Symptomatic treatment (see Table 3) and supportive care are usually sufficient for management of mild opioid withdrawal. When tapering off benzodiazepines, you’ll always want to work with a trained healthcare professional who can monitor you for side effects and adjust your pace accordingly. A therapist or other mental health professional can offer support with navigating these effects and helping improve your overall quality of life during the withdrawal period. In addition to the immediate health risk, benzodiazepine withdrawal can seriously affect your quality of life.
3. WITHDRAWAL MANAGEMENT FOR OPIOID DEPENDENCE
Slowly reducing the dose, less than 5 to 10% of the current dose monthly, can minimize the severity of the withdrawal symptoms and is the recommended way to discontinue benzodiazepines safely. Benzodiazepine withdrawal is a series of physical, emotional and behavior changes experienced when a person tries to reduce its dose or cease taking a benzodiazepine like Xanax, Klonopin, Ativan, Diazepam, Librium or Onfi. When a person becomes physically dependent on benzodiazepines their body and brain become so accustomed to having the drug that they will experience withdrawal symptoms when you cut down the dose or stop the drug. This syndrome is clearly not a disease entity; it probably represents an amalgam of pharmacological and psychological factors directly and indirectly related to benzodiazepine use. Generally, benzodiazepine withdrawal symptoms fluctuate; the intensity of the symptoms does not decrease in a steady fashion as is the case with most other drug withdrawal syndromes. It is not recommended to increase the dose when symptoms worsen; instead, persist with the current dose until symptoms abate, then continue with the dose reduction schedule.
What happens when you stop taking benzodiazepines?
- Although differentiating withdrawal reactions from recrudescent psychiatric symptoms after drug withdrawal is always difficult, a number of factors favored the former interpretation of the newly-appearing symptoms and signs.
- Codeine phosphate alleviates opioid withdrawal symptoms and reduces cravings.
- Patients in withdrawal should not be forced to do physical exercise.
- The drug isn’t approved for this use, but it has been shown to be helpful in treating alcohol withdrawal.
- Benzodiazepine withdrawal syndrome (BZWS) can result from the chronic prescription and use of benzodiazepines or Z-drugs.
When benzodiazepines attach to your neurons, they invite a bunch of chloride ions inside. These ions change the neuron’s electrical charge, so it has to work much harder to activate and send signals. Benzodiazepines have a sedative effect because of how they work in your brain. These drugs mimic the effects of a neurotransmitter called gamma aminobutyric acid (GABA). GABA acts as a sort of speed bump that helps all the other chemical messengers travel through your brain at a reasonable pace.
Management of benzodiazepine withdrawal
Inhalant withdrawal symptoms can begin anywhere between a few hours to a few days after ceasing inhalant use. Symptoms may last for only 2-3 days, or may last for up to two weeks. As for management of mild alcohol withdrawal, with diazepam as in Table 11. When used appropriately they are very effective in treating these disorders. However, when used for an extended period of time (e.g. several weeks), dependence can develop. Codeine phosphate alleviates opioid withdrawal symptoms and reduces cravings.
Management of inhalant withdrawal
One known case of death was that of David Stojcevski, an inmate at the Macomb County Jail 17 days into a 30 day sentence for an unpaid traffic ticket. His death was a direct result of involuntary benzodiazepine cessation. Anecdotally, many patients afflicted with protracted withdrawal from benzodiazepines post-cessation disclose that when they report to their medical provider complaining of the symptoms and the duration they are met with disbelief. It is estimated that percent of patients taking benzodiazepines long-term (past severe benzodiazepine withdrawal syndrome the 2-4 week prescribing guidelines) will experience protracted withdrawal or a “post-withdrawal syndrome”. There may be a genetic predisposition or gene expression phenomenon that occurs during the withdrawal syndrome to shift into a protracted withdrawal syndrome and damaged central nervous system. Experts agree that the incidence of protracted symptoms in those who have abruptly stopped a benzodiazepine is higher, and those who have undergone a slow taper at the patient’s individual pace is almost certainly very much lower.
To avoid the risk of overdose in the first days of treatment methadone can be given in divided doses, for example, give 30mg in two doses of 15mg morning and evening. Providing withdrawal management in a way that reduces the discomfort of patients and shows empathy for patients can help to build trust between patients and treatment staff of closed settings. People who are not dependent on drugs will not experience withdrawal and hence do not need WM. Refer to the patient’s assessment to determine if he or she is dependent and requires WM.
The benzodiazepine withdrawal syndrome
Withdrawal symptoms may be mild in people who take the drugs for short periods. However, there is still a possibility of severe reactions and withdrawal symptoms. Some people who use inhalants regularly develop dependence, while others do not. Patients should be monitored 3-4 times daily for symptoms and complications.
Short-term symptoms
But when you start removing benzodiazepines from your system, suddenly your clogged neurons become an open freeway with no traffic lanes. All those extra chemicals flood your brain, and the excess activity causes symptoms like anxiety and sweating. If you’re predisposed to seizures, your risk of having a seizure may also increase during the withdrawal period. If you are pregnant or are thinking about becoming pregnant, talk to your OBGYN or psychiatrist about your plans.
- Patients with DTs or other severe withdrawal symptoms may require admission to the intensive care unit due to the risk of mortality.
- Methadone is useful for detoxification from longer acting opioids such as morphine or methadone itself.
- In addition to the immediate health risk, benzodiazepine withdrawal can seriously affect your quality of life.
- Many patients report experiencing hundreds of symptoms at the time.