Kaiser Permanete's guidelines in the management of chronic BZD patients

[[Te...]]

I have Kaiser insurance. My Pdoc didn't follow the guideline of only prescribing short term (up to two weeks) and not using benzos for insomnia. He prescribed me 1mg per night for insomnia for years. He also prescribed me 3mg per day for over a month when my anxiety was ramping up. I wish he DID follow these guidelines and kept me out of this mess in the first place....

 

He is, however, NOW following the tapering guidelines and allowing me to DLMT slowly. I'll bet he won't prescribe benzos the way he did for me with future patients. I told him I was angry he never warned me of dependence risk, etc.

 

HOORAY!!!!! Unfortunately, too few of us have the courage to confront physicians. Luckily you had the KP info regarding benzos to help back you up.

[[li...]]

It would be helpful to understand that recommendation a little better with data to back it up.

 

Me too,  Seltzerer.  I also would like to see evidence regarding the recommendation to dose 2 times a day for lorazepam. Per the Benzodiazepine Information Coalition:

 

“Those who choose or are required to taper using a shorter-acting benzodiazepine may find it particularly helpful to take their dose several times per day, depending on the half life of the medication. For example, patients taking Klonopin may benefit from dosing 3-4x per day, whereas those taking Ativan may need to dose 4-5x per day.  Some patients on Xanax may require 5-6 doses per day just to maintain steady serum levels. Patients who dose at regular intervals are more likely to successfully complete a benzodiazepine taper because they do not experience severe ‘drops’ throughout the day between doses that make discontinuation intolerable. These symptoms are commonly referred to as ’interdose’ withdrawal.”

 

What nonsense is that ? If there is one drug that is not short acting, it is K. Maybe someone should update BIC ? Not sure where they state that.

Individual experiences vary.

[[Te...]]

And let's get real here, for a moment, about Ativan's effects. I started taking Ativan at 60 years of age. Unless there are VERY STRONG guidelines, and ditching the AS NEEDED, which is a joke, a person can get into a world of trouble. Among the things one must worry about with seniors is forgetfulness. If a person starts taking two instead of one pill, within a short time a person could get very dependent. Will they remember to dose a number of times a day? I developed very bad vertigo (for the first time in my life) after only taking it for 10 months due to the "as needed" guideline I got. (That was the ONLY guideline I was given.) In fact, dizziness and vertigo were the first signs I had. Seniors being really dizzy is a definite hazard. They are usually out walking because they don't have cars (maybe have stopped driving). A fall could end up being deadly because of all the consequences.

 

Valium, I think, is a useful drug for seniors when one is talking about being on benzos (something I don't condone AT ALL now except for emergencies). Klonopin is difficult especially because of problems with cognitive function and for some reason an inability to exercise for long periods of time. I've noticed this in a lot of the posts I've read. Valium doesn't seem to have that effect. Valium can cause depression, but so can K and Ativan. I know a woman who's 99 who has been on Valium for decades. You would NEVER find that with Ativan, or it would be very unusual. A senior would have to be crossed over to another longer-lasting benzo, further exacerbating healing. Ativan is a crap pill as far as I'm concerned for seniors. It wouldn't matter how much you dose, I don't think. Somewhere along the (short) line a person is going to be dependent.

[[cs...]]

And let's get real here, for a moment, about Ativan's effects. I started taking Ativan at 60 years of age. Unless there are VERY STRONG guidelines, and ditching the AS NEEDED, which is a joke, a person can get into a world of trouble. Among the things one must worry about with seniors is forgetfulness. If a person starts taking two instead of one pill, within a short time a person could get very dependent. Will they remember to dose a number of times a day? I developed very bad vertigo (for the first time in my life) after only taking it for 10 months due to the "as needed" guideline I got. (That was the ONLY guideline I was given.) In fact, dizziness and vertigo were the first signs I had. Seniors being really dizzy is a definite hazard. They are usually out walking because they don't have cars (maybe have stopped driving). A fall could end up being deadly because of all the consequences.

