Benzodiazepines are a highly potent class of medication and it’s quite common for patients to experience withdrawal symptoms. The most common strategy for getting off benzodiazepines is what’s known as tapering.
Tapering is the act of gradually decreasing the amount of the drug in the body with the intention of lowering the necessary dosage or ceasing drug use entirely. It’s much safer than quitting cold turkey (which is never recommended for any type of drug use) and can allow for benzo withdrawal while minimizing its risks. There are several different tapering strategies a person could employ, some being safer and more effective than others.
How to Get Off Benzodiazepines: Tapering Strategies
Benzodiazepine withdrawal is usually managed through the gradual process known as tapering. The medication dosage is gradually reduced over a period of weeks or months to minimize withdrawal symptoms, allowing the body to adjust to decreasing amounts of the medication.
The key to doing so successfully is to take things slowly. Very slowly. Trying to reduce one’s dosage too quickly can result in post-acute withdrawal symptoms known as PAWS, a serious condition whose psychological symptoms can mimic disorders such as agitated depression; generalized anxiety, panic, or obsessive-compulsive disorders; schizophrenia; and can last over a year. The risk is independent of how long a person has been using benzodiazepines, as even just a few weeks of use can put them at risk of PAWS.
The Wrong Way
Let’s start with the wrong way to taper off benzodiazepines, which also just so happens to be one of the most standard methods recommended by physicians: the four-week taper. This involves patients reducing their dosage by 25% each week. Experts agree that this is far too fast, and the vast majority (as many as 90%) experience withdrawal symptoms with this approach.
Another common, but equally misguided, method is to skip doses, usually one dose a week for several weeks. The results are just as disastrous as the four-week taper if not more so, as the irregular decline can lead to greater fluctuations in the body leading to more severe withdrawal symptoms.
The Right Way
There are two recommended ways to get off benzodiazepines safely. One is the “cut and hold” approach, and the other is the “micro-taper”. Both involve much smaller dosage reductions, and over a much longer period.
The “cut and hold” reduces dosage by no more than 5-10% at a time. This dosage is maintained until any symptoms of the new decreased dose have stopped, typically a few weeks. Similarly, micro-tapering” also decreases the dosage by no more than 5-10% per month. The difference is that this method involves daily decreases in dosage (via micrograms) for an extremely gradual tapering off.
If you or someone you know is struggling with benzodiazepine addiction and wants to get off these medications, it’s essential to seek professional help and guidance. The process of safely discontinuing benzodiazepines should be done under the supervision of a healthcare professional. Here are some steps that are typically involved in the benzodiazepine withdrawal process: Reach out to a healthcare professional who specializes in addiction or substance abuse. They will assess your situation, provide guidance, and develop an individualized tapering plan.
Tips for Successful Tapering:
All tapering should be done under the supervision of a medical professional. Do not attempt to do so on your own.
- Consider switching from a short-acting- to a long-acting benzodiazepine
- Dose multiple times a day (but keep the total daily dosage the same)
- Use medications to address withdrawal side effects, but proceed with caution as the risk of drug interactions is high
- Liquid tapering allows for much greater control of the dosage when allowed (not all benzodiazepines are liquid soluble)
- Purchase tapering strips to help track dosage reductions
Get Help Treating Benzodiazepine Withdrawal
Benzodiazepines were initially created to be a safer and less addictive replacement for barbiturates. Though many risks were lessened and generally safe when used as prescribed and under medical supervision, benzodiazepines are far from harmless. They can still result in withdrawal, addiction, or even death — even when taken exactly as prescribed (it’s partially why these prescription sedatives are a controlled schedule IV substance monitored by the DEA). This risk is heightened when deliberately misused (as nearly 5 million Americans have done) or combined with other substances.
If you or a loved one has been using benzodiazepines (prescribed or otherwise) for more than a few weeks, you may be at risk. Talk to a mental health professional today to learn your best options to get off benzodiazepines.