Additionally, younger patients tend to have a decreased success rate of discontinuing BZD use than older patients [66]. Interestingly, those who used alcohol while taking BZD experienced no difference in discontinuation rate from those who did not use alcohol [64]. The risk of falls leading to injuries in elderly BZD users is significantly increased in patients greater than 80 years old, while the increased risk is not significant in patients under 80 [22].

Misuse and addiction

• Symptomatic medications should be offered as required for aches, anxiety and other symptoms.
• Once the patient achieves 10 mg the dose should be tapered more slowly (e.g. 5 mg twice daily for two weeks, then once daily for two weeks, and then 2 mg daily for two weeks and then cease).
• In terms of anxiety, BZDs are used as a bridge when starting another medication or as abortive therapy for panic attacks.
• Women are more susceptible to BZD overuse because they are more likely to be prescribed than men [29].

The current treatment of choice is to switch the current short-acting BZD for a long-acting alternative then gradually taper the dose to wean the individual off BZD completely [8]. Clonazepam has been used in the outpatient setting as a medication for taping the use of BZD. However, no set schedule for a taper has been validated in the current literature.

2. STANDARD CARE FOR WITHDRAWAL MANAGEMENT

A person in withdrawal may be vulnerable and confused; this is not an appropriate time to commence counselling. Patients may find that the symptoms of withdrawal (see Box) are typical of their previous problems such as insomnia or anxiety. This should be discussed with them, and psychotherapy or appropriate pharmacotherapy offered. This can be done by regular dispensing of small quantities at a local pharmacy with clinical review, for example daily dispensing with fortnightly clinical review. Inpatient rehab is one of the more intensive parts of the rehabilitation program. While this stage is not required — some patients elect to jump straight to outpatient rehab — it is recommended because it often leads to a stronger recovery.

• One study showed that administration of BZD in patients with Alzheimer’s disease do not lead to further cognitive decline after 18 months of taking the drug [74].
• Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy.
• In the case of benzodiazepines, people can experience severe sleeplessness, anxiety, panic attacks, or seizures during withdrawal.
• The experimental group in this study had a weekly 1/10-dose reduction after a 2 week stabilization period [72].

104 Treatment for illicit benzodiazepine dependence in adults enrolled in an opioid substitution programme

Patients who are opioid dependent and consent to commence methadone maintenance treatment do not require WM; they can be commenced on methadone immediately (see opioid withdrawal protocol for more information). 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.

Side Effects of Benzodiazepines

Inpatient treatment is a likely step for people suffering from drug addiction. Inpatient rehabilitation provides an opportunity to leave potentially harmful severe benzodiazepine withdrawal syndrome influences or environments. Once people decide to seek treatment, the first step in the recovery process is to evaluate the level of care that is needed.

Managing benzodiazepine dependence in primary care

Management of benzodiazepine withdrawal