Of those with a history of benzodiazepine prescription, the most common indication was anxiety (81.2%), followed by sleep (11.3%), other psychiatric condition (5.6%), and pain or medical condition (2%). There was significant variability in the length of the longest benzodiazepine prescription; however, more than half of participants (54.6%) reported a duration of at least one year and 13.4% reported duration of more than 10 years. Most participants reported that benzodiazepines had been described by their prescriber as short-term treatment for acute symptoms (55.4%).
To reduce the risk of acute withdrawal reactions, use a gradual taper to reduce the dosage or to discontinue benzodiazepines. Developing tolerance means that, over time, you need more of the drug to get the same effect. If you stop taking benzodiazepines for a few days and then start again at the same dose, you may increase your chances of an overdose. This is because you lose the tolerance you have built up, after you stop taking it, even if just for a few days.Mixing benzodiazepines with other depressants such as alcohol and/or opioids can be dangerous. Combining these substances increases the risk of overdose, because they all have sedative properties.
ASAM Recommendations for Alcohol Withdrawal Management
The dose of BZD given also positively correlated with increased risk of an overdose death 50. Patients with a lower risk of relapse are those taking a daily dose of 10 mg diazepam equivalent or less at the start of tapering, and those who have made a substantial dose reduction themselves before the start of tapering. The results of the present review are qualified by several methodological limitations.
Types of benzodiazepines
- Women are more likely to report misusing benzodiazepines to cope with negative affect, and associations between psychiatric distress and benzodiazepine misuse appear to be stronger in women than in men.
- Other studies have shown that there is no correlation between BZD use and cognitive decline.
- Future research is needed to identify individuals who are most vulnerable to alcohol and benzodiazepine co-use and motives for this combination.
Most treatment studies have focused on benzodiazepine tapers in people with long-term benzodiazepine prescriptions for anxiety or insomnia, and do not specifically focus on misuse (Morin et al., 2004; Otto et al., 2010). The development of effective interventions to mitigate benzodiazepine misuse is particularly important to reduce overdose risk. Of note, adding cognitive-behavioral therapy (particularly, interoceptive exposure-based treatment) to a slow benzodiazepine taper enhances success among people seeking to discontinue benzodiazepine prescriptions (Otto et al., 2010; Otto et al., 1993). Accordingly, such approaches may also have promise for the treatment of benzodiazepine misuse, particularly given the strong link between anxiety and benzodiazepine misuse (McHugh et al., 2018; McHugh et al., 2017). Worldwide rates of SHA use disorder are also similar to those reported in the U.S. In the same study referenced above conducted in the Ubon Ratchathani Province region of Thailand, 0.6% of respondents met criteria for DSM-IV benzodiazepine abuse and 0.2% of respondents met criteria for dependence (Puangkot et al., 2010).
What is my risk?
Most recent benzodiazepine-related work has focused either on misuse in the context of opioid use (14–16) or tranquilizer and/or sedative medication misuse but not benzodiazepines specifically (17, 18). The lack of information about misuse among older adults is particularly striking because they are prescribed benzodiazepines at the highest rates, are most at-risk of related adverse events, and are using alcohol and other substances more than prior cohorts (19, 20). A recent systematic review of benzodiazepine and opioid misuse in older adults (21) found just one study that estimated potential benzodiazepine misuse among older adults in the U.S. (22). Given their widespread use, abuse potential (23), and related risks, what is alcoholism surprisingly little is known about benzodiazepine misuse.
I did cite Wagner et al3 in order to point out reduction in benzodiazepine use as a result of increased overseeing by states. The authors assume my “alarm and disapproval” of provisions in Section 175 of the MIPPA and https://ecosoberhouse.com/ that I would “like to see benzodiazepine prescription coverage denied to those on Medicare.” The authors also assert that I advocate for denying benzodiazepines to people under age 65. The fact is that I wholeheartedly support provisions in Section 175 of the MIPPA. At no point in my letter did I make a case for exclusion of benzodiazepines for those on Medicare or for people under age 65.
As a result, we cannot determine how likely it is that someone will experience adverse side effects when taking benzodiazepines. Your health care professionals know you best, so talk to them if you have questions or concerns about risks of taking benzodiazepine medicines. Other studies have assessed different methods of counseling on BZD dangers and alternatives to patients alongside a benzo withdrawal timeline gradual taper off the drugs. One study compared the mainstay of treatment with a standardized interview/counselling approach to treatment 72.
Benefits of Holistic Medication Tapering and Addiction Treatment
Future research is needed to identify individuals who are most vulnerable to alcohol and benzodiazepine co-use and motives for this combination. Other notable populations in need of additional research include those with psychiatric disorders and individuals with benzodiazepine prescriptions. The few studies in psychiatric samples published to date have focused exclusively on samples of patients who have been prescribed benzodiazepines and only one has examined benzodiazepine misuse. Two studies examined dependence on benzodiazepines (e.g., worry about a missed dose, desire to stop use) and found that dependence is common, with estimates in the range of 29–47% (de las Cuevas et al., 2003; de las Cuevas et al., 2000; Yen et al., 2015). One study specifically assessed benzodiazepine misuse (i.e., taking benzodiazepines at a frequency or dose higher than prescribed); this study of elderly people receiving inpatient psychiatric hospitalization found that 7.9% misused benzodiazepines (Yen et al., 2015).
Associated Data
The 10-item version used in the present study has good psychometric properties (Yudko et al., 2007). For the purpose of this analysis, participants with no drug use in the past year were coded as a “0” on the DAST. For example, he cites a 2001 article by van Haaren, Lapane, and Hughes as a source of evidence that “in many cases benzodiazepines were overprescribed.” In fact, this paper does not provide evidence that benzodiazepines were overprescribed. Van Haaren concluded that the triplicate prescription policy “did affect prescription and administration of benzodiazepines in nursing homes in states with, versus without, a triplicate prescription policy. If you or someone you love is experiencing the long-term effects of benzodiazepine abuse, remember that help is available. With proper treatment, you can recover from benzodiazepine addiction consequences and live a healthy, fulfilling life.
Withdrawing from Opiate or Opioid Abuse
There is therefore a need to develop a better evidence base and treatment paradigm for these patients. There are no standard tapering regimens and the rate of tapering depends on the starting dose, duration of therapy, risk of relapse and how well tapering is tolerated by the patient. In general, at higher doses (e.g. greater than 10 mg diazepam equivalents per day) the dose may be tapered more rapidly. Once the patient achieves 10 mg the dose should be tapered more slowly (e.g. 5 mg twice daily for two weeks, then once daily for two weeks, and then 2 mg daily for two weeks and then cease).
