Addiction Medicine Made Easy | Fighting back against addiction

Benzodiazepines - Pills That Sedate but Don't Rehabilitate

• Casey Grover, MD, FACEP, FASAM

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Dr. Casey Grover explores the challenging world of benzodiazepines, explaining why these commonly prescribed medications can create more problems than they solve for patients struggling with anxiety and other conditions.

• Benzodiazepines work like alcohol in pill form, enhancing the brain's natural "downer" chemical GABA
• Long-term use leads to tolerance, dependence, and potentially Benzodiazepine-Induced Neurological Dysfunction (BIND)
• The four most commonly prescribed benzos are diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax)
• Benzodiazepine withdrawal can cause seizures months after the last dose, making it particularly dangerous
• Unlike opioid addiction, there are no specialized medications to treat benzodiazepine addiction
• Tapering from benzodiazepines is extremely challenging, often taking months or years with patients experiencing severe rebound symptoms
• Modern medical understanding now recognizes benzos as inappropriate for long-term anxiety treatment
• Case studies demonstrate how patients prescribed benzos for anxiety often never learn proper coping skills and suffer increasingly worse symptoms

Thanks for listening and remember treating addiction saves lives.

To contact Dr. Grover: ammadeeasy@fastmail.com

Speaker 1:

Welcome to the Addiction Medicine Made Easy Podcast. Hey there, I'm Dr Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years I worked in the emergency department seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started.

Speaker 1:

Today's episode is on benzodiazepines. I am the medical director for a drug and alcohol treatment program near me and as a part of my medical director duties, every month I do an educational lecture for the staff of the program and we choose a different topic each month. This month I did an overview of benzodiazepines a very challenging topic. Here we go. A very challenging topic here we go. Okay, so today we're going to be talking about benzodiazepines and before we start I just need to put in a little disclosure, which is that benzodiazepines can be prescribed and used by a physician and a patient if that's the right decision for that patient. And I realized that when I'm speaking to the audience, someone in this audience might be taking benzodiazepines and I don't mean to offend anyone, but in my opinion, given what I do as an addiction medicine doctor, benzodiazepines are a really bad problem and they cause quite a bit of harm. And I'm going to be as honest as I can be. I don't mean to offend anyone and if anyone has a relationship with their physician and they're on benzodiazepines and it's working, please realize I'm not meaning to judge, I just have my perspective, given what I do as an addiction medicine doctor. So, as you can imagine, I'm not going to paint a very pretty picture of benzodiazepines and I will share how I approach them in my practice.

Speaker 1:

So benzodiazepines are a group of medications that act like a sedative or a downer. So the way they work is they increase the effects of the brain chemical GABA, and GABA stands for gamma-aminobutyric acid and it's one of our brain's natural downers. And if you remember some of our lectures on alcohol, gaba is how alcohol acts like a downer. Alcohol makes GABA work better in the brain, so it takes the brain's natural downer and makes it work better. And benzodiazepines are the same way. In fact, many physicians often try to explain to patients that benzodiazepines are basically like alcohol in a pill.

Speaker 1:

Why do we use them? As I mentioned, they're downers, they're a sedative, and so we used to use them for anxiety, and I'll explain why we're reevaluating this. We will often use it to make people sleepy around a medical procedure, like if people are claustrophobic to get into an MRI. When people are really agitated in the hospital, we'll use them to sedate people and they have a very profound downer effect. And so when people have seizures, actually we use benzodiazepines. They're really effective when someone is having a seizure, to terminate the seizure. And when someone is taking a downer and they're in withdrawal from that downer, we sometimes use benzodiazepines to suppress the withdrawal and they're really the best medication we have when someone has severe alcohol withdrawal and as we really the best medication we have when someone has severe alcohol withdrawal and as we'll talk about, unfortunately we don't have a lot of options to treat benzodiazepine addiction or withdrawal or dependence. So when people are on benzodiazepines, we actually use benzodiazepines to manage their withdrawal and we'll talk about that in quite a bit of detail Now I'm going to show you a chart here.