 

Valium, I think, is a useful drug for seniors when one is talking about being on benzos (something I don't condone AT ALL now except for emergencies). Klonopin is difficult especially because of problems with cognitive function and for some reason an inability to exercise for long periods of time. I've noticed this in a lot of the posts I've read. Valium doesn't seem to have that effect. Valium can cause depression, but so can K and Ativan. I know a woman who's 99 who has been on Valium for decades. You would NEVER find that with Ativan, or it would be very unusual. A senior would have to be crossed over to another longer-lasting benzo, further exacerbating healing. Ativan is a crap pill as far as I'm concerned for seniors. It wouldn't matter how much you dose, I don't think. Somewhere along the (short) line a person is going to be dependent.

 

 

“Ativan is a crap pill as far as I'm concerned for seniors.”

:thumbsup: :thumbsup:

 

I’m not a senior, but it’s a crap pill to the max.  Complete junk.

[[se...]]

I’d like to see some data or a clinical explanation. In my mind Ativan is most similar to Xanax and I would absolutely take Xanax over Valium or Klonopin if I had to taper again (will never happen). The Klonopin being in my system over time like that was the problem I believe. I seem to be the only one with this view?

[[se...]]

I’d like to see some data or a clinical explanation. In my mind Ativan is most similar to Xanax and I would absolutely take Xanax over Valium or Klonopin if I had to taper again (will never happen). The Klonopin being in my system over time like that was the problem I believe. I seem to be the only one with this view?

 

I wouldn’t recommend this for others btw but I know how to taper correctly now and how to get the dose I need. I would dose multiple times a day if needed.

[[si...]]

I’d like to see some data or a clinical explanation. In my mind Ativan is most similar to Xanax and I would absolutely take Xanax over Valium or Klonopin if I had to taper again (will never happen). The Klonopin being in my system over time like that was the problem I believe. I seem to be the only one with this view?

 

In my experience, I'd agree with you, selzerer. 

 

Early in my taper I attempted to c/o to valium.  Not only did it depress me, but more importantly, it turned me into a completely zoned out zombie.  It's such a heavy sedative in comparison to Ativan in my system.

 

Since I have to work while tapering and I was unable to cognitively function on valium, I quickly returned to Ativan, from which I've been tapering since. 

 

sierra 

[[mo...]]

And let's get real here, for a moment, about Ativan's effects. I started taking Ativan at 60 years of age. Unless there are VERY STRONG guidelines, and ditching the AS NEEDED, which is a joke, a person can get into a world of trouble. Among the things one must worry about with seniors is forgetfulness. If a person starts taking two instead of one pill, within a short time a person could get very dependent. Will they remember to dose a number of times a day? I developed very bad vertigo (for the first time in my life) after only taking it for 10 months due to the "as needed" guideline I got. (That was the ONLY guideline I was given.) In fact, dizziness and vertigo were the first signs I had. Seniors being really dizzy is a definite hazard. They are usually out walking because they don't have cars (maybe have stopped driving). A fall could end up being deadly because of all the consequences.

 

Valium, I think, is a useful drug for seniors when one is talking about being on benzos (something I don't condone AT ALL now except for emergencies). Klonopin is difficult especially because of problems with cognitive function and for some reason an inability to exercise for long periods of time. I've noticed this in a lot of the posts I've read. Valium doesn't seem to have that effect. Valium can cause depression, but so can K and Ativan. I know a woman who's 99 who has been on Valium for decades. You would NEVER find that with Ativan, or it would be very unusual. A senior would have to be crossed over to another longer-lasting benzo, further exacerbating healing. Ativan is a crap pill as far as I'm concerned for seniors. It wouldn't matter how much you dose, I don't think. Somewhere along the (short) line a person is going to be dependent.

 

 

“Ativan is a crap pill as far as I'm concerned for seniors.”

:thumbsup: :thumbsup:

 

I’m not a senior, but it’s a crap pill to the max.  Complete junk.

 

Totally agree. Ativan is total darkness in pill form. I would choose Xanax if I had to choose between the two, and Xanax can eat sh*t and die.

[[si...]]

And let's get real here, for a moment, about Ativan's effects. I started taking Ativan at 60 years of age. Unless there are VERY STRONG guidelines, and ditching the AS NEEDED, which is a joke, a person can get into a world of trouble. Among the things one must worry about with seniors is forgetfulness. If a person starts taking two instead of one pill, within a short time a person could get very dependent. Will they remember to dose a number of times a day? I developed very bad vertigo (for the first time in my life) after only taking it for 10 months due to the "as needed" guideline I got. (That was the ONLY guideline I was given.) In fact, dizziness and vertigo were the first signs I had. Seniors being really dizzy is a definite hazard. They are usually out walking because they don't have cars (maybe have stopped driving). A fall could end up being deadly because of all the consequences.

