Will VA taper you off benzos to quickly?

[[Be...]]

My question is geared to veterans who tried to taper off benzos through the VA. 

[[Be...]]

[[Be...]]

Does this sound right after being on benzos for 24 years?

Edited March 26 by [Be...]

[[Nu...]]

They publish other guidelines which I'll reference below. These excerpts are pulled from them.

Department of Veteran Affairs (2021)

• Design a slow taper to the lowest dose necessary to maintain function and good symptom control. Slowly tapering can lessen withdrawal and rebound symptoms and promote successful discontinuation.
• A slow taper is associated with total cessation of benzodiazepine use in about two thirds of patients.
• There is no one-size-fits-all approach to tapering benzodiazepines. Each patient may require a different rate of taper. A proper benzodiazepine taper can take many months or even years. Patients on high doses of benzodiazepines or those who have been taking the medication consistently for many years may need a slower taper. The rate of taper should ultimately be determined by the patient’s symptoms.

Department of Veteran Affairs (2021). Re-evaluating the use of benzodiazepines.

[[Li...]]

@[Be...]

The taper schedules presented by the US Department Veteran’s (VA) affairs in Re-evaluating the Use of Benzodiazepine: A VA Clinician’s Guide (2021, p. 14) are:

SHORTER TAPER
- Gradually reduce dose by 50% over the first 4 weeks (e.g. 10-15% weekly)
- Maintain on that dose (50% original dose) 1- 2 months then
- Reduce dose by 25% very 2 weeks

LONGER TAPER
- 10-25% every 2-4 weeks

The general guideline used in this community is 5-10% every 2 to 4 weeks.  However, the key is that the taper rate is adjusted over time based on how the individual responds to reductions.  

The VA’s clinician’s guide was published in 2021.  It will be interesting to see if the US Department of Veteran’s Affairs updates its guidance based on The Maudsley Deprescribing Guidelines (2024).

Primary Source:
Re-evaluating the Use of Benzodiazepine: A VA Clinician’s Guide (2021)
https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/508/10-1528_Benzos_Provider_ReEvaluatingtheUseofBenzos_P97048.pdf

Edited March 26 by [Li...]
Format

[[Be...]]

Libertas, I was afraid of that. 

Edited March 26 by [Be...]

[[Li...]]

@[Be...]

Has your psychiatrist (or any of your other clinicians at the VA) suggested that you reduce or stop the clonazepam?  

[[Be...]]

Libertas, Actually they have suggested a taper. I declined but I didn’t know about about the adverse affects due to long term use.

Edited March 26 by [Be...]

[[Be...]]

Libertas, I will discuss this with my VA Psychiatrist and hope they can be flexible if needed. 

[[Li...]]

@[Be...] Thank you for confirming that a benzo taper has already been suggested.  This gives you a good ‘excuse’ to ask your psychiatrist for more information - how exactly would they approach a benzo taper?  

@[Nu...] has done a good job of identifying key points from the VA clinician’s guide:

• There is no one-size-fits-all approach to tapering benzodiazepines. Each patient may require a different rate of taper.
• A proper benzodiazepine taper can take many months or even years.
• The rate of taper should ultimately be determined by the patient’s symptoms.

The more of these points your psychiatrist identifies, the better.  A red flag would be if they indicate they would follow the formulaic ‘longer’ taper schedule given in the guide (10-25% every 2-4 weeks). 

Needless to say, you’ll want to avoid any references to being addicted to or ‘hooked on’ the clonazepam.   Instead, based on what you’ve shared with us, it sounds like you are physically dependent and also may be experiencing either interdose withdrawal or tolerance.  Given that you are taking multiple psychoactive medications, I also wonder if some of the symptoms you are experiencing may be due to adverse drug reactions or drug interactions.

In closing, I wonder if it might be helpful for you to contact Angie Peacock (a fellow vet - she served in the US Army). Like you, she was prescribed multiple psychoactive medications but managed to discontinue all of them and is now helping others do the same.  She may have suggestions on how to approach the conversation with your VA psychiatrist and/or how to negotiate and navigate a patient-centered taper within the VA system.  You can learn more about Angie at her website or YouTube channel:

 

https://www.apeacockconsulting.com/

https://www.youtube.com/@AngiePeacockMSW/videos

 

 

 

[[Ch...]]

@[Be...]

The Maudsley Guidelines have been widely known and well-regarded in psychiatric medicine for 30 years now. Please let your doctor know about the new (2024)  Maudsley Deprescribing Guidelines (mentioned above). The text specifically discusses safe methods for getting patients off of antidepressants, benzodiazepines, gabapentinoids, and Z-drugs.

[[Nu...]]

It's also not a bad idea to make a few notes from the VA references given here and take them in with you. Let your doc know that you like to be educated about your health so you took the initiative to do some research. I'd make note that the above are from the VA, specifically.