So it’s important to offer an older adult the right approach, and a lot of support, when it comes to getting off these drugs. There are particularly compelling reasons why older people should withdraw from benzodiazepines since, as age advances, they become more prone to falls and fractures, confusion, memory loss and psychiatric problems (see Chapter 1). So, for those starting out, many previous users will testify that almost anyone who really wants to can withdraw from benzodiazepines.
Combining Tapering With Holistic Support
Two studies focused on reviews of drug vendors and strategies to reduce the harms of polysubstance use 70, 71. The first study highlighted advocacy for home drug testing 70, whereas the second identified discussions on low dosing, controlling drug use frequency, and safer drug use at home 71. Drug checking emerged as the most widely reported harm reduction approach for benzodiazepine use, with consistent positive outcomes across studies. 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.
Even by halving these tablets the smallest reduction one could easily make is the equivalent of 2.5mg diazepam. (Some patients become very adept at shaving small portions off their tablets). Because of limited dose formulations, it may be necessary to switch to diazepam even if you are on a fairly long-acting benzodiazepine of relatively low potency (e.g. flurazepam Dalmane). Liquid preparations of some benzodiazepines are available and if desired slow reduction from these can be accomplished by decreasing the volume of each dose, using a graduated syringe. The DEA has extended its telemedicine flexibilities for prescribing controlled substances through December 31, 2025.
It has a half-life of up to 200 hours, which means that the blood level for each dose falls by only half in about 8.3 days. The only other benzodiazepines with similar half-lives are chlordiazepoxide (Librium), flunitrazepam (Rohypnol) and flurazepam (Dalmane), all of which are converted to a diazepam metabolite in the body. The slow elimination of diazepam allows a smooth, gradual fall in blood level, allowing the body to adjust slowly to a decreasing concentration of the benzodiazepines. The switch-over process needs to be carried out gradually, usually in stepwise fashion, substituting one dose at a time.
- Twelve different novel benzodiazepines were detected, with clonazolam and etizolam most common.
- Longer-acting benzodiazepines like Klonopin (clonazepam) can stay in the system longer, which means it can be one to two days or even longer before withdrawal symptoms start.
- Technological and analytical limitations remain a challenge, especially when detecting novel benzodiazepines at low concentrations.
- Many doctors are uncertain how to manage benzodiazepine withdrawal and hesitate to undertake it.
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This study identified specific drugs, including heroin, novel benzodiazepines, and nonprescribed methadone, are linked to increased overdose risk in youth. The key risk factors for overdose include homelessness, drug detoxification, and psychological distress. A later study reviewed harm reduction strategies for adolescents in public health settings 75.
The funders had no decision-making role in designing and conducting the systematic reviews, data collection, analysis, and interpretation of the data or approval privilege on the recommendations. As requested, FDA officers provided nonbinding feedback and technical support to the guideline panel and methodological team. These guidelines are intended to help inform clinical decision making by prescribers and patients. They are not intended to be used for the purposes of restricting, limiting, delaying, or denying coverage for or access to a prescription issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice. A concise six-page guide that provides evidence-based strategies for safely tapering patients from benzodiazepines.
There are some older patients — often with severe chronic anxiety — who seem to overall benefit from a low dose of these drugs. For these reasons, geriatricians almost never prescribe a drug like Ativan to older adults, and we’re big fans of trying to get our older patients to taper off of benzodiazepines, whenever possible. As in, 62% older adults who received this tool — a brochure with a quiz followed by key information — discussed stopping the medication with a doctor or pharmacist, and 27% were successful in discontinuing their benzodiazepine. The brochure includes a handy illustrated guide on slowly and safely weaning a person off these habit-forming drugs. Technological and analytical limitations remain a challenge, especially when detecting novel benzodiazepines at low concentrations. The trade-off between cost, speed, and accuracy proves difficult to balance.
Study selection criteria
However, benzodiazepines can cause physical dependence and withdrawal even when they are taken as directed. A rapid review focused on etizolam 77 suggests established harm reduction advice, such as avoiding the combination of benzodiazepines with other sedatives, remains relevant and increasingly important due to the growing prevalence of nonmedical benzodiazepine use. Analyses indicate that novel psychoactive substances (NPS), including benzodiazepines, are widely available for purchase online 5, 25. Drug cryptomarkets, operating on the darknet, are an overlay of the internet accessible only via specialised software and facilitate the anonymous sale of illicit drugs through online marketplaces 26. Since the 2011 launch of the Silk Road, numerous such platforms have emerged, and despite significant law enforcement efforts, cryptomarkets continue to play a persistent role in the global drug trade 25, 26. A recent analysis of 14 drug cryptomarkets (1st February 2024 to 31st January 2025) revealed that benzodiazepines comprised the third-largest percentage (8.1%) of all drug listings 27.