 

Valium, I think, is a useful drug for seniors when one is talking about being on benzos (something I don't condone AT ALL now except for emergencies). Klonopin is difficult especially because of problems with cognitive function and for some reason an inability to exercise for long periods of time. I've noticed this in a lot of the posts I've read. Valium doesn't seem to have that effect. Valium can cause depression, but so can K and Ativan. I know a woman who's 99 who has been on Valium for decades. You would NEVER find that with Ativan, or it would be very unusual. A senior would have to be crossed over to another longer-lasting benzo, further exacerbating healing. Ativan is a crap pill as far as I'm concerned for seniors. It wouldn't matter how much you dose, I don't think. Somewhere along the (short) line a person is going to be dependent.

 

 

“Ativan is a crap pill as far as I'm concerned for seniors.”

:thumbsup: :thumbsup:

 

I’m not a senior, but it’s a crap pill to the max.  Complete junk.

 

Totally agree. Ativan is total darkness in pill form. I would choose Xanax if I had to choose between the two, and Xanax can eat sh*t and die.

 

Battle of the Benzos   :boxer:

[[mo...]]

And let's get real here, for a moment, about Ativan's effects. I started taking Ativan at 60 years of age. Unless there are VERY STRONG guidelines, and ditching the AS NEEDED, which is a joke, a person can get into a world of trouble. Among the things one must worry about with seniors is forgetfulness. If a person starts taking two instead of one pill, within a short time a person could get very dependent. Will they remember to dose a number of times a day? I developed very bad vertigo (for the first time in my life) after only taking it for 10 months due to the "as needed" guideline I got. (That was the ONLY guideline I was given.) In fact, dizziness and vertigo were the first signs I had. Seniors being really dizzy is a definite hazard. They are usually out walking because they don't have cars (maybe have stopped driving). A fall could end up being deadly because of all the consequences.

 

Valium, I think, is a useful drug for seniors when one is talking about being on benzos (something I don't condone AT ALL now except for emergencies). Klonopin is difficult especially because of problems with cognitive function and for some reason an inability to exercise for long periods of time. I've noticed this in a lot of the posts I've read. Valium doesn't seem to have that effect. Valium can cause depression, but so can K and Ativan. I know a woman who's 99 who has been on Valium for decades. You would NEVER find that with Ativan, or it would be very unusual. A senior would have to be crossed over to another longer-lasting benzo, further exacerbating healing. Ativan is a crap pill as far as I'm concerned for seniors. It wouldn't matter how much you dose, I don't think. Somewhere along the (short) line a person is going to be dependent.

 

 

“Ativan is a crap pill as far as I'm concerned for seniors.”

:thumbsup: :thumbsup:

 

I’m not a senior, but it’s a crap pill to the max.  Complete junk.

 

Totally agree. Ativan is total darkness in pill form. I would choose Xanax if I had to choose between the two, and Xanax can eat sh*t and die.

 

Battle of the Benzos   :boxer:

 

Yep. Battle for yuckiest.

[[Re...]]

For better or worse, this appears to be the most recent Kaiser Permanente's Guidelines & Protocols to "minimize practice variation in the management of patients on chronic benzodiazepine therapy to improve

patient safety and increase both patient and provider satisfaction."

 

According to wikipedia, Kaiser Permanente is the largest managed care organization in the U.S. (1)

 

 

https://wa.kaiserpermanente.org/static/pdf/public/guidelines/benzo-zdrug.pdf

 

I don't know how Kaiser Permanente's guidelines compare with your experience & knowledge but I thought I'd toss it out there for your consideration. best wishes

 

(1) https://en.wikipedia.org/wiki/Kaiser_Permanente

 

thanks for sharing this it made my day

[[Te...]]

I’d like to see some data or a clinical explanation. In my mind Ativan is most similar to Xanax and I would absolutely take Xanax over Valium or Klonopin if I had to taper again (will never happen). The Klonopin being in my system over time like that was the problem I believe. I seem to be the only one with this view?

 

In my experience, I'd agree with you, selzerer. 

