Since the 1960s benzodiazepines have been prescribed as sedative-hypnotics. In the short-term benzodiazepines prove very effective for insomnia and anxiety. While they are generally not recommended for persistent use beyond 2 to 4 weeks, once started many individuals continue them long term. To date they remain one of the most frequently prescribed outpatient medications. Additionally, there is a prominent illicit market for benzodiazepines and a growing market for “designer” benzodiazepines. In September 2020 the FDA updated the boxed warning for benzodiazepines to expand upon the risks observed with long term use. The boxed warning included a warning that physical dependence can develop when benzodiazepines are taken steadily for several days to weeks, even as prescribed. It also advised that patients taking prescribed benzodiazepines be provided a gradual outpatient taper to reduce or discontinue benzodiazepines to reduce the risk of acute and protracted withdrawal reactions. Some patients experienced protracted benzodiazepine withdrawal symptoms lasting weeks to more than twelve months.

While the updated boxed warning provides some guidance for how to approach outpatient taper of prescribed benzodiazepines, it does not clarify what approach should be taken for patients with a sedative-hypnotic use disorder nor for patients with a co-occurring substance use disorder(s). In this workshop we will review the limited current evidence for different approaches to withdrawal management of long term benzodiazepines use on both an inpatient and an outpatient basis. We will include discussion of a variety cases to consider different approaches for benzodiazepine withdrawal management.

• Review the pharmacology of benzodiazepines with particular focus on mechanism for developing tolerance and risk of acute and protracted withdrawal.
• Evaluate the current evidence for different approaches to benzodiazepine withdrawal management on inpatient versus outpatient basis and the associated risks and benefits of the different approaches.
• Discuss how to approach benzodiazepine withdrawal management in patients with sedative-use hypnotic disorder or other co-occurring substance use disorders.

• Benzodiazepine
• Withdrawal Management
• Physical Dependence

Alexis Ritvo, MD, Chairperson, Presenter

     

Alexis Ritvo, MD MPH is Program Director for the Addiction Psychiatry Fellowship at the University of Colorado (CU) School of Medicine where she is an Assistant Professor of Psychiatry. Clinically she is supervising attending of general psychiatry residents in the CU Medicine Outpatient Psychiatry clinic where she directs a co-occurring disorder subspeciality clinic. Her growing interest in the safe prescribing and deprescribing of prescription benzodiazepines led her to co-found the Benzodiazepine Action Work Group with the Colorado Consortium for Prescription Drug Abuse in November 2020. In January 2022, she also became medical director for the national non-profit the Alliance for Benzodiazepines Best Practices. 

Alena Balasanova, MD, Co-Chair, Presenter

 

Dr. Alëna A. Balasanova is an associate professor at the University of Nebraska Medical Center (UNMC) in the Department of Psychiatry and also holds an appointment in the College of Allied Health Professions. She is dually board certified in psychiatry and addiction medicine. After obtaining her undergraduate degree from The Johns Hopkins University, Dr. Balasanova went on to earn her M.D. at Harvard Medical School and completed residency training at Boston University Medical Center. As the Director of Addiction Psychiatry Education for the Department of Psychiatry in the College of Medicine, Dr. Balasanova has developed novel educational programs for medical students, residents, fellows, and allied health professionals. Dr. Balasanova was the founding director of the Outpatient Addiction Psychiatry Clinic and also developed and now co-directs the inpatient Addiction Psychiatry Consultation Liaison Service, both at the Nebraska Medical Center. Dr. Balasanova’s professional interests lie at the intersection of medical education and stigma reduction. She has presented and published nationally and internationally on addiction psychiatry education and destigmatizing substance use disorders; in recognition of this work, Dr. Balasanova was awarded the prestigious American Medical Association Foundation Award for Health Education in 2020, the American Psychiatric Association Irma Bland Award for Residency Education in 2022 and Nancy Roeske Award for Medical Student Education in 2023. Dr. Balasanova was also named the Nebraska Medical Association Young Physician of the Year in 2021 and received the Leonard Tow Humanism in Medicine Award from the Gold Humanism Honor Society earlier this year.  

Christopher Blazes, MD, Presenter

       

Dr. Blazes is Associate Professor of Psychiatry at OHSU. He is triple board-certified in psychiatry, addiction psychiatry, and emergency medicine and is the director of the OHSU addiction psychiatry Fellowship. 

Daniela Rakocevic, MD, Presenter

        

Dr. Daniela Rakocevic currently serves as Chief of Addiction Psychiatry Division and Addiction Psychiatry Fellowship program director at Nortwestern University, Department of Psychiatry and Behavioral Sciences.