Tapering Strips for Benzodiazepines

Peter Groot, MD
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In 2003 I experienced the worst depression I had ever had in my entire life, and I started to use antidepressants. As a patient and as a scientist I started reading about depression and about antidepressants. Quickly I found out that it can be very difficult to stop using these drugs. For the antidepressant I use, Venlafaxine, it is practically impossible to stop without suffering from withdrawal symptoms. If today I forget to take my daily capsule, tomorrow morning I will experience the first symptoms of withdrawal.

The best way to minimise withdrawal symptoms is to gradually reduce the dose over a prolonged period of time. How long? Nobody really knows. This can differ between patients. If a patient has the opportunity to take enough time, my guess is that most if not all withdrawal symptoms can be prevented. The same is true for other types of drugs, for instance benzodiazepines, where physical dependence after chronic use is another major problem.

July 11th is Benzodiazepine Awareness Day and also the birthday of Professor Heather Ashton, famous now for her work on helping people withdraw from difficult-to-stop drugs like benzodiazepines. She has been advocating very gradual tapering, over periods of months and if necessary even years. She also advocates patient-choice and shared decision making, saying that doctors who want to help their patients should listen to them and work together during the taper. Shared decision-making empowers patients and encourages them to take responsibility for their own treatment.

Realising a gradual tapering method in daily practice has turned out to be very difficult. The major problem, in my opinion, is the fact that the different doses needed to do this are not readily available. After becoming aware of these problems and with the help off others (and making a very long story very short here) I became involved in the development of so-called ‘Tapering Strips’. Currently these tapering strips are available for patients in the Netherlands for 24 different drugs, including the benzodiazepines clonazepam, diazepam, lorazepam, oxazepam and temazepam.

A tapering strip uses the same principle as the coins we use to pay small amounts of money with. We can pay 40 cents using three coins — one of 25, one of 10 and one of 5 cents — or 20 cents using two coins of 10 cents or four coins of 5. With pills we can do the same. What we need is pills with low doses and we can then put together every dose we want.

The practical problem is how to deal with this as a patient. We found that a practical solution to solve this was readily available. We package the pills for each separate daily dosage in a pouch of so-called “baxter strips,” or medication on a roll. Each roll provides medication for a practically convenient period of 28 days.

One size fits all does not work. It is not possible to use the same tapering schedule for all patients who wish to stop with a certain drug. Therefore we had to come up with a flexible solution that was both practical and allowed doctors and patients to make the choice they deemed appropriate. What we came up with was a modular system, consisting of a number of different tapering strips for a given drug. This offered the possibility to choose for different tapering schedules by using one or more tapering strips consecutively.

Doctors who prescribed the tapering strips, along with their patients, told us that it was sometimes necessary to adapt the taper: to let the patient go slower or to give the patient a ‘pause’ by staying on the same dose for a certain period of time, before continuing the taper further. To allow patients to do this is it possible to use so-called stabilisation strips. What we also heard from patients is that not everybody was able to stop completely, but they were able to continue using their drug at a lower dose than the dose they used previously. This is not surprising, if you realise that drugs are prescribed at the same average doses to all patients.

We worked out this whole system by listening carefully to what patients and doctors told us. We also ask patients who have used the tapering strips what their experiences are. What patients tell us is that tapering with the use of tapering strips becomes much easier. They suffer fewer withdrawal symptoms and are very satisfied with the tapering strips and the information provided.

Currently most information about the tapering strips is still only available in Dutch. The reason is that we wanted to make the strips available to patients as quickly as possible and it was easier to do this is if, for the time being, we limited it to our own country. By now, we feel confident that the system we have developed is ready to be used in other countries too. Not all information has been translated into English yet, but we are working hard to make important available as as soon as possible. The most important information, a user (patient) written provisional protocol which we hope will be commented on and endorsed by official guideline committees, and receipt-order forms for all the drugs for which tapering strips are currently available, can be found at www.taperingstrip.org.

