Frequently Asked Questions
Frequently Asked Questions About Benzodiazepines
While exact numbers are difficult to come by, an industry study conducted in 2012 found that 94 million prescriptions for benzodiazepines were filled annually in the United States.
Non-benzodiazepines (“Z-drugs”) are a class of psychoactive drugs that are benzodiazepine-like in nature. Non-benzodiazepine pharmacodynamics offer very similar benefits, side-effects, and risks as benzodiazepines. However, non-benzodiazepines have different chemical structures, and therefore differ from benzodiazepines on a molecular level.
Anything longer than 2-4 weeks.
Tolerance occurs when a higher dose of the drug is needed to achieve the same response achieved initially. Tolerance can be likened to a mini withdrawal for someone dependent on benzodiazepines, because the body demands the drug, and is technically receiving the drug but is too acclimated to the dose to respond in the intended manner.
Interdose withdrawal refers to the withdrawal effect experienced when the drug wears off prior to the next scheduled dose.
No. Patients, especially those still on the drug, tend to experience multiple “unexplained” issues and receive multiple incorrect diagnoses.
Yes. They impede the ability to retain information and form memories, which are essential for the most highly effective anxiety therapies, CBT and exposure therapy. They can also interfere with EMDR and first-line PTSD trauma processing therapies.
Is there such thing as a “low dose” of a benzodiazepine, and are you at risk for physical dependence when taking a “low-dose” of a benzodiazepine or “Z-drug”?
No. Some patients do not experience any detrimental side effects while taking benzodiazepines. In other cases, they do experience side effects — such as digestive issues, autoimmune or thyroid problems — which are misdiagnosed or not correctly attributed to the drug.
Frequently Asked Questions About Cessation
Sudden cessation of benzodiazepines is highly dangerous, with the possibility of seizures, severe and/or protracted withdrawal syndrome, and even death. A sensible taper plan can avoid the risk of seizures and mitigate, although not eliminate, withdrawal symptoms.
A taper is a gradual reduction in benzodiazepine dosage. Depending on your individual situation, a taper may last weeks, months, or even years.
“Half-life” is the amount of time for the concentration of drug in the blood to fall by 50 percent. This time-period will vary between individuals. Commonly used “short” half-life benzodiazepines include Ativan and Xanax, while “long” half-life benzodiazepines include Klonopin, Valium, and Librium. Of note, Valium and Librium are further transformed into “active” metabolites, each with their own elimination half-lives. This means that they accumulate gradually and are cleared more slowly from the body, which can provide an advantage in tapering, as it can help prevent withdrawal between doses. Elimination half-lives are often doubled or tripled in the elderly, due to less efficient metabolism in the liver.
Why aren’t all benzodiazepines available in smaller dosage amounts or liquid formulations to facilitate tapering?
There is not yet adequate awareness in the U.S for the FDA to require this of manufacturers.
Kindling refers to the neurological condition resulting from repeated withdrawal episodes from sedative–hypnotic drugs such as alcohol and benzodiazepines. Each withdrawal leads to more severe withdrawal symptoms than the previous withdrawal syndrome. Individuals who have had multiple withdrawal episodes are at an increased risk of severe withdrawal symptoms.
Many patients are told they are doing a slow taper, when they are actually doing a fast taper. The rule of thumb is not more than 5-10% of the current dose every 2-4 weeks. Most tapers take 10 months or much longer.
All benzodiazepines have an estimated dose that is equivalent to doses of other benzodiazepines. Unlike opiates, equivalence conversions between different benzodiazepines are not defined or required by the FDA. Evidence-based information on benzodiazepine equivalents is limited and many different sources report dissenting information. For this reason, some equivalence rates are listed in a range, as they are estimates and mostly based on clinical observation and judgement. People who take prescribed benzodiazepines are unique and will not all have identical experiences. An equivalent dose that works for one person may be too low or too high for another person taking the exact same drug and dose.
Do you have to crossover to another benzodiazepine to taper, or can you taper directly from the one you are taking?
Patients should become their own best advocate. A good prescriber allows you to control your own taper based on symptoms and proceed at a speed that is comfortable for you. Additionally a good prescriber will not require you to use adjunctive medication if this is against your wishes. If your prescriber doesn’t meet the minimum requirements in terms of knowledge and support, it is advisable to find someone more suitable to oversee your taper. Given the dangers of benzodiazepine cessation, you should not stay with a doctor who is not qualified or helpful. Some things to ask: Will the prescriber provide access to your “crossover” drug of choice (if you plan on crossing over)? Does the provider understand tapering can be a long term (longer than a year) venture that includes the risk of disability? Do they understand benzodiazepines and withdrawal both can be life altering and disabling? Are they willing to sign any disability forms, if needed? How often will they want to see you?