 

Early in my taper I attempted to c/o to valium.  Not only did it depress me, but more importantly, it turned me into a completely zoned out zombie.  It's such a heavy sedative in comparison to Ativan in my system.

 

Since I have to work while tapering and I was unable to cognitively function on valium, I quickly returned to Ativan, from which I've been tapering since. 

 

sierra 

 

But we aren't talking about crossovers, that may be too much for the system. This is about seniors being put on a benzo right out of the gate who may not know anything about tapering. And doctors are, unfortunately, no help. Ativan is fraught with potential, and deep, problems for someone who isn't versed on going slowly and doing micro-tapering. Doctors are no help in this either.

 

You people know about tapering and going slowly to balance out the CNS. A senior is not going to know that unless they've been on this forum.

[[se...]]

I’d like to see some data or a clinical explanation. In my mind Ativan is most similar to Xanax and I would absolutely take Xanax over Valium or Klonopin if I had to taper again (will never happen). The Klonopin being in my system over time like that was the problem I believe. I seem to be the only one with this view?

 

In my experience, I'd agree with you, selzerer. 

 

Early in my taper I attempted to c/o to valium.  Not only did it depress me, but more importantly, it turned me into a completely zoned out zombie.  It's such a heavy sedative in comparison to Ativan in my system.

 

Since I have to work while tapering and I was unable to cognitively function on valium, I quickly returned to Ativan, from which I've been tapering since. 

 

sierra 

 

But we aren't talking about crossovers, that may be too much for the system. This is about seniors being put on a benzo right out of the gate who may not know anything about tapering. And doctors are, unfortunately, no help. Ativan is fraught with potential, and deep, problems for someone who isn't versed on going slowly and doing micro-tapering. Doctors are no help in this either.

 

You people know about tapering and going slowly to balance out the CNS. A senior is not going to know that unless they've been on this forum.

 

As a “people” with this view, I agree Terry.  For this population and as a general recommendation, I don’t think it’s a good idea to crossover and taper off a more potent benzo.  Ideally and in theory and symptom-wise and bc of the half-life, I think a shorter acting benzo is better if you do it carefully but again, I don’t think it’s feasible in the vast majority of cases in this population. I don’t know about Ativan specific symptoms but Xanax I would prefer to Klonopin or Valium. That’s from my experience. I’d like to see some clinical research information about Ativan specific symptoms before ruling that one out altogether. I’ve heard mixed anecdotal information and my own experience with Xanax is anecdotal as well I should add.

[[si...]]

I’d like to see some data or a clinical explanation. In my mind Ativan is most similar to Xanax and I would absolutely take Xanax over Valium or Klonopin if I had to taper again (will never happen). The Klonopin being in my system over time like that was the problem I believe. I seem to be the only one with this view?

 

In my experience, I'd agree with you, selzerer. 

 

Early in my taper I attempted to c/o to valium.  Not only did it depress me, but more importantly, it turned me into a completely zoned out zombie.  It's such a heavy sedative in comparison to Ativan in my system.

 

Since I have to work while tapering and I was unable to cognitively function on valium, I quickly returned to Ativan, from which I've been tapering since. 

 

sierra 

 

But we aren't talking about crossovers, that may be too much for the system. This is about seniors being put on a benzo right out of the gate who may not know anything about tapering. And doctors are, unfortunately, no help. Ativan is fraught with potential, and deep, problems for someone who isn't versed on going slowly and doing micro-tapering. Doctors are no help in this either.

 

You people know about tapering and going slowly to balance out the CNS. A senior is not going to know that unless they've been on this forum.

 

As a “people” with this view, I agree Terry.  For this population and as a general recommendation, I don’t think it’s a good idea to crossover and taper off a more potent benzo.  Ideally and in theory and symptom-wise and bc of the half-life, I think a shorter acting benzo is better if you do it carefully but again, I don’t think it’s feasible in the vast majority of cases in this population. I don’t know about Ativan specific symptoms but Xanax I would prefer to Klonopin or Valium. That’s from my experience. I’d like to see some clinical research information about Ativan specific symptoms before ruling that one out altogether. I’ve heard mixed anecdotal information and my own experience with Xanax is anecdotal as well I should add.