I sincerely hope that a lot of patients will benefit from them.

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Editor’s note: MIA Radio Host James Moore is petitioning the UK Medical Authorities to provide support for the use of tapering strips. Read his blog about the campaign, and sign the petition here.

11 COMMENTS

  1. There is no painless way to do it.

    “Quitting by the gradual withdrawal method. I discuss this method quite extensively in my seminars. I always tell how if there is anyone attending who knows a smoker who they really despise they should actively encourage them to follow the gradual withdrawal “cut down” approach. They should call them up every day and tell them to just get rid of one cigarette. Meaning, if they usually smoke 40 a day, just smoke 39 on the first day of the attempt to quit. The next day they should be encouraged to smoke only 38 then 37 the next day and so on. Then the seminar participant should call these people every day to congratulate them and encourage them to continue. I must reemphasize, this should only be done to a smoker you really despise.” http://whyquit.com/joel/Joel_01_13_gradual_withdrawal.html

    The way I think best to quit benzos is to take that first dose later and later every day. No pain no gain. Don’t even play with the night dose and the insomnia till you make it through a full day without any benzo.

    I lived the force you off benzos “for you own good” so many times and those clueless people usually, no always gave the last pill in the morning.

    There is always hell to pay quitting benzodiazepines, one way or another either months of “minor” hell or a week of major hell, hell is going to get paid.

    Pay hell during the day as long as you can taking minimal amounts till you can make it a whole day with none and continue to take a nice 2mg Xanax, Klonopin, Ativan or what ever you are up to … at night during that time. It makes it easier to pay off hell during the day knowing that nice relief is coming that night. Then as I already said when you have gotten to the point of doing your day without any then start cutting the night dose and maybe messing with other sleep aids.

    Thats how its done. I got myself out of the benzo trap that way on my own the very last time no help from the “professionals”. I had to, supply running out and I was just was not playing that game anymore.

    Be careful with the alcohol, it can carry you though a tough spot but the rebound seriously erases forward progress.

    • Cat
      What your experience is/was does not necessarily translate into other’s.

      I think there’s a lot to be said for micro tapers, which is discussed and supported at length on Surviving Antidepressants. I thought tapering over a year and a half was slow; 42 months later and still significantly impaired, I wish I would have known about *anything* at all regarding how to safely discontinue long term use of Klonopin.

      • Its been my experience that hell must be payed and I don’t think there is any way to pay less. How many months in that state of like tolerance withdrawal is required to quit the “easy way” ?

        I just still think the best way to beat the hell collector out of some of the pain of that withdrawal state is looking forward to and knowing a nice reliving dose is coming night and a complete break from it to get thoughts and reality back in order. Rest up and prepare for battle the next day.

        I don’t know what the best way is for everyone but the worst way is when someone else dictates it and starts playing games with the Zoloft and Abilify or what ever there favorite concoction is.

        Never once heard anyone in group say some crap concoction like Zoloft and Abilify was helping them in any way only complaints of side effects and the doctor being a moron looking things up on Google during the session.

        I think/know a good drug to battle benzo withdrawal is Seroquel, alot of people absolutely hate it cause they were given too much, restless legs all night then zombied out the next morning… Its a weird drug in that less is more when used for sleep and I think its good for the end of the benzo battle. Keep it @ <= 25mg. Get all hungry zombie then eat and sleep. Trazadone is a toxic bad joke, Trazodone has a narrow "window" of sleep-promoting effect. That stuff completely sucks.

        The people in detox would miss the "window" but not the other effects up all night pacing and miserable.

        That micro taper would never work for me, I would start drinking to get right after being stuck in that state of half ass withdrawal for weeks.

  2. And beware beware beware of this “non addictive” S— will help with the anxiety… And they send you down the road of Paxil, Cymbalta, Zyprexa, Lamictal, Zoloft, Abilify…

    After going to rehab myself and living the “this ‘non addictive’ S— will help with the anxiety” nightmare then working in one and watching them do it to so many other people I named it “Benzo nightmare part II”

    I never understood this logic: “You are mentally ill and need to take psych pills every day but not those benzos because they cause dependency and you will need to take them every day”

    Wait what ?

