Compass Opioid Stewardship 2026 Virtual Symposium-FREE NO CME-09-Benzo Taper-Scott Weirner-Handouts

09-Benzo Taper-Scott Weirner-Handouts

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This presentation summarizes benzodiazepine tapering principles based on the 2025 American Society for Addiction Medicine (ASAM) Benzodiazepine Tapering Guidelines, aimed at clinicians across outpatient, inpatient, ED, and behavioral health settings (excluding palliative/end-of-life care). It distinguishes physical dependence (a biologic adaptation to repeated medication use) from benzodiazepine use disorder, noting survey data suggesting only a small minority of benzodiazepine users meet criteria for a use disorder; tapering is therefore most often pursued for safety reasons.<br /><br />Key guideline takeaways emphasize ongoing, individualized risk–benefit assessment to determine whether continued prescribing or tapering is appropriate, with more frequent reassessment for higher-risk patients (e.g., those also taking opioids, those with substance use disorder, obstructive sleep apnea, or certain psychiatric comorbidities). Shared decision-making is central, and abrupt discontinuation should be avoided due to potentially life-threatening withdrawal (including seizures and delirium) and recurrence of the original symptoms (anxiety, insomnia, seizures).<br /><br />Most tapers can be done outpatient, but inpatient or medically managed residential care should be considered when risk is high (e.g., imminent harm, dangerous drug interactions/overdose, falls, suicidality, severe cardiopulmonary disease, uncontrolled psychiatric illness, cognitive impairment, prior withdrawal seizures/delirium, very high-dose dependence). Recommended initial taper pace is generally 5–10% dose reductions every 2–4 weeks, typically not exceeding 25% every 2 weeks, with flexibility to slow, pause, or maintain a lower dose if needed; some tapers may take months to years. Transitioning to a longer-acting benzodiazepine may help selected patients.<br /><br />Adjunctive supports include psychosocial interventions (CBT, CBT-I), treatment of co-occurring medical/psychiatric conditions (including SUD), and harm reduction strategies such as naloxone provision for patients at opioid overdose risk. Practical pearls include building rapport, not abandoning patients, avoiding PRN dosing during tapers, using pharmacists/resources, and viewing any dose reduction as meaningful harm reduction. Evidence cited suggests many patients can successfully discontinue with structured follow-up and may experience cognitive and symptom improvements, though some observational data on mortality after discontinuation remain unclear due to unknown taper methods.

Keywords

benzodiazepine tapering

ASAM 2025 guidelines

physical dependence vs use disorder

risk-benefit assessment

shared decision-making

withdrawal seizures and delirium prevention

outpatient vs inpatient taper criteria

5-10% dose reduction schedule

transition to long-acting benzodiazepine

CBT and CBT-I adjunctive support