Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits

Centers for Disease Control and Prevention. Multiple Cause of Death Data 2000-2020 on CDC WONDER Online Database. December 2021 ed. CDC WONDER: Centers for Disease Control and Prevention, National Center for Health Statistics; 2021.

Soyka M. Treatment of benzodiazepine dependence. N Engl J Med. 2017;376(12):1147-1157. https://doi.org/10.1056/NEJMra1611832

Article  CAS  PubMed  Google Scholar 

Lader M. Benzodiazepines revisited--will we ever learn? Addiction. 2011;106(12):2086-2109. https://doi.org/10.1111/j.1360-0443.2011.03563.x

Article  PubMed  Google Scholar 

US Food and Drug Administration. FDA Drug Safety Communication. Updated 09-23-2020. Accessed August 1, 2024. https://www.fda.gov/media/142368/download

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health 2023 Detail Files. Retrieved from https://datafiles.samhsa.gov. 2024.

Symphony Health Metys™, data years 2013-2023. June 2024.

Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996-2013. Am J Public Health. 2016;106(4):686-688. https://doi.org/10.2105/AJPH.2016.303061

Article  PubMed  PubMed Central  Google Scholar 

Jones CM, McAninch JK. Emergency department visits and overdose deaths from combined use of opioids and benzodiazepines. Am J Prev Med. 2015;49(4):493-501. https://doi.org/10.1016/j.amepre.2015.03.040

Article  PubMed  Google Scholar 

Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiatry. 2015;72(2):136-142. https://doi.org/10.1001/jamapsychiatry.2014.1763

Article  PubMed  Google Scholar 

Gerlach LB, Maust DT, Leong SH, Mavandadi S, Oslin DW. Factors associated with long-term benzodiazepine use among older adults. JAMA Intern Med. 2018;178(11):1560-1562. https://doi.org/10.1001/jamainternmed.2018.2413

Article  PubMed  PubMed Central  Google Scholar 

Kan CC, Hilberink SR, Breteler MH. Determination of the main risk factors for benzodiazepine dependence using a multivariate and multidimensional approach. Compr Psychiatry. 2004;45(2):88-94. https://doi.org/10.1016/j.comppsych.2003.12.007

Article  PubMed  Google Scholar 

Tournier M, Benard-Laribiere A, Jollant F, et al. Risk of suicide attempt and suicide associated with benzodiazepine: A nationwide case crossover study. Acta Psychiatr Scand. 2023;148(3):233-241. https://doi.org/10.1111/acps.13582

Article  CAS  PubMed  Google Scholar 

Dodds TJ. Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature. Prim Care Companion CNS Disord. 2017;19(2):16r02037. https://doi.org/10.4088/PCC.16r02037

Article  Google Scholar 

Santo L, Rui P, Ashman JJ. Physician office visits at which benzodiazepines were prescribed: findings from 2014-2016 National Ambulatory Medical Care Survey. Natl Health Stat Report. 2020;(137):1-16.

Google Scholar 

Curran HV, Collins R, Fletcher S, Kee SC, Woods B, Iliffe S. Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psychol Med. 2003;33(7):1223-1237. https://doi.org/10.1017/s0033291703008213

Article  CAS  PubMed  Google Scholar 

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. American Psychiatric Association; 2022:1120.

Blanco C, Han B, Jones CM, Johnson K, Compton WM. Prevalence and Correlates of Benzodiazepine Use, Misuse, and Use Disorders Among Adults in the United States. J Clin Psychiatry. 2018;79(6). https://doi.org/10.4088/JCP.18m12174

Department of Justice Announces DEA Seizures of Historic Amounts of Deadly Fentanyl-Laced Fake Pills in Public Safety Surge to Protect U.S. Communities. US Dept of Justice; September 30, 2021. https://www.justice.gov/opa/pr/department-justice-announces-dea-seizures-historic-amounts-deadly-fentanyl-laced-fake-pills

Agarwal SD, Landon BE. Patterns in outpatient benzodiazepine prescribing in the United States. JAMA Netw Open. 2019;2(1):e187399-e187399. https://doi.org/10.1001/jamanetworkopen.2018.7399

Article  PubMed  PubMed Central  Google Scholar 

O’Brien C P. Benzodiazepine use, abuse, and dependence. J Clin Psychiatry. 2005;66 Suppl 2:28-33.