Speaker 1:

There's quite a few different benzodiazepines and we really look at them in a couple of ways how fast do they come on and how long do they last, and do they have metabolites that are also active? And so here are some names alprazolam, clonazepam, diazepam, lorazepam, medazolam. You see they all end in pam or lam and you can see some of them come on quickly like alprazolam, but it doesn't last very long. Something like diazepam comes on quickly and lasts a long time. And the reason why this understanding of how the different benzodiazepines work matters is because as physicians we have to choose the right benzodiazepine for the patient in the right circumstance. So let's say, somebody is in alcohol withdrawal which can last for several days. We don't want a benzodiazepine that's short-acting because when it wears off we don't want a benzodiazepine that's short-acting because when it wears off they're going to be in withdrawal again. So we usually use long-acting benzodiazepines like diazepam or chlorodiazepoxide to manage withdrawal, because they are long-acting.

Speaker 1:

The other thing is traditionally we used to think of benzodiazepines as useful for anxiety, and when people are anxious they want to feel better quickly. So we would use a fast onset benzodiazepine. I'll talk quite a bit in detail about how using benzodiazepines for anxiety is really not considered good medicine anymore, and so we really don't use alprazolam or clonazepam to manage anxiety. But you can see here that, based on how they work, because they're fast acting, that was why they were chosen. Now, as you can see, one, two, three, four, five, six, seven, eight, nine, 10, 11, 12, 13, 14.

Speaker 1:

This chart has 14 different benzodiazepines. The big four are the ones that doctors use the most and I'm gonna try to use generic names. I may slip up a little bit, but there's diazepam, also known as Valium. There's lorazepam, also known as Ativan, and there's clonazepam, also known as Klonopin, and there's Alprazolam, known as Xanax. Those four medications are the ones that are most commonly prescribed in the outpatient setting. We do use some other ones in the hospital, but again, these are the big four that you're mostly going to see when someone's getting a prescription for them from a doctor.

Speaker 1:

Now, the other thing to understand about benzodiazepines is that they are different in their potency, and again we're going to focus on the big four diazepam, clonazepam, alprazolam and lorazepam. And you can see they are different in their potency. So I usually, when I'm getting people off of benzodiazepines, convert everything to diazepam, kind of like how with opiates we convert everything to morphine to understand their relative potencies. So alprazolam and clonazepam are 10 times stronger than diazepam and lorazepam is five times stronger than diazepam. And what happens is people get told oh, don't worry, you're just on a milligram of clonazepam and it's no big deal. One milligram doesn't sound like a lot, but when we actually look at the potency of benzodiazepines because clonazepam and alprazolam are so potent people's tolerance and dependence goes up fairly quickly, even though it seems like a small dosage. And we'll talk about what I do when I get people off of benzodiazepines.

Speaker 1:

Now, the reason I find benzodiazepines so frustrating is, like other medications and substances when people take them chronically, the brain changes and we see the same things we see with other substances. They get tolerance where they need more to feel the same effects. They get dependence, so they feel sick or go into withdrawal when they stop. But there's actually more to the story, specifically around benzodiazepine use and one of my patients I just talked to him last night. He is completely miserable as we taper him off of benzodiazepines and he actually taught me about this condition, which is called BIND B-I-N-D benzodiazepine-induced neurological dysfunction, and this is why I was saying that we used to prescribe them pretty regularly for anxiety. But what we're learning is they're not benign long-term.

Speaker 1:

So benzodiazepine-induced neurological dysfunction involves a lot of different symptoms that people get when they're on benzodiazepines chronically and it's the worst as they try to taper off of benzodiazepines. Symptoms can include anxiety, fear, poor sleeping, palpitations, nerve sensations, and it can be really debilitating. It can interfere with relationships, work, interpersonal functioning, and I didn't actually know what this was originally, but I would get referred all of these patients to me that were on chronic benzodiazepines when their physician retired or said oops, I've had you on Alprazolam for five years. I don't think it's a good idea anymore and I just couldn't figure out why people had no ability to regulate their emotions once they were on chronic benzodiazepines. And I had come up with my own term they seem so emotionally fragile that I called it benzodiazepine-induced emotional fragility. And it turns out that's actually not just my observation, but that is something that we are now seeing is a side effect of long-term benzodiazepine use, and I'm going to call it BIND just for simplicity's sake as we go forward. And again, that's benzodiazepine-induced neurological dysfunction, and we'll talk about why it makes getting off of benzodiazepines so difficult.

