Authors: Brunner E, et al.
Journal of General Internal Medicine. June 17, 2025.
The American Society of Addiction Medicine, together with nine other medical societies, released the first Joint Clinical Practice Guideline on Benzodiazepine Tapering to address the widespread and often long-term use of these medications for conditions such as anxiety and insomnia. The guideline provides consensus- and evidence-informed strategies to minimize risks associated with withdrawal, which can be prolonged and dangerous if benzodiazepines are stopped abruptly.
Key recommendations emphasize individualized, gradual tapering: reducing the total daily dose by 5–10% every 2–4 weeks, monitoring frequently, and allowing tapering to extend beyond a year for long-term users. Abrupt discontinuation is strongly discouraged. Clinicians are urged to reassess the risk-benefit balance of continuing benzodiazepines regularly, particularly in older adults, and to consider tapering when risks outweigh benefits.
Patient advisors contributed extensively to the guideline, stressing the importance of recognizing the wide spectrum of withdrawal symptoms, supporting very slow or “micro” tapers using liquid formulations, and counseling patients about avoiding alcohol and sedative co-use.
A simultaneous JAMA Viewpoint warned against repeating mistakes made after the 2016 CDC opioid guideline, where misapplication led to unsafe discontinuations. The authors note that while benzodiazepines can be effective for select long-term cases, many patients are prescribed them for extended periods when safer alternatives exist.
What You Should Know
• Long-term benzodiazepine use is common, with 9% of US adults receiving prescriptions in 2023.
• Safe tapering is slow, individualized, and can take over a year for chronic users.
• Never abruptly stop benzodiazepines in dependent patients due to risk of severe withdrawal.
• Patients should be prioritized for tapering when risks outweigh benefits, particularly older adults and those at highest risk of harm.
• Patient-centered strategies include micro-tapering, broad withdrawal symptom recognition, and education on brain receptor recovery.
References
Brunner E, et al. J Gen Intern Med. 2025. doi:10.1007/s11606-025-08932-1
Zgierska AE. J Gen Intern Med. 2025. doi:10.1007/s11606-025-08933-0
Brunner E, McCabe J, Wakeman S. JAMA. 2025, 333:2487-2489. doi:10.1001/jama.2025.9471
Lader M, Tylee A, Donoghue J. CNS Drugs. 2009, 23:19-34. doi:10.2165/0023210-200923010-00002
Soyka M. Int J Neuropsychopharmacol. 2017, 20:103-111. doi:10.1093/ijnp/pyw098
Thank you Journal of General Internal Medicine for allowing us to use this article.