Intravenous or intramuscular lorazepam may be used in patients with hepatic disease, pulmonary disease or in the elderly where there is risk of over-sedation and respiratory depression with diazepam. In these cases, we recommend that patients should be started immediately on a SML dose regimen, while monitoring the withdrawal severity (CIWA-Ar ratings) and clinical signs of tachycardia and hypertension. A fixed dose regimen can be Benzodiazepine withdrawal safely used in such patients in case adequate trained personnel are not available or if outpatient treatment is advised.
Symptom-triggered treatment (STT)
However, there is still a possibility of severe reactions and withdrawal symptoms. Withdrawal symptoms from short-acting drugs, such as Xanax, may come on faster than withdrawal symptoms from long-acting drugs, such as Valium. Most people do okay with tapering their benzodiazepines at home with the help of their primary care doctor or psychiatrist. You should plan to stay in touch with your doctor regularly during the tapering process, either by phone or during office visits.
- These substances pose additional risks due to their largely unknown safety profiles and potency and are frequently detected in counterfeit pills 22.
- Protracted withdrawal is a long-term withdrawal syndrome that may come and go for several months.
- Current treatment approaches for benzodiazepine dependence primarily involve deprescribing through initial stabilisation and/or conversion to prescribed benzodiazepine followed by stepwise dose reduction with the goal of eventual abstinence 14, 37.
The study reported an 89% reduction in benzodiazepine prescriptions over two years, with no decrease in patient caseloads 62. Two qualitative studies explored individuals’ perceptions of benzodiazepine use and treatment 57, 58. 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.
The Time is Now!
Prescribing and policy interventions demonstrated variable impacts, often influenced by broader systemic factors. Critically, a clear gap remains in harm reduction approaches for those not seeking treatment, highlighting a need for inclusive, flexible and pragmatic responses. There is also a need for more robust evaluation of harm reduction interventions to strengthen the evidence base and inform practice.
Blood samples from 24 severely affected patrons (median age 22) revealed polysubstance use, with toxicology confirming a median of four drugs per individual. MDMA, ketamine, and cocaine were most common, and nearly half of the samples contained NPS despite none reporting intentional use. Approaches to care for people prescribed benzodiazepines vary significantly, reflecting differences in how harm reduction is interpreted and applied. 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.
Protracted withdrawal syndrome refers to symptoms persisting for months or even years. A significant minority of people withdrawing from benzodiazepines, protracted withdrawal syndrome which can sometimes be severe. Tinnitus occurring during dose reduction or discontinuation of benzodiazepines is alleviated by recommencement of benzodiazepines. Dizziness is often reported as being the withdrawal symptom that lasts the longest. The evidence on the effectiveness of agonist treatment for benzodiazepine dependence remains limited and methodologically diverse.
Benzodiazepine withdrawal can be managed with a gradual dose reduction, which will cause milder symptoms that come and go in waves. During the first week, you can also expect physical symptoms like headaches and hand tremors. The risk factors for DT were analyzed by Ferguson et al.12 and further factors are tabulated in Table 4. During alcohol use and withdrawal the increase in CNS dopamine levels contribute to the clinical manifestations of autonomic hyper arousal and hallucinations.
Growing evidence for drug checking
A person should always withdraw from benzos under the guidance of a healthcare professional. They should never quit benzos suddenly without first consulting a professional and developing a plan with them. The primary difference between these drugs is the length of time they stay active in the body.
If the person’s original symptoms return once they stop taking prescription benzodiazepines, doctors may also prescribe a different class of medications, or other drugs or therapies, to help manage them during withdrawal. Benzo withdrawals can be severe, and life threatening complications can occur. A healthcare professional should supervise benzo withdrawal to help monitor and manage the symptoms. There is a risk that people who quit benzodiazepines without a taper may experience a life-threatening grand mal seizure.
Search our physician member directory
Other therapies, including counseling and cognitive behavioral therapy (CBT), may be helpful for people looking to manage symptoms without relying on other drugs. Dependence appears to occur in a similar way to how it does with other addictive drugs. Dopamine is a type of messenger that is partly responsible for how humans feel pleasure. Along with these symptoms, the person may experience severe cravings for the drug or other drugs to sedate them. People who have been through acute withdrawal often say that this phase is the most difficult.
Benzodiazepine withdrawal
- According to the American Psychiatric Association (APA), withdrawal symptoms from short-acting benzodiazepines peak on the second day and improve by the fourth or fifth.
- These criteria were refined during the screening calibration process to prioritise studies where benzodiazepines were central to the intervention or findings.
- Approaches to care for people prescribed benzodiazepines vary significantly, reflecting differences in how harm reduction is interpreted and applied.
- A 2021 review included five studies that explored the rescheduling of alprazolam in Australia from Schedule 4 to Schedule 8 in 2014 59.
- In parallel, regulatory responses, such as medication rescheduling, have been used to address broader issues related to benzodiazepine harm and dependence 38.
Similarly, drug and alcohol treatment services tend to focus on cessation and deprescription, which are options that may not address the needs of those not seeking to stop using benzodiazepines in the short term. 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. 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.
The best way to detox from a benzodiazepine is under medical supervision and in the care of addiction specialists. Whether you are struggling with addiction, mental health or both, our expert team is here to guide you every step of the way. Don’t wait— reach out today to take the first step toward taking control of your life.
If you prefer someone else, any primary care physician or psychiatrist can help you taper your dose. Long-term treatment after benzodiazepine withdrawal will depend on your reasons for taking them in the first place and your reasons for quitting. If you have a psychiatric condition that was managed by the benzodiazepines, you will need an alternative plan to manage your condition. Your doctor will help make an individualized tapering schedule based on your current dose and particular circumstances. From 1996 to 2013, the number of people filling benzodiazepine prescriptions increased by 67%. Benzodiazepine abuse and dependence has become more significant among all age groups, from teens to elderly adults.
Table 2 gives a clinical description of alcohol withdrawal syndrome by severity and syndromes.4,5,6 Figure 2 depicts the time course of symptom evolution. 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.
Some clinics adopt a policy of refusing all requests for BZDs from patients not known at their practice. Another approach for after-hours emergency presentations would be to prescribe enough BZDs to maintain the patient until their regular practitioner is able to review them. The latter approach reduces the risk of seizures and while discouraging doctor shopping. Benzodiazepine users may present requesting a script for a specific BZD or they may present in a variety of other ways e.g. stating they need BZDs to assist in heroin or alcohol withdrawal, or to treat an anxiety disorder or sleep problems. If withdrawal symptoms become severe, doctors may prescribe other medications. They will make this decision on a case-by-case basis, depending on the type and severity of the symptoms affecting the individual.