ASAM Pocket Guidelines and Patient Guide

4 5. Clinicians should design the tapering strategy to minimize harms from both continued BZD use and the tapering process, such as withdrawal symptoms and recurrence of symptoms for which the BZD was originally prescribed. The initial pace of the BZD taper should generally include dose reductions of 5% to 10% every 2–4 weeks. The taper should typically not exceed 25% every 2 weeks. a. Patients who have been taking lower doses for a relatively short period of time (e.g., <3 months) may be able to taper more quickly. b. The goal of tapering may be discontinuing the BZD medication or reducing the BZD dose to the point where the risks no longer outweigh the benefits. 6. Clinicians should tailor tapering strategies to each individual patient and adjust tapering based on patient response. a. Clinicians can consider transitioning patients without contraindications to a comparable dose of a longer-acting BZD medication for the taper (See Benzodiazepine Dose Equivalents, Table 7). b. Clinicians should monitor patients for the emergence of BZD withdrawal signs and symptoms with each dose reduction. If significant signs or symptoms emerge, the taper should be slowed or paused (See Table 3). b c. Some patients experience significant withdrawal symptoms, even with gradual tapering, and should be offered slower tapering as needed. d. In some cases, maintaining c a patient on a lower dose may be sufficient to reduce the current risks such that they no longer outweigh the benefits. 7. Clinicians should offer patients undergoing BZD tapering adjunctive psychosocial interventions (e.g., cognitive behavioral therapy [CBT], cognitive behavioral therapy for insomnia [CBT-I]) to support successful tapering (See Table 9 and Recommendation 10). 8. Clinicians should provide concurrent treatment for any co-occurring physical health conditions and psychiatric disorders, including SUDs, that could interfere with the BZD taper. 9. Clinicians should employ harm reduction strategies—such as providing opioid overdose reversal medication (e.g., naloxone) to those concomitantly taking opioids or otherwise at risk for opioid overdose, connecting patients to local resources, and providing patient education—based on each individual patient's risks. 10. It may take months to years to fully taper off BZDs, particularly if patients have been taking a high dose for an extended period of time. a e certainty of evidence and strength of recommendations associated with the key takeaways can be found in the Summary of Recommendations. b Pausing a BZD taper refers to temporarily halting dose reductions until withdrawal symptoms subside. c Maintaining a BZD taper refers to discontinuing dose reductions with no plan to further reduce the dose. Key Points

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