3
Key Takeaways
Î BZDs should not be discontinued abruptly in patients who are likely to
be physically dependent on the medication and at risk for withdrawal
(See Table 2); rather, their medication dosage should be tapered
gradually over a period of time under clinical supervision.
The following are ten key takeaways of this Guideline for adult patients
who have been taking BZDs regularly and may be at risk for physical
dependence
a
:
1. Clinicians should base clinical recommendations regarding
continued BZD prescribing on ongoing assessment of the risks
and benefits of continued BZD use as well as those of tapering/
discontinuation (See Table 1). Tapering is generally indicated when
the risks of continuing BZD medication outweigh the benefits.
a. Clinicians should conduct more frequent risk–benefit assessments of continued
BZD prescribing for patients who:
i. Are concomitantly taking opioid medication.
ii. Have a substance use disorder (SUD).
iii. Have additional risk factors for adverse effects, such as co-occurring physical
conditions (e.g., obstructive sleep apnea) or mental health conditions (e.g.,
bipolar spectrum disorder).
b. Clinicians should use caution if utilizing urine drug screen immunoassays for
BZDs due to known limitations.
c. Clinicians should consider the maternal–fetal dyad when assessing the risks and
benefits of continued BZD prescribing in patients who are pregnant.
d. Clinicians should taper BZDs in most older adults (i.e., ≥65 years) unless there
are compelling reasons for continuation.
2. Clinicians should consider approaches to BZD tapering in
collaboration with patients and their care partners utilizing shared
decision-making strategies.
3. Clinicians should not discontinue BZDs abruptly in patients who
are likely to be physically dependent and at risk for withdrawal
symptoms (See Recommendation 2).
a. Physical dependence can develop within weeks and is heterogeneous across
patients (See Table 2).
4. Although most patients can complete BZD tapering in outpatient
settings, clinicians should consider inpatient or medically managed
residential care when patient presentation indicates significant risk
that cannot be safely managed in outpatient care.
