Benzodiazepines are used for several problems seen in the primary care office. Chronic users are often older, medically ill, and with multiple needs. These are often used by abusers of narcotics. Focusing on the treatment of the primary problem usually results in the secondary condition to be treated as well.
Benzodiazepine withdrawal can be life threatening.
Substitution schedule illustrating conversion doses for various benzodiazepines to phenobarbital which is then given t.i.d. was shown. Outpatient detox may be done with a prolonged taper of the benzodiazepine but this is very difficult to accomplish if the individual is addicted verses having drug dependence. Look for alternative treatments if there is an underlying anxiety disorder, insomnia, or chronic pain along with addiction. A table was shown giving suggestions for drug prescription for various anxiety disorders - drugs such as SSRI drugs that do not have addiction potential. Physicians may fear prescribing for several reasons including the fear of inducing addiction and fear of penalties for prescribing large amounts of narcotics.