 

And therein lies the real problematic issue - a plethora of anecdotal personal experiences abound instead of solid controled clinical studies.  The sad truth is big pharma funds virtually all clinical studies.  Unless there is a clear profit to be had with said investment, it's just not going to happen.  And so it goes in our for profit health care (disease creating) system.

[[se...]]

I think what we’re talking about here doesn’t necessarily need an RCT but a knowledgeable clinical discussion. What sparked this is the clinical explanation to switch bc of metabolite build up. More explanation is needed with some evidence cited so we can understand that reasoning better.

[[Te...]]

I agree with you, seltzerer. A KNOWLEDGEABLE clinical discussion with people who understand benzos. But where in the world would you find that??? To understand benzos would mean actually speaking with people who have gone through this - which goes against their scientific viewpoint, unfortunately.

 

In favoring Ativan, there seems to be only a scientific basis, that of metabolite buildup, but they failed to take into account real people's potential problems with this pill. Leaving personal experiences out entirely is not going to get that group anywhere because it's too important of an issue in my view.

[[mo...]]

I think what we’re talking about here doesn’t necessarily need an RCT but a knowledgeable clinical discussion. What sparked this is the clinical explanation to switch bc of metabolite build up. More explanation is needed with some evidence cited so we can understand that reasoning better.

 

I agree, and understand there is a problem with metabolite build up especially in the elderly.

 

Also, I agree that no two of us are exactly the same and each individual experience absolutely counts and has value. I am not discounting that some may do better with Ativan—that simply was not me or my impression of many experiences I have read reported here... it seems yours is different and this is both valuable and informative.

 

I need to include the month on 1mg/day Ativan that is part of my history, in my signature at some point. There are just so many pieces each of us seem to be attempting to put together after having gone through much confusion.

[[Te...]]

I was thinking of something else. There are no tests to check for the extensive damage that benzos cause. Using only scientific evidence is ridiculously short-sighted, in my opinion.

[[Li...]]

I think what we’re talking about here doesn’t necessarily need an RCT but a knowledgeable clinical discussion. What sparked this is the clinical explanation to switch bc of metabolite build up. More explanation is needed with some evidence cited so we can understand that reasoning better.

Well said, Seltzerer.  I too would like to see the evidence that informed this recommendation by the Kaiser Foundation Health Plan of Washington.  My take-away after a first pass review of the Evidence Summary and References is that the recommendation to switch patients who are 65 and older to lorazepam MAY be based on only one piece of evidence (a study which has several methodological limitations including, most notably, that it did not address the essential question “Is lorazepam a better/safer alternative for tapering than diazepam for patients who are 65 and older?”).

 

I wonder what your thoughts are regarding the Kaiser Foundation Health Plan of Washington’s recommendations regarding taper rates?

 

Starting on page 9, the Kaiser Foundation Health Plan of Washington guideline states:

 

“The most effective strategy to manage benzodiazepine discontinuation and prevent adverse outcomes associated with severe withdrawal—such as severe seizures—is a gradual taper of benzodiazepines.”

 

The above statement is followed by Table 3 which gives two “taper methods”:

 

10% a week or

10% every 2 or 4 weeks

 

This is then followed on page 10 by:

 

“A subset of patients will experience clinically significant withdrawal symptoms even with 10% dose reductions and/or gradual tapering. Consider switching patients to a longer-acting benzodiazepine; see section below.”

 

My first-take on the above is:

 

(1) Kaiser Foundation Health Plan of Washington’s definition of a “gradual taper” is 10% every 2 or 4 weeks.

 

(2) Would the following version of this recommendation represent an “improvement” in terms of increasing the likelihood of success for tapering/discontinuation?

 

A subset of patients will experience clinically significant withdrawal symptoms even with 10% dose reductions and/or gradual tapering. Consider:

 

(A) decreasing the taper rate to 5% (or less) every 2 or 4 weeks

(B) recalculating the taper rate based on remaining dose (instead of original dose)

© exploring whether interdose withdrawal might be a factor and, if so, increasing dose frequency

 

Your thoughts?

 

 

[[se...]]

I think what we’re talking about here doesn’t necessarily need an RCT but a knowledgeable clinical discussion. What sparked this is the clinical explanation to switch bc of metabolite build up. More explanation is needed with some evidence cited so we can understand that reasoning better.