No. Many people avoid severe symptoms with a slow and sensible taper. Roughly 20 percent will experience no withdrawal symptoms at all, no matter the cessation method. But nobody should assume any given patient is in this minority. Anyone attempting to discontinue a benzodiazepine should err on the side of caution and taper slowly, and thus avoid or mitigate the most severe and/or protracted withdrawal symptoms. Some patients have horrible side effects on the drug, and relatively mild withdrawals. Everyone’s experience is different.
Does having benzodiazepine dependence and related injury mean that you have an “addiction” and should contact a rehab or detoxification program?
No. If you are able to follow your prescription, you are able to follow a taper plan. Most detox programs end up causing more problems for benzodiazepine-dependent patients. Many have even stopped treating benzodiazepine patients altogether, because tapering properly is a drawn-out process, and benzodiazepine detox is high risk with a low success rate. If a rehab program promises you a successful detox, do not be fooled, as there are no certainties with benzodiazepine cessation. We are contacted regularly by patients, even those who went to the most “prestigious” rehabs, who were made worse, only to have their symptoms denied, be sent home to either reinstate and have to taper again, or ride out the post acute withdrawal symptoms for months to years, waiting to get their life back. Evidence shows that overly-rapid detox or taper puts the patient at risk for a longer, more debilitating withdrawal.
Why does it feel like your prescriber disbelieves that the benzodiazepine has caused injury? Why do they imply that the symptoms are “all in your head”?
Why do some people have no issues with taking benzodiazepines, while others become injured or disabled?
Currently there is not enough knowledge about the way benzodiazepines affect the entire body and how different patients respond to them. This is why further research is desperately needed. At present, there is no way to screen a patient for the risk of being injured. We do know these injuries can occur, through no fault of their own, in patients adhering to their prescribed dose.
How can there be so little knowledge or help available if benzodiazepines and “Z-drugs” are such commonly prescribed drugs?
This is a silent epidemic, driven by ignorance on the part of doctors, patients, and society at large. Many are too sick or ashamed to speak up, or unaware they are affected. By the time they discover the cause they often are too sick to even advocate for themselves, and are silenced or ignored when they attempt to.
Withdrawal and healing from benzodiazepines can be very time consuming, varying greatly between individuals. Tapering may last weeks, months, and even years. Likewise, post-cessation healing can last weeks, months, and, in some cases, many years.
There is not enough evidence in the literature to recommend a specific adjunctive medication at this time. In this area, too, more studies are needed, as there are no drugs currently approved to treat benzodiazepine withdrawal. Off label, very small studies (less than 40 patients) and case reports have shown that drugs such as gabapentin, carbamazepine, and propranolol may help as aids in withdrawal. Trazodone, mirtazapine, and quetiapine may be helpful in some patients for insomnia. But not everyone finds them helpful; they must be tapered off; and they carry the potential of causing their own withdrawal syndrome. Some patients have reported relief of withdrawal symptoms with the use of CBD oil or medical marijuana. Many patients are able to successfully complete a taper without the use of adjunctive medication.
When used long term (more than 2-4 weeks) all doses, even the lowest available doses of each benzodiazepine can cause patient injury and require a taper. We have received many reports of patients being injured on doses that are typically regarded in medicine as small, such as .25 milligrams of xanax, .5 milligrams of ativan, 5 milligrams of valium or .125 milligrams of klonopin.
Frequently Asked Questions About BIC
Benzodiazepine-injured patients, who grew tired of suffering in silence, decided to take action and spread awareness and advocacy for patients about the benzodiazepine epidemic.
Yes , BIC has 501(c)3 non-profit status
BIC provides resources on their website, instigates media coverage and research, and networks with medical professionals to break the silence around this epidemic and to bring benzodiazepine injury to the forefront of medical discussion.
Absolutely not. BIC exists to educate on the dangers of benzodiazepines only.
No. Due to the complicated and potentially disabling nature of benzodiazepine cessation, we firmly believe each patient has the right to a fully informed consent in choosing if and when to take benzodiazepines, and to choose a taper rate of their own when they decide to stop taking them.
We hope to prevent further patient injury by providing accurate information on the risks of benzodiazepine use. We understand that the most complicated and dangerous aspect of benzodiazepine use is cessation; the last thing we want to see is an outright ban on benzodiazepines that would result in thousands of unnecessary deaths.