In the first week of tapering off, your doctor may reduce your dose as much as 30% to get you to a safe amount. After that first leap, the steps become smaller, usually 5% to 10% of the original dose. Depending on your situation, your doctor may reduce your dose on a monthly, weekly, or even daily basis.

Management of stimulant withdrawal

However, benzodiazepines can cause physical dependence and withdrawal even when they are taken as directed. The difference in these characteristics dictates the clinical applicability of the drugs. Oxazepam, temazepam, and chlordiazepoxide which are low potency benzodiazepines are well tolerated with low toxicity levels. Alprazolam, lorazepam and clonazepam are high potently clinically used to treat panic disorders and serve as adjuncts for treating many other diseases [1]. Due to their toxic effect on the central nervous system, appropriate care is necessary with BZD.

Alcohol Withdrawal Scale8

A therapist or other mental health professional can offer support with navigating these effects and helping improve your overall quality of life during the withdrawal period. Experiencing rebound symptoms means the symptoms you had before taking benzodiazepines come back even stronger than before. Patients who have been using large amounts of cannabis may experience psychiatric disturbances such as psychosis; if necessary, refer patients for psychiatric care. Inhalant withdrawal symptoms can begin anywhere between a few hours to a few days after ceasing inhalant use. As for management of mild alcohol withdrawal, with diazepam as in Table 11.

Benzodiazepines Withdrawal

However, no set schedule for a taper has been validated in the current literature. Oral route of administration, or swallowing a pill, is by far the most common route of administration (Brandt et al., 2014a; McLarnon et al., 2014; Pauly et al., 2012). Smoking and injecting benzodiazepines are both relatively uncommon and have primarily been documented in samples with SUDs or severe patterns of substance use (e.g., injection heroin use). Even in these populations, the prevalence of smoking benzodiazepines is low (i.e., 3–7%) (Lankenau et al., 2012a; Navaratnam and Foong, 1990; Vogel et al., 2013). In this review, we use the term misuse to broadly encompass any use of a prescription medication without a prescription, at a higher frequency or dose than prescribed, or for the feelings of the drug rather than its medical indication.

However, until further research has established the efficacy of the medication for this purpose, it is not recommended for use in closed settings. Offer symptomatic medication as required for symptoms such as headaches, nausea and anxiety (Table 3). Patients severe benzodiazepine withdrawal syndrome with cognitive impairments as a result of alcohol dependence should be provided with ongoing vitamin B1 (thiamine) supplements. After withdrawal is completed, the patient should be engaged in psychosocial interventions such as described in Section 5.

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It also reduces the expression of mRNA transcripts such as CaMKIIa, BDNF, GIF, c-fos, NGFIa which are necessary for regulating synapses and plasticity [42]. The suppression of CaMKIIa by diazepam has a long-lasting effect leading to a limited neuronal response to changes in intracellular calcium and decreased response by GABA-A receptors [42]. Every person’s body chemistry is different, and the time it takes for someone to develop a tolerance for benzos will vary from person to person. The amount of benzos someone uses and other factors can also influence how quickly they develop a tolerance to benzos. If you believe that you or a loved one may be overdosing on benzodiazepines or any other drugs, call 911 immediately.

• This dose of diazepam (up to a maximum of 40mg) is then given to the patient daily in three divided doses.
• For this reason, physicians are cautious about prescribing benzos long-term.
• Despite the increase in risk, less than 13% of the non-overdose deaths were trauma related.
• While there is no FDA-approved medication to treat benzodiazepine withdrawal, your doctor may also prescribe other medications to help you manage withdrawal symptoms.
• Oral route of administration, or swallowing a pill, is by far the most common route of administration (Brandt et al., 2014a; McLarnon et al., 2014; Pauly et al., 2012).

These symptoms can be managed using anti-psychotic medications and will usually resolve within a week of ceasing stimulant use. When used appropriately they are very effective in treating these disorders. However, when used for an extended period of time (e.g. several weeks), dependence can develop.

• Providing withdrawal management in a way that reduces the discomfort of patients and shows empathy for patients can help to build trust between patients and treatment staff of closed settings.
• Prescribing interventions, substitution, psychotherapies and pharmacotherapies can all contribute.
• Dosing differs depending on which benzodiazepine you take, as well as things like your size, gender, and whether you’re used to taking them.
• Much like other prescription drugs (e.g., opioids, stimulants) (McHugh et al., 2015), benzodiazepines are most commonly misused for reasons aligned with the drug’s indication (e.g., sleep, anxiety).
• Benzodiazepine abuse is common in those on methadone maintenance treatment (MMT), so special consideration must be taken for those withdrawing from the drugs while on MMT [68].

Little is known about benzodiazepine misuse in older adults, despite high rates of prescribing in this group (Maust et al., 2018; Schepis et al., 2018b). Rates of tranquilizer and sedative misuse are lower in adults over the age of 50, as compared to younger age groups (Maust et al., 2018; Schepis et al., 2018b), and are lower than rates of prescription opioid misuse in this age group (Blazer and Wu, 2009). Yet, the prevalence of lifetime and past-year tranquilizer misuse increased among this age group from 2002–2003 to 2012–2013 (from 4.5% to 6.6% and 0.6% and 0.9%, respectively; Schepis and McCabe, 2016). In addition, the proportion of individuals with past-year tranquilizer misuse who are over the age of 50 doubled from 2005–2006 to 2013–2014 (from 7.9% to 16.5%; Palamar et al., 2019). Benzodiazepine misuse and dependence appears to be more common among older adults with a prescription or who are treated in psychiatric settings (Landreat et al., 2010; Voyer et al., 2009; Yen et al., 2015).

Who Uses Benzodiazepines?

Much like other prescription drugs (e.g., opioids, stimulants) (McHugh et al., 2015), benzodiazepines are most commonly misused for reasons aligned with the drug’s indication (e.g., sleep, anxiety). Over 75% of NSDUH respondents with past-year tranquilizer misuse reported that they misused prescription tranquilizers to help with conditions for which benzodiazepines are indicated, such as sleep, tension, or emotions (CBHSQ, 2018b). The finding that self-treatment or coping motives are the most common reasons for benzodiazepine misuse has been replicated across heterogenous samples (see Supplementary Materials).

Short Opioid Withdrawal Scale7

Long-term use can lead to addiction as the user can develop benzodiazepine dependence. For this reason, physicians are cautious about prescribing benzos long-term. The same U-M study also identified that for every ten additional days of medication prescribed, a patient’s risk of long-term use nearly doubled over the next year. Although prevalence estimates for misuse of specific benzodiazepine formulations appear to coincide with prescribing rates, certain benzodiazepines are more preferred than others, potentially reflecting higher abuse liability. However, these studies were published over two decades ago, and therefore preference might—at least in part—reflect availability during this period.