Speaker 1:

Now, as I mentioned, what we were seeing with benzodiazepines is people just were so unable to manage their emotions once they were on chronic benzodiazepines and in part, that's a little bit about how addiction works in general. Right, I ask my patients what does alcohol do for you? Oh well, I got beat up horribly as a child by my stepdad, and when I drink alcohol, I don't have to remember it. I use it to numb out. And so, in addition to the unique issues that benzodiazepines cause in terms of changing our brain function, long-term a benzodiazepine addiction, or chronic benzodiazepine use, is like any other addiction. People learn that the substance is the only way that they can manage anything, and that's part of what plays in to why it's so hard to get people off of. Benzodiazepines is, forgive me, they're very effective at acting like a downer and calming people down, but then people don't actually ever learn how to manage anxiety and I feel so bad. I have so many patients that have been on benzos for longer than I've been alive and they're horribly anxious and they don't know how to manage it and their doctor never referred them for mental health services and their doctor just kept giving them more benzodiazepines. It's actually really sad. So let's go through some clinical cases and you can start to see what this actually looks like when someone comes to me and they've been on benzodiazepines for a long period of time.

Speaker 1:

So this is my first case. This is a 45-year-old female who came to my clinic and she wanted to get off of clonazepam. So she had a history of cancer and her oncologist started her on benzodiazepines because she was very anxious while she was getting her cancer treatment. And because she was on clonazepam chronically, her brain adapted to it. She developed tolerance and her oncologist just kept increasing the dose of her clonazepam and so on my very first visit with her, she was on two milligrams of clonazepam three times daily. That's a total again, of six milligrams a day. And she kept telling me like, oh, it's not that bad, it's only six milligrams. And I had to show her that it's a really high dose. She's on the equivalent of 60 milligrams of diazepam or Valium a day and insurance won't actually cover that high of a dose of diazepam. It's felt to be unsafe. And what was so challenging during this visit is she complained the entire visit about how anxious she was and I remember thinking like what's even the point of being on clonazepam? She's just anxious and now we have to worry about withdrawal. So we're going to put a pin in her case and we're going to come back to it because we need to talk about why we have to be really careful when we get people off of benzodiazepines.

Speaker 1:

So you probably all know, as we've talked about various substances, that usually substances have a withdrawal syndrome. Alcohol withdrawal we've talked about. People get shaky, they get restless, they can have seizures. Opiate withdrawal people have nausea and vomiting and diarrhea. They get restless.

Speaker 1:

Benzodiazepines are a downer and the way I look at it is if the drug takes you down, the withdrawal syndrome is the opposite You're up and so essentially what we see is because the benzodiazepines act as a sedative, withdrawal involves the opposite. So mild withdrawal would just be anxiety or insomnia or restlessness. But as people are on higher doses and the withdrawal gets worse, it can be very number one unpleasant and number two life-threatening. So moderate withdrawal people get a lot more somatic symptoms muscle tension, sweating, sensitivity to light and sound, and they can also get some psychiatric symptoms. Beyond anxiety and insomnia. They can get what's called depersonalization, where they feel like they're having an out-of-body experience. It can mess what's called depersonalization, where they feel like they're having an out-of-body experience. It can mess with their mood and then again, because it's a downer, you get some other things that come up, like you can get a fast heart rate or palpitations. And what we really worry about is severe benzodiazepine withdrawal. People will seize, they will get delirious, where they get acutely confused and then they can even begin to hallucinate, where they get psychosis. And if any of you have heard of delirium tremens, that is the absolute most severe form of alcohol withdrawal and really bad benzodiazepine withdrawal can look like that and it can put people in the intensive care unit.