Well said, Seltzerer.  I too would like to see the evidence that informed this recommendation by the Kaiser Foundation Health Plan of Washington.  My take-away after a first pass review of the Evidence Summary and References is that the recommendation to switch patients who are 65 and older to lorazepam MAY be based on only one piece of evidence (a study which has several methodological limitations including, most notably, that it did not address the essential question “Is lorazepam a better/safer alternative for tapering than diazepam for patients who are 65 and older?”).

 

I wonder what your thoughts are regarding the Kaiser Foundation Health Plan of Washington’s recommendations regarding taper rates?

 

Starting on page 9, the Kaiser Foundation Health Plan of Washington guideline states:

 

“The most effective strategy to manage benzodiazepine discontinuation and prevent adverse outcomes associated with severe withdrawal—such as severe seizures—is a gradual taper of benzodiazepines.”

 

The above statement is followed by Table 3 which gives two “taper methods”:

 

10% a week or

10% every 2 or 4 weeks

 

This is then followed on page 10 by:

 

“A subset of patients will experience clinically significant withdrawal symptoms even with 10% dose reductions and/or gradual tapering. Consider switching patients to a longer-acting benzodiazepine; see section below.”

 

My first-take on the above is:

 

(1) Kaiser Foundation Health Plan of Washington’s definition of a “gradual taper” is 10% every 2 or 4 weeks.

 

(2) Would the following version of this recommendation represent an “improvement” in terms of increasing the likelihood of success for tapering/discontinuation?

 

A subset of patients will experience clinically significant withdrawal symptoms even with 10% dose reductions and/or gradual tapering. Consider:

 

(A) decreasing the taper rate to 5% (or less) every 2 or 4 weeks

(B) recalculating the taper rate based on remaining dose (instead of original dose)

© exploring whether interdose withdrawal might be a factor and, if so, increasing dose frequency

 

Your thoughts?

 

 

 

I did a little searching (not exhaustive) and I can't find anything they might be referring to for that specific recommendation of switching to lorazepam.  I didn't look for the case studies of delirium which they mentioned but didn't cite.  This reference, https://www.ncbi.nlm.nih.gov/pubmed/29273607, discusses the use of long-acting benzos in the elderly.  It may be that that recommendation is just clinical preference for one of the authors.

 

Wrt tapering rate, I'm not the best to ask because both of mine were fast.  I think symptom-based and patient controlled are most important.  I am fine with 10% every 2-4 weeks as a guideline.  I think there is a negative aspect to drawing it out for too long so it's a balance.  Interdose w/d seems very likely while tapering and it makes a lot of sense to dose more frequently to handle it.  I would if I had to do it again (will never happen).  One can also probably get stuck not knowing which effects are from the reduction and readjustment of receptors and not having a constant level in your system while gradually reducing.  Difficult to tease out and probably pretty unrealistic to do for most people/doctors.

[[Li...]]

Thank you for sharing your thoughts Seltzerer.  I just wish the guideline gave more options than “switch to a longer-action benzo” (or in the case of people 65 and older, switch to a shorter-acting benzo) if either of the two recommended “Taper Methods” fails.  Taper Method 1 is a 10% reduction every week (this is very fast).  Taper Method 2 (aka a “gradual taper’) is a 10% reduction every two to four weeks (this is more reasonable but may still be too fast for some individuals).  So why not try slowing the taper rate down even further (or even better, starting off at a slower taper rate and then increasing it if tolerated) before putting the patient through a CNS jarring switch to another benzo (which they may or may not tolerate)?

 

[[Te...]]

Thank you for sharing your thoughts Seltzerer.  I just wish the guideline gave more options than “switch to a longer-action benzo” (or in the case of people 65 and older, switch to a shorter-acting benzo) if either of the two recommended “Taper Methods” fails.  Taper Method 1 is a 10% reduction every week (this is very fast).  Taper Method 2 (aka a “gradual taper’) is a 10% reduction every two to four weeks (this is more reasonable but may still be too fast for some individuals).  So why not try slowing the taper rate down even further (or even better, starting off at a slower taper rate and then increasing it if tolerated) before putting the patient through a CNS jarring switch to another benzo (which they may or may not tolerate)?[/i]

 

I agree with this. Not every patient can go that fast, and the tapers NEED TO BE TAILORED TO THE PATIENT. Again, the one-size-fits-all approach is not going to work with benzos. Why screw up the CNS even further, exacerbating dizziness/vertigo and making it difficult for the patient to even walk?

