Rapid Benzodiazepine Detox FAQs

1. What are benzodiazepines?
2. How do benzodiazepines work?
3. What is benzodiazepine dependence?
4. How long does withdrawal from benzodiazepines take to get over?
5. What are the different ways to detoxify from benzodiazepines?
6. What is the Rapid Benzodiazepine Detoxification (RBD) program?
7. Who is a good candidate for the RBD?
8. What are patient expectations and requirements to be considered for the RBD Treatment?
9. What is Flumazenil therapy and why is it important?
10. Are there any risks and side effects?
11. How do patients feel during the detox?
12. What happens after the detoxification?

1. What are Benzodiazepines?

Benzodiazepines are a class of medications used for anxiety, insomnia, panic attacks and other medical disorders. The benzodiazepine class of drugs includes Valium (Diazepam), Ativan (Lorazepam), Xanax (Alprazolam), Klonopin (Clonazepam), and Restoril (Temazepam).

2. How do benzodiazepines work?

Benzodiazepines are powerful drugs that attach to the Gamma–Amino–Butyric-Acid (GABA) receptors in the brain. The GABA system in the brain is part of our “sedation” or calming down system. The GABA system helps us to feel calm and relaxed when we are under stress or feeling upset. In a normal situation, whenever we feel anxiety or stress, we all produce extra GABA molecules and this extra GABA attaches to our GABA receptors. This helps us feel calm and relaxed. It can also help us to sleep.

3. What is benzodiazepine dependence?

Benzodiazepine dependence is a condition where people have been taking these benzodiazepine drugs and the body has become physically dependent on them. This dependence usually happens within a period of weeks or months. When patients take any kind of benzodiazepine, the body essentially shuts down its own GABA production and then the body has very limited ability to feel calm or relaxed. If the person stops taking their benzodiazepine or even starts weaning off, patients feel severe anxiety and restlessness. Symptoms of benzodiazepine withdrawal include agitation, anxiety, panic, flushed feeling, increased pulse rate, increased blood pressure, sweating, and insomnia. The symptoms can even progress to seizures, confusion, and a loss of contact with reality. Some patients have a relatively easy withdrawal, but for others it can be a very difficult process.

4. How long does withdrawal from benzodiazepines take to get over?

There are two phases to benzodiazepine withdrawal:

1. Acute phase – lasting 7 days to 90 days
2. Post-Acute Withdrawal Syndrome (PAWS) – in some cases, lasting up to 2 years

The length of time to get completely free of the benzodiazepines varies according to the benzodiazepine that the patient was taking. A short acting drug, like Xanax, has a short acute withdrawal phase, usually lasting around 7 days. A long acting benzodiazepine, like Valium, can have acute withdrawal symptoms which last 90 days.

The Post-Acute Withdrawal Syndrome (PAWS) Phase is usually mild and essentially consists of a slight increase in anxiety and insomnia. Patients find themselves worrying more than they need to, but this goes away over time. The symptoms can usually be helped with a combination of counseling, support and sometimes non-addictive medicines.

5. What are the different ways to detoxify from benzodiazepines?

The acute benzodiazepine withdrawal takes so long that it is almost never performed in a hospital. Insurance companies usually don’t want to pay for patients to stay in a hospital long enough to complete the withdrawal period.

The withdrawal method that most doctors recommend is for patients to wean down from the benzodiazepine that they are taking. Sometimes, doctors will switch from one benzodiazepine to a longer acting one such as Klonopin, to try to make this process easier. Doctors will usually try to get their patients to wean down by about 10% per week. This means the detox may be able to be completed in about 10 weeks. Unfortunately, this slow taper is almost never successful. The withdrawal symptoms are just so strong that most patients are unable to tolerate them. Most patients suffer with severe anxiety, increased insomnia and panic attacks. They feel so bad that usually they go back up on their dose. Success rates of tapering benzodiazepines are very low.