Speaker 1:

We also need to specifically discuss seizures as it pertains to benzodiazepine withdrawal. Now, as I mentioned, we actually treat seizures with benzodiazepines. So let's say somebody has epilepsy and 911 gets called because they're having a seizure. The paramedics will often give a dose of benzodiazepine to terminate the seizure and it is a known side effect of coming off of benzodiazepines that you can get seizures. Essentially, the way to think of it is because they're a downer. They turn down brain activity and as people are coming off of it, the brain activity goes up and eventually the brain activity can. And as people are coming off of it, the brain activity goes up and eventually the brain activity can get so intense that a seizure gets triggered. And with alcohol withdrawal, people only are at risk for seizures within like the first couple of days of coming off of alcohol.

Speaker 1:

Benzos are different. People can randomly have a seizure for months as they're coming off of benzodiazepines and they might even, let's say, take their last dose of benzodiazepine in July. They could have a seizure related to benzosensation in November or December, and it's really unfortunate because it can be really unpredictable we have to worry about. Is it epilepsy? Is it just coming off of benzos? And the highest risk for a seizure coming off of benzodiazepines is when someone abruptly stops, and so usually we put people on a long, slow taper to try to get them off of benzodiazepines safely. But even then you can still get seizures when you're doing it carefully and slowly with a taper, when you're doing it carefully and slowly with a taper.

Speaker 1:

Okay, so I've been mostly talking about people getting benzodiazepines from a doctor, getting them prescribed. We've talked about dependence, we've talked about bind, we've talked about tolerance, we've talked about withdrawal. Can you get addicted to benzodiazepines? And I think you all know the answer is yes, and so you can also get a benzodiazepine use disorder. And again, just to make sure we understand everything, anyone who is prescribed benzodiazepines regularly will develop tolerance and dependence and go through withdrawal.

Speaker 1:

A use disorder is an addiction. It's the psychological phenomenon of cravings, compulsive use and using despite consequences, and it's the same criteria we use to diagnose any addiction. There are 11 of them. You can see them on the screen. You're using more or for longer than you wanted to. You've tried to cut down. You spend a lot of time trying to get it. Cravings for benzodiazepines. Because of your use, you do not fulfill your major role obligations. You continue to use despite social or interpersonal problems. You're giving up hobbies and other activities. You use when it's physically dangerous. You use despite having psychological harm to your body and then, as we've talked about, because people tend to get dependent because they're using it so frequently, we also see tolerance and withdrawal. So, yes, we see, unfortunately, quite a few patients with benzodiazepine use disorder in our practice. Disorder in our practice.

Speaker 1:

Now, how do we treat benzodiazepine addiction? I'm going to try to be funny here. The great news is we have incredibly effective medications for benzodiazepine addiction. Kind of like we have methadone for opioids we have methabenzone, and like we have suboxone for opioids we have benzoboxone. I'm completely kidding. There are no effective medications to treat benzodiazepine addiction. It's horribly frustrating. We don't have a methadone or a suboxone for benzodiazepines. All we can really do is get people into counseling. They might need to go to residential and we're going to want to get them to mutual support groups and then we just very slowly wean them off of benzos. Having discussed this with a number of other addiction medicine doctors, we all pretty much agree that the hardest addiction to treat is benzodiazepines. It's the most frustrating problem I have as an addiction medicine doctor.

Speaker 1:

Now we've talked about the fact that when people get dependent on benzos whether it's prescribed by a doctor or it's because of their benzodiazepine use disorder we have to get them off of benzodiazepines safely. How do we do this? It's really weaning them off of it over several months. What I like to do, as I mentioned, is I put them on a long-acting benzodiazepines my preference is diazepam because it's long-acting and if they miss a dose they're not going to be in really bad withdrawal and then we just start dropping the dose and it takes time. So let's say somebody is buying Alprazolam on the street and they're taking two 2-milligram Alprazolam bars a day. I'm going to convert so it's 10 to 1. So 4 milligrams of Alprazolam is going to be the same as 40 milligrams of diazepam. I'm going to start them on 40 milligrams of diazepam, let them equilibrate and then I'm going to drop the dose by about 10% every few weeks. So that's probably going to look like something where we'd go from 40 to 35, and then to 30, and then down to 25, etc. And actually at the end of the taper we might even go even slower, like below 10 milligrams, we might drop by 2 milligrams. So it's a very time-consuming process and I've got some more cases where I can show you just how long this takes.

