The drugs treat disorders such as anxiety, panic attacks and insomnia, but stopping them abruptly can compound users’ symptoms and even endanger their lives.
“Prescriptions for benzodiazepines like Xanax, Ativan and Valium have been trending down since 2016, in part because of doctors’ concerns. Even so, these medications are considered quick and efficacious, and they remain among the most commonly prescribed drugs in the country to treat conditions including anxiety and sleep disorders. In 2019, an estimated 92 million benzodiazepine prescriptions were dispensed in the United States, according to the Food and Drug Administration.
Current guidelines recommend prescribing the lowest effective dose for the shortest possible duration, usually less than four weeks. But patients tend to stay on them longer than that. A F.D.A. review found that in 2018 about half of patients took them for two months or longer. Sometimes patients stay on them for years without regular check-ins to see if the drugs are still needed or well tolerated, said Dr. Edward K. Silberman, a professor emeritus of psychiatry at the Tufts University School of Medicine who has frequently written about benzodiazepines.
Because patients can develop a physical dependence within several weeks of steady benzodiazepine use, going off the drugs — even after a short period — requires a gradual process. However, many practitioners are not well trained in tapering the prescriptions. To make the process clearer, in March experts at the American Society of Addiction Medicine released new guidelines for dosage reduction that were developed with funding from the F.D.A.
“It’s absolutely insane to pressure people to get off and to withdraw people abruptly,” Dr. Silberman said.
[..] even though benzodiazepines have been around since the ’60s, some doctors are unaware of how best to help their patients stop taking these drugs. This is in part because there is no one-size-fits-all tapering strategy. It is the withdrawal symptoms, some patients say, that make it necessary for them to continue to access these drugs while slowly tapering. [..]
The A.S.A.M.’s new guidelines for reducing a patient’s dosage of a benzodiazepine draw heavily from clinical experience given the sparse and limited research on tapering. They recommend that clinicians assess the risks and the benefits of ongoing benzodiazepine prescribing at least every three months, and, when tapering, consider reducing the current dose by 5 to 10 percent every two to four weeks. The guidelines also say patients who have been taking benzodiazepines for years may require more than a year of tapering, and should be monitored even after the drug has been discontinued.”
Full article, C Caron, New York Times, 2025.5.14