How to wean off benzodiazepines safely
About 30.6 million people in the United States regularly take benzodiazepine drugs for anxiety and insomnia. The drugs can be highly addictive and quitting them cold turkey is very dangerous. It can cause painful withdrawal symptoms, seizures and even death.
“Basically, it’s like coming off of alcohol,” said Jennifer Marlin, DNP, a psychiatric nurse practitioner at Cape Cod Healthcare Human Services, Inc. “A benzodiazepine hits your brain just like alcohol does. So, just like if you stop alcohol cold turkey, it lowers your seizure threshold, so you have a higher propensity to seize. It’s the same receptor sites in your brain. There’s no difference between a Xanax and a glass of wine to your brain.”
Marlin regularly helps people who are dependent on benzodiazepine drugs, also known as benzos, wean off of them. The trick is to taper off slowly – and it takes some time. The average amount of time in her experience is one and a half years.
“I don’t think there is actually a norm,” she said. “I think every provider does it their own way.”
If you withdraw too fast, it can be very uncomfortable, she added, and the patient is not learning any supports in the meantime. “I think a slower process allows people to have autonomy. It allows people to pick up new ways of management,” she said.
Benzos Work Against You
Most people taking benzos don’t realize that the drugs actually lower or take away the brain’s ability to manage anxiety. The drugs decrease the brain’s ability to manage stress and process trauma because the person is basically checked out. That, in turn, makes their stress tolerance lower, the same way opioids lower people’s pain tolerance over time.
The side effects of benzos include depression, disinhibition, cognitive impairment, an increase in traffic accidents, higher tolerance, dependence, and accidental overdoses.
“I don’t think people realize how dangerous benzos are,” Marlin said. “Fifty percent of all overdose-related deaths have benzos in the bloodstream. Whether that’s prescribed or illicit, I’m not sure. The use of benzodiazepines in people over the age of 65 increases the risk of mortality by 50 percent if they fall.”
Harm Reduction is Paramount
The older the patient is and the longer they have been on the medication, the slower Marlin goes with their withdrawal. It could take years to humanely taper the dose of an older patient who has been on benzos for 30 years, she said. And some people simply can’t come off of them. In all cases, harm reduction is her preferred method.
“A common-sense approach is to reduce by a couple of tabs a month and talking to people about how they are doing while they are doing it,” Marlin said. “It’s about the journey not the destination. The person is going to come off the med. And if they don’t come off the med, you’ve got them successfully down to a dose they can manage.”
For example, if a patient is taking .5 milligrams of Ativan three times a day, Marlin would tell them that instead of 90 pills a month, she is only going to prescribe 88. The patient then gets to decide which two times during the month they can cut the pills in half or skip them. If that goes well, she reduces it further by a couple of pills the following month. If the patient is having a hard time, she might give them a two-month break from tapering before starting up again.
In her experience, that gives the patient more control over the situation, which also helps make them more successful, because ultimately, anxiety is a fear of not having control. While she is slowly tapering their dose, she works with the patient to help them develop other healthier coping skills to deal with their anxiety. Some patients might need to go on an antidepressant because they are also anti-anxiety meds.
One of Marlin’s patients weaned herself from a benzodiazepine with the help of the herb lavender. Every time she took her pill, she smelled lavender at the same time. Eventually when she didn’t take the pill anymore, she just smelled the lavender, and it helped to calm her.
“You have to really look at each individual person and see how bad is their stress, what’s going on in their life, and you have to be kind,” Marlin said. “You have to look at it from a harm reduction standpoint where you can’t cause more harm when you are trying to do good. I think the harm reduction approach is the most humane way to meet them where they are.”