Speaker 1:

Okay, so back to case one. So this was my 45-year-old patient that was put on clonazepam by her oncologist. How has it been going? Well, I've been seeing her for over a year and I've gotten her down from six milligrams of clonazepam a day to three and a half milligrams a day. I haven't even gotten 50% of the dose down yet, and the reason why is she has horrible anxiety and insomnia that the benzos have been masking for years, and the problem is the benzo didn't help anything, it just masked it.

Speaker 1:

And one of the things that we've learned and this may be bind, I think we're still figuring it out is when people are coming off of benzos, the original symptoms that the benzos were prescribed to treat come back, even worse than before they were on benzos. So we call it rebound anxiety or rebound insomnia and so, as we've brought her dose down, every time we dose drop she can't sleep and she's even more anxious than her usual. And I got to be honest. It looks really, really unpleasant to have to go through this. And what I'm also trying to do is add in non-addictive medications to try to make the tapering less uncomfortable and to treat those rebound symptoms of anxiety and insomnia. So I have her on gabapentin to try to help with anxiety and restlessness. She gets a lot of muscle symptoms, so I have her on tizanidine, which is a non-addictive muscle relaxant, and then we've tried some different non-addictive sleep medications and I'll probably be doing this for another six to nine months with her if it goes well. She has BIND. She does not have a lot of ability to manage negative emotions. I'm trying to get her into a therapist. It's really been challenging. Okay.

Speaker 1:

Case two this is a 40-year-old male who came to the clinic and he asked for help with multiple substances. He used alcohol, cannabis, opioids and benzodiazepines. We were able to get him on Suboxone to manage his opioids and then he went to residential and in residential we put him on what we felt to be the equivalent dose of the benzos he was getting on the street and that was 60 milligrams of diazepam a day and we started very slowly tapering him down. I initially started dropping his dose by about five milligrams every two weeks. I've been seeing him for 18 months and he's still on benzodiazepines and same thing. He gets all these rebound symptoms, insomnia, anxiety, and he bargains with me every time I tell him it's time to drop. No doc, please, please, just another two, three weeks and the other addiction doctor and I in the practice are actually going to probably switch to doing a protocolized taper where people know what they're going to get and we don't have this like please, can I drop the dose next time?

Speaker 1:

Because people really feel miserable as they come off of benzodiazepines and it's a really difficult question. If I push them too hard, will I cause a relapse? If I push them too hard, are they gonna develop some psychosis or have debilitating anxiety and have to be hospitalized in the mental health unit? There's not a good answer on what to do with this. The American Society of Addiction Medicine just released some guidelines on benzo tapering which, I will admit, I am behind. I haven't read them and I'm actually gonna interview a psychiatrist on my podcast later this year to give some advice on how to do this better. I'm just trying to really keep people from relapse and keep them engaged in treatment and, to this gentleman's credit, he's been working hard. We've dropped his dose. We're almost down to zero. I anticipate that we're probably going to get him off of benzos in the next several months, but it's been really challenging.

Speaker 1:

Okay, so I think you guys know the answer to this question based on what I've been saying. But should we be using benzodiazepines for anxiety? And I have to say what I was taught in medical school is anxiety equals benzos. When people are anxious, give them benzos. And I remember, as a new doctor out of my residency training, people would come into the ER for anxiety attacks and we'd send them home with like 20 lorazepam. And, based on what I know now, I personally believe this is my opinion that it is medical malpractice to treat anxiety with benzodiazepines because, as I've pointed out to you, it is so miserable for the patient to get off of them and there's no end game. It's not like going to therapy and learning coping skills. It's just basically taking a sedative to not feel anxious. So, in my humble opinion, I think using benzodiazepines for anxiety is wrong.

Speaker 1:

Now, that being said, I am not a psychiatrist, and if a psychiatrist wants to manage their patient on benzodiazepines, great. They have the knowledge of what the potential consequences are. And if somebody has really severe mental illness, like schizophrenia or bipolar, and they need benzodiazepines and that psychiatrist thinks it's the right decision, I say go for it. But in my practice, given what I see in the world of addiction, putting people on benzos just results in them being completely miserable when they try to taper off of them. And my heart goes out to my patients because it's so uncomfortable to watch. They just feel so bad all the time. I was actually trying to find a text message. One of my patients actually the one that taught me about BIND will send me messages of like Dr Grover, this is so bad, why do doctors prescribe this? And he's really trying, and it's just I'm trying my best to support him.

