What Did the Lisa Ling Benzo Episode Get Right About Withdrawal and Tapering?

What was the Lisa Ling benzo episode?

On October 6, 2019, CNN, the cable news network, aired “The Benzos Crisis,” an episode of its documentary series “This Is Life with Lisa Ling.” The episode followed people who had taken benzodiazepines as prescribed, were harmed by long-term use, and struggled to come off them. Benzodiazepines are the anxiety and sleep medications that include Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam).

For many viewers, it may have been the first time anyone said plainly that a medication taken exactly as directed could do this. What did the episode get right, and what should a family do after watching it?

The episode was right that these are patients.

A person who takes a benzodiazepine every day because a doctor prescribed it, and who becomes ill when the dose drops, is not chasing a high. That person has physical dependence, which is the nervous system’s adaptation to a medication taken steadily. Addiction is a different condition, a pattern of compulsive use despite harm.

The distinction decides what kind of care follows, which is why the labels matter. Dependence is not addiction.

In September 2020, less than a year after the episode aired, the United States Food and Drug Administration (FDA) required an updated boxed warning for every benzodiazepine. In announcing it, the agency said that physical dependence can occur when these drugs are taken steadily for several days to weeks, even as prescribed. The label caught up with the patients.

Why is a benzo detox the wrong thing to look for?

After a program like this, a family’s next search is often for a benzo detox. For a benzodiazepine, the safe version of that idea is a gradual, medically supervised taper over months. Unfortunately, much of what the search turns up is addiction treatment facilities, where a stay lasts days or weeks and the goal is to be off the drug by discharge.

That speed is the harm. The FDA’s 2020 update warns that stopping abruptly, or reducing the dose too quickly, can cause withdrawal reactions, including seizures, that can be life-threatening. Call 911 for a seizure or any other medical emergency.

Professor C. Heather Ashton wrote about these facilities in Chapter II of the Ashton Manual, her tapering guide. She wrote that withdrawal in a hospital or special center usually involves a fairly rapid withdrawal, often removes control from the patient, and is commonly followed by setbacks at home. While she allowed that such a center may suit a small minority of people, she favored slow withdrawal in the patient’s own environment.

Think of landing an airplane. A long, shallow descent and a nosedive both end on the ground, yet only one of them is a landing.

What does a safe taper look like?

Fortunately, the alternative is well described. In the Ashton Manual, slow withdrawal means tapering the dose gradually, usually over a period of some months, and many people have taken a year or more. The Manual suggests aiming for up to one tenth of the dose at each step, and it leaves the pace to the patient.

The Maudsley Deprescribing Guidelines add hyperbolic tapering, in which each step is sized to the dose that remains, so the reductions get smaller as the dose gets lower. The actual numbers are worked out between the patient and the prescriber, and the patient may hold at a dose for as long as it takes.

Where it helps, a person taking a short-acting benzodiazepine may first switch to diazepam, which is known as a crossover taper. Diazepam is a long-acting benzodiazepine that leaves the body slowly and allows a smooth, gradual fall in blood level. It is the same class of drug, in a form that is easier to reduce.

Does withdrawal always end in a few weeks?

Not for everyone. Chapter III of the Ashton Manual describes a minority of people whose symptoms do not go away for months or even years, which is known as protracted withdrawal. The FDA’s 2020 update describes it as well, with symptoms that can last for many months.

Yet, Professor Ashton also wrote that a steady decline in symptoms almost invariably continues, though it can take a long time. She added that protracted symptoms are almost certainly much less common after a slow taper under the patient’s own control.

What should a family do after watching?

So, the first step is not a facility. It is a conversation with a physician who understands physical dependence and who will plan a taper at the patient’s pace, with no deadline.

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida. His practice provides medically supervised tapering of benzodiazepines and z-drugs, the related sleep medications, for patients in Florida. He works directly with each patient, and the taper is gradual, patient directed, and measured in months, sometimes longer.

A viewer who recognized a family member in that episode is not looking at a drug problem. That viewer is looking at a medical condition with a slow and well-described way out, and Dr. Leeds’ practice is built around it. Contact the office to ask about a gradual, medically supervised benzodiazepine taper.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.