Although intravenous flumazenil is an effective agent for benzodiazepine reversal, most deaths unfortunately occur before medical intervention is possible. It is clearly unwise to give a patient who is out of control with drug use a retail quantity of drug. If immediate detoxification is not possible then smaller quantities on a regular basis may be more appropriate. This has been used in out-patient reduction regimens, usually with diazepam. The harm reduction philosophy allows those who are addicted access to limited quantities of safe drugs within a medical framework.
Pharmacists are usually prepared to participate in more frequent dispensing of smaller quantities.
Some unstable patients benefit from daily supervised dosing, while others can take a week's supply at a time. The patient should have some input into the goal setting which should not be imposed arbitrarily by the doctor. Some limits and objectives should be agreed. Initial doses should be according to the patient's current tolerance. The longer and slower the reductions, the more likely the process is to succeed long term.