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Tapering a Patient off Designer Benzos in Resident ...
Tapering a Patient off Designer Benzos in Residential Treatment
Pdf Summary
"Designer benzodiazepines" have become increasingly popular and pose a new challenge for physicians and addiction specialists globally. These compounds, which can be purchased online as "research chemicals," have a growing subculture around their recreational use, with individuals sharing their experiences on online forums. The supplies of these compounds are variable, contributing to the increased risk of unintentional overdose.<br /><br />Patients who use these designer benzodiazepines may initially report using them to self-medicate anxiety and distress. They may seek treatment when they are unable to manage the symptoms of physiologic dependence and withdrawal despite continued use. However, there is very little published information on using typical benzodiazepine taper protocols with these substances.<br /><br />Clinicians may also face challenges in determining the equivalent dose of designer benzodiazepines compared to prescription benzodiazepines or phenobarbital. Urine drug assays may not detect the presence of these designer benzodiazepines, making it difficult to confirm which compounds the patient has actually taken.<br /><br />Future research is needed to determine the best approach for tapering patients off these understudied compounds. This includes investigating the appropriate length of taper and identifying the best medication to manage withdrawal based on the specific compound being used. Additionally, the development of a medical database identifying these compounds and their equivalent dosing to prescription benzodiazepines would aid in developing taper protocols for these patients.<br /><br />The case described a 32-year-old male who presented to residential treatment for medically managed withdrawal from designer benzodiazepines. The patient had a history of depression and ADHD and had been using various designer benzodiazepines for the past 18 months. He had previously attempted self-directed tapers at home and one inpatient detoxification with phenobarbital. <br /><br />The patient's withdrawal was complicated by psychosis, possibly due to a reaction to phenobarbital, as well as recent heavy cocaine and prescription dextroamphetamine use. The psychosis resolved without the use of antipsychotics.<br /><br />The patient was discharged on gabapentin and close follow-up with an outpatient addiction psychiatrist. Since discharge, he has remained abstinent from all designer benzodiazepines and has had his gabapentin dose titrated for anxiety and his dextroamphetamine dose titrated for ADHD.
Keywords
Designer benzodiazepines
physicians
addiction specialists
recreational use
withdrawal
taper protocols
equivalent dose
urine drug assays
psychosis
gabapentin
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