HelixTalk Episode #68 - Hooked on a feeling: how to discuss benzodiazepine tapers with your patients

Date posted: October 17, 2017, 6:00 am

In this episode, we will discuss the current state of benzodiazepine use, expected trends in prescribing, and risks associated with use. Lastly, we will discuss techniques for ensuring that a benzodiazepine taper is performed in a safe manner with lowest risk of harm.

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Key Concepts

1. Benzodiazepine use has been clearly associated with risk of falls, altered mental status, impaired cognition, dependence, and interference with psychotherapy.
2. At the same time, there are social and cultural underpinnings which result in some individuals using these  medications for decades, leading to (justified) hesitancy to consider discontinuation.
3. Dosing tapers need to be designed on a patient specific basis, in terms of length of taper and agent used.
4. Ensure that alternate treatment strategies are used to address any emergent or underlying anxiety, with ideal focus on non-pharmacologic methods such as Cognitive Behavioral Therapy.

References

1. VA Academic Detailing Service. Re-evaluating the use of benzodiazepines: A VA clinician’s guide. 2016. Available: https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Academic_Detailing_Educational_Material_Catalog/22_Benzodiazepine_Provider_AD_Educational_Guide_IB_10_928.pdf. Accessed 9/29/17.
2. Tannenbaum C,Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education. The EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890-898.