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Tapering means taking progressively smaller doses over the course of a few weeks or months. Longer-acting benzodiazepines like Klonopin (clonazepam) can stay in the system longer, which means it can be one to two days or even longer before withdrawal symptoms start. If you have been using benzodiazepines for longer than six months, suddenly stopping your dose can cause grand mal seizures and delirium—this is why it’s best to involve your doctor or healthcare professional in your withdrawal process. The primary difference between these drugs is the length of time they stay active in the body.
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You may need to resist attempts from outsiders (clinics, doctors) to persuade you into a rapid withdrawal. The classic six weeks withdrawal period adopted by many clinics and doctors is much too fast for many long-term users. Actually, the rate of withdrawal, as long as it is slow enough, is not critical. Whether it takes 6 months, 12 months or 18 months is of little significance if you have taken benzodiazepines for a matter of years.
Nasal Ketamine and Ketamine Infusion
For this reason, MAPS for Recovery emphasizes a personalized, medically supervised benzodiazepine tapering approach to safely manage withdrawal symptoms and reduce potential health risks. Determining whether you should taper off benzodiazepines under professional medical supervision, such as at Maps for Recovery, depends on several important factors. At Maps for Recovery, we prioritize your safety and comfort by creating individualized tapering plans designed to minimize withdrawal symptoms and complications, ensuring a smoother, safer path to recovery. Three studies focused on a “safer supply” of substances during the COVID-19 pandemic to support individuals in isolation 32, 55, 56. The first study involved prescribing long-acting benzodiazepines at 50% of the patient’s usual dose for six residents with high-dose dependence (8% of the sample) 55.
- 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.
- Some participants preferred a discontinuation approach to treatment 58, emphasising the importance of choice and individualised treatment.
- Critically, there is a notable absence of harm reduction interventions for individuals who are not seeking abstinence or formal treatment.
- MDMA-assisted psychotherapy is an emerging treatment that combines therapy with MDMA to enhance emotional processing, helping individuals with PTSD and mental health challenges achieve deeper healing and recovery.
One study evaluated a ‘no benzodiazepine’ policy that was implemented across six outpatient mental health clinics in 2016 in the United States 62. To reduce overdose deaths, the clinics removed benzodiazepines from the approved medication list and provided patients with individualised treatment plans, including psychoeducation, psychotherapy, slow taper, and inpatient detoxification. The study reported an 89% reduction in benzodiazepine prescriptions over two years, with no decrease in patient caseloads 62. Approaches to care for people prescribed benzodiazepines vary significantly, reflecting differences in how harm reduction is interpreted and applied.
Benzodiazepines are a group of central nervous system stopping benzodiazepines safely depressants used to treat anxiety, insomnia, and seizures. Benzodiazepines are among the most commonly prescribed medications in the United States. Several types of benzodiazepines are sold under popular brand names like Valium (diazepam), Xanax (alprazolam), and Klonopin (clonazepam). Drug checking emerged as the most widely used harm reduction strategy, with nine studies employing various methods for drug sample analysis. These methods range from laboratory analyses to portable point-of-care methods.
If you or a loved one are considering tapering off benzodiazepines or ketamine, this guide will provide key insights from recent research, practical steps for discontinuation, and expert-backed strategies to support a smoother transition. Aleksandra E. Zgierska, MD, PhD, with Penn State College of Medicine in Hershey, Pennsylvania, pointed out in an accompanying editorial that patients who experienced tapering helped develop the guideline at each step. The guideline, with lead author and Chair Emily Brunner, MD, with the Hazelden Betty Ford Foundation in Minneapolis recommends a slow tapering process, adjusted according to each patient’s response. For those who have been using the medication for years, tapering can take a year or more, the authors noted. Estimates suggest that 10 to 25% of people who take benzodiazepines for extended periods experience what’s known as protracted withdrawal. Withdrawing from benzodiazepines can be a difficult, even dangerous process.
The second study outlined the provision of ‘up to 30 mg daily’ to prevent benzodiazepine withdrawal for more than 70 residents; the specific type of benzodiazepine was not specified 56. Both studies reported positive outcomes, with the first study finding low rates of adverse events (intoxication, diversion), no overdoses, and successful isolation completions. The second study revealed improvements in residents’ general health, behaviour, and compliance with public health measures, as reported by staff 56.