 

I know this was for seltzerer, but I added my two cents here. I just would hate to see seniors in worse shape because of a tapering plan, and God forbid having them switch to a short-acting benzo. I don't care what any BB member thinks about that. They know the hazards and have the tools here to circumvent that. But a doctor? NO. A patient? NO. It's like the blind leading the blind.

[[Li...]]

I agree with this. Not every patient can go that fast, and the tapers NEED TO BE TAILORED TO THE PATIENT. Again, the one-size-fits-all approach is not going to work with benzos. Why screw up the CNS even further, exacerbating dizziness/vertigo and making it difficult for the patient to even walk?

 

I know this was for seltzerer, but I added my two cents here. I just would hate to see seniors in worse shape because of a tapering plan, and God forbid having them switch to a short-acting benzo. I don't care what any BB member thinks about that. They know the hazards and have the tools here to circumvent that. But a doctor? NO. A patient? NO. It's like the blind leading the blind.

Thank you so much for contributing to this discussion, Terry38!  I’m heartened that I’m not alone in thinking that this guideline has the potential to cause harm to “taken as prescribed” seniors who want to taper.  I agree 100% with you on the need to tailor the taper to the individual.  As you know, the guideline does include the following statement:

 

“Tapering should be guided by individual choice and severity of withdrawal symptoms. Drug discontinuation may take 3 months to a year or longer. Some people may be able to discontinue the drug in less time.”

 

Unfortunately, the above statement is in fine print and I am concerned that busy docs will just “skip to the highlights” and select one of the two recommended “Taper Methods,” both of which may be too fast for seniors, some (many?) of whom have been taking benzos as prescribed for a long time.

 

I wonder if you would be willing to share your thoughts on the  “Risk Statification and Intensity of Monitoring” section that begins on page 6?  Is it appropriate to place all patients who are 65 and older into the high-risk category?  Is it appropriate to require an annual Urine Drug Screening for all patients who are 65 or older?

[[Te...]]

What I always worry about is a doctor's tendency to rush the patient to get off the drugs. I was very disheartened when I was in the hospital and a doctor took away six of my bp pills (yes, I take a lot of pills and wish I hadn't drunk the Kool-Aid of doctor advice!) and then claimed that I wouldn't have any rebound issues. WHAT??? So I think it's the same with this.

 

“Tapering should be guided by individual choice and severity of withdrawal symptoms. Drug discontinuation may take 3 months to a year or longer. Some people may be able to discontinue the drug in less time.” In my opinion this should have been put in bold print.

 

I don't know about the high-risk category. I know that people at this age group (and I'm one of them) tend to be a bit more fragile than the rest of the population. They can be forgetful. They're also the ones who tend to walk to get their groceries, so falls is a big risk. I think this ought to be up to the physician.

 

The falls category is going to be across the board. Doctors ought to realize that these drugs AUTOMATICALLY cause risk of falling because of the dizziness/vertigo they produce a/c of vestibular problems resulting from the benzos.

 

An annual UDS ought to be up to the physician. After all, doctors are the ones who prescribed the benzos. Should everyone be treated as a potential addict and not to be trusted? I don't think so.

 

Anyway, that's my opinion.

[[Li...]]

 

“Tapering should be guided by individual choice and severity of withdrawal symptoms. Drug discontinuation may take 3 months to a year or longer. Some people may be able to discontinue the drug in less time.” In my opinion this should have been put in bold print.

 

An annual UDS ought to be up to the physician. After all, doctors are the ones who prescribed the benzos. Should everyone be treated as a potential addict and not to be trusted? I don't think so.

 

Thank you so much for continuing to contribute to this discussion of the Kaiser Health Foundation Plan of Washington’s “Benzodiazepine and Z-Drug Safety Guideline.”  (As an aside, I’m still looking but have not as yet found evidence that this guideline has been adopted by Kaiser Permanente at the national level.)

 

I agree with you that the statement “Tapering should be guided ...”  should be in bold print!

 

I also agree with your comments re: Urine Drug Screening (UDS).  FYI The guideline also states that the results of the UDS will be included in the patient’s permanent medical record and hints that the costs for this test may not be covered by the Kaiser Health Foundation Plan of Washington.