ARE BENZODIAZEPINES SAFE TO PRESCRIBE?
It has become clear to me that benzodiazepines can be difficult to stop. This may be related to the fact that these medications are frequently effective at lowering anxiety and helping to initiate sleep. Also, even if other treatments including other medications are helpful they may not be experienced as being as effective as the benzodiazepines. If people have been taking this type of benzodiazepines for months they could start experiencing withdrawal symptoms even if they are taking the same dose. This will feel like the medication is not helping as much. Importantly, if they are changing to new medications they might experience withdrawal symptoms when they lower the benzodiazepine and this can make people feel that they need to continue the medication. Also, because of the likelihood of withdrawal symptoms if you have been taking these medications for more than 2-3 months, stopping these medications has to be done slowly, requiring an increase in number of doses per day and can take a long time to taper off. In addition, since you will very likely develop tolerance taking benzodiazepines, causing the current dose to not be as effective, the dose will may need to be increased. All of these factors can lead to resistance in stopping benzodiazepines. Finally, care has to be taken to avoid prescribing benzodiazepines if opioid medications are also being taken and/or if alcohol is being consumed on a daily basis as benzodiazepines can significantly elevate the risk of respiratory depression if combined with opioids and alcohol.
Research [Implementing Benzodiazepine Deprescribing in the Primary Care Clinic. JAMA Intern Med. December 31, 2025] supports the above and also has led to recommendations to prescribe these medications using the lowest effective dose for a short time [< 3 months and ideally 4 weeks or less]. Also, it is critical to be very firm about the time limitation regardless of whether another medication has been identified that is effective in reducing the anxiety symptoms within this time frame. If someone is taking these medications 4 days per week or only been prescribed these for 4 weeks or less they are not likely to have any withdrawal symptoms and would not require a taper to stop it. However, since there is the possibility of some withdrawal symptoms it might be a good practice to taper down the dose over 4-6 weeks.
Finally, there are some conditions that might require long term prescribing of benzodiazepines and yet I do not treat these conditions even though they include difficult to treat generalized anxiety disorder [GAD] and some bipolar conditions. I believe that prescribing benzodiazepines for longer periods of time is specialized and may require separate training.
