Deprescribing Opioids and Benzodiazepines
Medically reviewed by Drugs.com. Last updated on Jun 5, 2024.
AMBULATORY CARE:
Deprescribing opioids and benzodiazepines (BZDs)
means working with healthcare providers to safely lower a medicine dose or stop the medicine. You may be given a prescription for more than one type of opioid, or an opioid with a BZD. A dose may need to be lowered if a medicine causes side effects. A medicine may be stopped if it is no longer needed, an alternative is available, or serious side effects happen. Do not lower or stop a medicine on your own. A sudden change may cause serious health problems. Your provider will taper (lower the dose) slowly.
Make a medicine review appointment:
This is an appointment specifically to talk with your healthcare provider about all your medicines. Ask questions and discuss any concerns you have.
- Bring all of your medicines or a list of your medicines. Include all medicines, vitamins, and supplements you use. If you create a list, put the dose and the time of day you use each item. Also put when and why you started using each. Bring the medicines or the list to each review appointment and follow-up visit.
- Write down any side effects or other problems you are having. For example, do you feel sleepy during the day? Have you fallen because you feel unsteady? Do you have trouble thinking clearly or remembering things? It may help to make a list of side effects or problems you think a medicine may be causing.
- Discuss the benefits and risks of continuing to use opioids or BZDs. Your provider can help you understand if a medicine is still benefiting you. You may no longer have the health problem the medicine was prescribed for. The prescribed dose may be stronger than you need it to be. You may be using other medicines that are interacting with the opioid or BZD. Your provider can help you understand risks, such as the following:
- You may become unresponsive or stop breathing. Opioids and BZDs will make you sleepy and slow your breathing. Your risk is higher if you use a combination of opioids or an opioid and a BZD. The risk is even higher if you also use alcohol, street drugs, or other sedating medicines.
- You may have life-threatening poisoning. Poisoning can happen if you use too much of a medicine or combine too many medicines. Signs and symptoms include trouble walking, confusion, being overly sedated, and slurred speech.
- You may become dependent. Opioids and BZDs are only intended for short-term use. You may become dependent if you continue longer than 2 weeks. Dependence means you feel you need it to function mentally or physically. You may feel you need more medicine over time to get the effect you want.
- Ask if changes can be made to your medicines. You may be able to use a lower dose of the opioid, the BZD, or both. It may be possible to continue 1 medicine but taper and stop the other. Your provider may lower your doses, increase time between refills, or include fewer doses in each prescription.
Help your healthcare provider deprescribe a medicine:
- Work with your provider to create a final dose goal. The goal should include a day you will use the final dose of a medicine. It may take several weeks of tapering to get to the final dose goal. The goal should also include what to do if you start to have symptoms the medicine was treating. For example, if you lower or stop an opioid, you may start to feel the pain the opioid was prescribed for. Your provider can help you find other ways to manage your symptoms. Examples include over-the-counter pain medicine, massage, physical therapy, acupuncture, and aromatherapy.
- Ask about alternatives. You may be able to use a different prescription or over-the-counter medicine instead of the opioid or the BZD. You may be able to manage health problems such as anxiety, insomnia, or pain with non-medicine alternatives. Examples include mental health counseling, physical activity, meditation, or setting a sleep schedule.
- Make a plan for handling withdrawal symptoms. Opioids and BZDs can cause withdrawal symptoms as you use less. Examples include sweating, shaking, nausea or vomiting, irritability, and chills. Do not use alcohol or street drugs to relieve withdrawal symptoms. Withdrawal symptoms can be unpleasant, but they usually last a short time. Your provider will monitor your condition during the deprescribing process. Your provider will help you make a plan for what to do if you start to have withdrawal symptoms.
- Use each medicine exactly as directed. Talk to your doctor or a pharmacist if you have any questions about a medicine. Do not use more medicine or less medicine than your plan states. The tapering process needs to be followed closely for it to work well.
Follow up with your doctor as directed:
Go over the final dose goal at each follow-up visit. You may be referred to a specialist if you need treatment for a condition such as anxiety, pain, or insomnia. Write down your questions so you remember to ask them during your visits.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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