepines safely key guideline takeaways to increase awareness and understanding among patients on safe tapering of benzodiazepines.
A clear need for population-specific approaches
People who have been on low doses of benzodiazepine for a relatively short time (less than a year) can usually withdraw fairly rapidly. Those who have been on high doses of potent benzodiazepines such as Xanax and Klonopin are likely to need more time. An understanding doctor may also be the one to offer support as well as advice.