PubMed  Google Scholar 

Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, Mackey S. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ. 2017;356:j760. https://doi.org/10.1136/bmj.j760

Article  PubMed  PubMed Central  Google Scholar 

Park TW, Saitz R, Ganoczy D, Ilgen MA, Bohnert AS. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ. 2015;350:h2698. https://doi.org/10.1136/bmj.h2698

Article  PubMed  PubMed Central  Google Scholar 

US Food and Drug Administration. FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. 2016.

Kroenke K, Alford DP, Argoff C, et al. Challenges with implementing the Centers for Disease Control and Prevention opioid guideline: a consensus panel report. Pain Med. 2019;20(4):724-735. https://doi.org/10.1093/pm/pny307

Article  PubMed  Google Scholar 

US Food and Drug Administration. FDA Drug Safety Communication: FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering. US Food and Drug Administration. 2019. https://www.fda.gov/media/122935/download?attachment

Coffin PO RC, Oman N, Sinchek K, Santos G-M, Faul M, et al. Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain. PLoS ONE. 2020;15(5):e0232538.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Pétursson H. The benzodiazepine withdrawal syndrome. Addiction. 1994;89(11):1455-1459. https://doi.org/10.1111/j.1360-0443.1994.tb03743.x

Article  PubMed  Google Scholar 

GRADE Working Group. Welcome to the GRADE working group. Accessed June 6, 2024, https://www.gradeworkinggroup.org/

RAND. Delphi Method. Accessed June 6, 2024, https://www.rand.org/topics/delphi-method.html

Schünemann H, Brożek J, Guyatt G, Oxman A, eds. GRADE Handbook. Updated October 2013. https://gdt.gradepro.org/app/handbook/handbook.html

Griffiths RR, Weerts EM. Benzodiazepine self-administration in humans and laboratory animals--implications for problems of long-term use and abuse. Psychopharmacology (Berl). 1997;134(1):1-37. https://doi.org/10.1007/s002130050422

Article  CAS  PubMed  Google Scholar 

Lee JY, Farrell B, Holbrook AM. Deprescribing benzodiazepine receptor agonists taken for insomnia: a review and key messages from practice guidelines. Pol Arch Intern Med. 2019;129(1):43-49. https://doi.org/10.20452/pamw.4391

Article  PubMed  Google Scholar 

Pottie K, Thompson W, Davies S, et al. Deprescribing benzodiazepine receptor agonists: evidence-based clinical practice guideline. Can Fam Physician. 2018;64(5):339-351.

PubMed  PubMed Central  Google Scholar 

Vinkers CH, Olivier B. Mechanisms Underlying Tolerance after Long-Term Benzodiazepine Use: A Future for Subtype-Selective GABA(A) Receptor Modulators? Adv Pharmacol Sci. 2012;2012:416864. https://doi.org/10.1155/2012/416864

Article  CAS  PubMed  PubMed Central  Google Scholar 

Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169. https://doi.org/10.1136/bmj.38623.768588.47

Article  PubMed  PubMed Central  Google Scholar 

Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 2000;162(2):225-233.

CAS  PubMed  PubMed Central  Google Scholar 

Poly TN, Islam MM, Yang HC, Li YJ. Association between benzodiazepines use and risk of hip fracture in the elderly people: a meta-analysis of observational studies. Joint Bone Spine. 2020;87(3):241-249. https://doi.org/10.1016/j.jbspin.2019.11.003

Article  CAS  PubMed  Google Scholar 

Rivasi G, Kenny RA, Ungar A, Romero-Ortuno R. Effects of benzodiazepines on orthostatic blood pressure in older people. Eur J Intern Med. 2020;72:73-78. https://doi.org/10.1016/j.ejim.2019.10.032

Article  CAS  PubMed  Google Scholar 

Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170. https://doi.org/10.1111/bdi.12609

Article  PubMed  PubMed Central  Google Scholar 

Bandelow B, Allgulander C, Baldwin DS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders. World J Biol Psychiatry. 2023;24(2):79-117. https://doi.org/10.1080/15622975.2022.2086295

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