    “You are mentally ill and need to take psych pills every day but not those benzos because they cause dependency and you will need to take them every day”

    So here is your “non addictive” Paxil, Cymbalta, Zyprexa, Lamictal … and its so “non addictive” you will get really sick if you stop taking it abruptly so check with your doctor before discontinuing this medication.

    So here is your antidepressant that “helps” with anxiety. It helps anxiety so well even the pharma paid off FDA could not approve it for anxiety. It takes 6 weeks to “get in your system” (what “system” are they talking about?) anyway this crap doesn’t “work” for six weeks but we will just load you up on it now wile your body, mind and nerves that are already a mess from benzodiazepines withdrawal just to give it more to deal with and lots of fun ‘side’ effects.

    And you are an “addict” and since we know addicts love to fly high, party and feel good here are some mood stabilizer mood remover pills to make sobriety feel even more flat, dull , tired and boring. When you go home and get sick of everything feeling flat dull tired and boring and drink or score some party drugs to overcome the flatness for a wile we will put all the blame on the “disease” of addiction.

    Just watch out for the benzo nightmare part 2.

  3. Come up for something for Zypexa olanzapine withdrawal micro tapering, I can’t even come up with a string of words to describe the wicked evil nightmare that is. I lived it when they gave me that poison to “help” with Xanax Xr withdrawal after 8mg to 0. Don’t worry it is “non addictive”…. Bastards.

    Its all the anxiety insomnia hell of benzo withdrawal combined with the nausea vomiting effects of opiates plus this bad trip like terrifying psychosis. It goes on for weeks. Its pure evil. One thing in common with everyone who writes about it online is they use words evil devil wicked and hell.

    Zyprexa victims don’t have the voice that people with the benzo sickess have but it is BAD S—-. For the full year of 2012, worldwide Zyprexa sales totaled $1.701 billion… Plus that olanzapine is generic now I can’t even guess how many people are stuck in Satans version of a rock and a hard place.

    The rock is the Zyprexa anhedonia that robs your ability to feel pleasure from anything and the hard place is the hell inspired withdrawals.

    A micro taper method for that stuff would make the world a better place for alot of people.

    In the hospital that I went to twice with vomiting and panic attacks getting admitted the second visit that luckily was not overly abusive, it took 8mg a day of Ativan to combat the Zyprexa withdrawal. The tryed to give me Geodon I said get lost but there I was 5 months after kicking the Xanax Xr back on Benzos to kick the “non addictive” poison they gave me. Back to benzo dependency then 2 years later kicking benzos again.

    And of course they tried pulling a “Part II” on me once again with the “non addictive” continuation but I knew better.

  4. I’m sorry. I’m now 64 and have been going around and around the system all my life dealing with this. I was mislabeled or labeled at all at an early age and yet accomplished a lot at a tremendous effort. I have lost everything of meaning to me and trying all kinds of tapers and cold turkeys drug substitutes etc of psych drugs. The reason to taper or get off these drugs is to return to your life of love, family, friends, occupation, hobbies, joys. What if you have nothing to return to?

  5. Peter what a great system sorely needed everywhere these drugs are prescribed please do whatever u can to proliferate world wide
    Sadly people are happy to prescribe them but completely indifferent to managing the side effects even when they are life threatening
    My son developed severe serotonin syndrome pulse 160 profuse sweating ocular signs etc on zoloft and respiridone taken to emergency and only treated properly thanks to us taking a copy of the John Hunter NSW serotonin syndrome protocol with us and giving it to the doctor who was about to have him locked up as psychotic
    he would’ve died in there and I’m sure many people do
    tapering you manage on your own as well as you can how can they prescribe these drugs without consequences ??