6. What is the Rapid Benzodiazepine Detoxification (RBD) program?

This outpatient program uses an accelerated detoxification method that can complete the acute withdrawal process in about 10 days. The patient stops their benzodiazepines, and is started on a subcutaneous infusion or injection of Flumazenil. The Flumazenil usually provides good relief for the withdrawal symptoms, and at the same time actually removes the benzodiazepines from the patient’s body. All patients must have a support person who will be with them throughout the detox. During the whole period, most patients usually remain fairly comfortable, and at the end of 10 days, they are free of the benzodiazepines.

7. Who is a good candidate for the RBD?

People can become addicted to Benzos for a number of reasons. In order to predict if you are a good candidate for the RBD procedure, we will take into consideration the reason you began using Benzodiazepines. This will also help to predict how easy it will be to get off of the drugs and stay off of them.

Patients generally fall into one of the following three categories of use:

A. Using benzos as part of a drug addiction problem
Many people abuse multiple drugs and often using Xanax or other benzos is part of their drug addiction. These people tend to complete the RBD fairly easily, they feel better fairly quickly, and they have few PAWS. Also, be aware patients cannot detox off benzos and other drugs at the same time.

B. Using Benzos for a short term stress situation
Many people are prescribed a benzo for a stressful situation such as relationship stress, business stress, loss of a loved one, etc. They may be prescribed Ambien for sleep or another benzo to use, as needed. Frequently, they become hooked on this benzo and cannot stop. These patients are good candidates for the RBD provided the original source of stress has been worked through and they have a good support system.

C. Using Benzos for a chronic anxiety disorder
Unfortunately, some patients have a chronic anxiety disorder, which may include generalized anxiety, panic attacks, or PTSD attacks. For some patients, this condition has been present for a long time and will require further counseling and treatment in the future. Frequently, patients with these conditions are prescribed Xanax or Clonopin or other benzos, often along with other medicines. These patients tend to have difficult time detoxing off their benzos, even with our program. Because the anxiety disorder will continue to affect patients after detox, patients tend to have a difficult time with symptoms after treatment. It is essential that these patients have a therapist and a psychiatrist who will work with them post detox.

8. What are patient expectations and requirements to be considered for the RBD Treatment?

9. What is Flumazenil therapy and why is it important?

Flumazenil attaches tightly to the benzodiazepine receptors. It is called a “partial agonist” and a “partial antagonist”. This means that the Flumazenil goes to the GABA receptors and binds so tightly to them that it actually displaces or pushes away any other benzodiazepines that the patient was taking. It then also very lightly turns on the switch so it provides some relief of withdrawal symptoms. It seems to stabilize the receptors so that patients feel comfortable and have less withdrawal symptoms. Interestingly, some clinicians believe that the Flumazenil actually re-sets the GABA receptors, back to a normal state, so that after the therapy is completed, most patients seem to lose their desire for any benzodiazepines. They also seem to lose a lot of their anxiety and panic symptoms. It is fairly easy for most patients to stay off the benzodiazepines. In this way it seems to greatly reduce the PAWS that patients usually experience.

10. Are there any risks and side effects?

All medical procedures have some risks associated with them. Flumazenil has been associated with seizures in about 1-3 % of patients when it is used for treating an overdose. If a patient takes a large dose of a benzodiazepine, most ER physicians give a large dose of Flumazenil to quickly reverse the benzodiazepine. About 1-3 % of these patients will have a seizure. However, the doses we use in our protocol are less than 1% of those given for overdose patients. We routinely use medicines to decrease any chance of seizures. We believe the risk of seizures is very low.

11. How do patients feel during the detox?

Most of our patients feel quite comfortable during the detoxification. Most patients have not experienced severe withdrawal symptoms. They have generally eaten and slept well throughout the whole 10 days. They have also not experienced severe post-acute withdrawal symptoms after the detoxification is complete. A small number of patients have experienced an increase in withdrawal symptoms as the Flumazenil is pushing their benzodiazepines out of their system. We use medicines to help with any discomfort, and as the detoxification continues, their withdrawal symptoms get better.

12. What happens after the detoxification?

After the detoxification, some patients benefit from non-addictive medications to help with making sure anxiety and depression do not return. We always recommend counseling and support groups. Again, there is a need to commit to having a psychiatrist or other medical doctor who agrees to see you in follow up after the detoxification.