Speaker 1:

Okay, case number three A 65-year-old male was referred to our clinic because he was on chronic alprazolam and his doctor retired and his new doctor didn't want to prescribe them for him because she felt it was inappropriate. And so the patient had a history of anxiety and his primary care doctor had put him on Alprazolam at four milligrams a day. Now you all know that's a fairly high dose and what's amazing is this primary care doctor had been giving this patient Alprazolam for years and had never referred him for any mental health services. So he comes to me, I believe, health services. So he comes to me. I believe, given what I'm lecturing you about, that he has BIND and he has panic disorder and an anxiety disorder. I actually think he probably has some PTSD because he had a bad accident that led to his anxiety and panic disorder starting in the first place. And he was pretty clear. I'm going to use the brand name here Xanax is the only thing that helps my anxiety. I don't want anything else. I've tried to refer him for therapy services.

Speaker 1:

He declines, and I think this is where we see that chronic benzodiazepine use is not as benign as we were led to believe years ago. And you know his doctor 20 years ago was probably doing what we thought was good medicine then. In fact, I just want to remind you, in medical school I was taught to treat benzos with anxiety and we didn't understand how chronic benzo use could lead to profound changes in the brain. My case continues His anxiety thanks to his chronic benzo use and bind has only worsened because of the years he's been on Alprazolam and the Alprazolam didn't help his anxiety. And I always try to tell him this, you know, I'll tell him like, if it really helped your anxiety, why are you on them 20 years later? And he really will not work with me on this. And I keep trying to try to get him some services and let's try a non-addictive med. He did, to his credit, accept a non-addictive sleep aid, but at a certain point I'm going to have to tell him like, look, I think this is wrong, I'm going to have to have you see someone else or have you see a psychiatrist. I just feel like I'm making your anxiety worse and it's going to be a difficult conversation with him that I'm going to have to have and again, I feel so bad for him.

Speaker 1:

Anxiety is really, really uncomfortable. He actually does not have a benzodiazepine use disorder. He is not addicted, he does not crave it, he does not misuse it, but because he's been on benzos for so long, he has tolerance, he is dependent and he has benzodiazepine-induced neurological dysfunction and his anxiety has never been treated. It's very frustrating. Okay, as I mentioned, we talked about rebound symptoms. Rebound symptoms are the idea that when people try to come off of benzodiazepines, the symptoms that they were originally treated for emerge worse than before. And he gets this a lot. His anxiety gets worse over time. I've been seeing him for about a year. I can tell, even in the year that I've been seeing him, that his anxiety only continues to worsen.

Speaker 1:

And a little bit of levity here, this was a meme. I don't always make bad decisions, but when I do, I make sure to repeat them over and over again, and this is a lot of what we see in patients that have been managed with benzodiazepines for years and years and years is, to some extent, no one really knows what to do with them, except just to try to continue to taper off of them, get them on better, safer medications. But some of these patients have been on benzodiazepines for like 60 years and the changes in their brains are just profound. Okay, so what do I do?

Speaker 1:

In my practice, a single dose of a benzodiazepine before a medical procedure is not my preferred medication. But if someone has claustrophobia and they need to get an MRI, a single dose of diazepam isn't really going to hurt anything. Given how much frustration benzodiazepines cause my patients and I I just I really struggle to even sign the prescription if I have to write them. I've had a number of patients that were put on benzodiazepines before they came to me and as I'm working on tapering with them, I'll continue them if they're not dependent on just a few doses a week. So I had one patient come to me.

Speaker 1:

Her primary care doctor put her on lorazepam for anxiety and she came to me basically saying I want to get off of them but I don't know what to do with my anxiety. And she is amazing. She has worked so hard on her anxiety, believe it or not. She went on YouTube and watched video after video on how to treat anxiety and she on her own, along with her therapist, has come up with all these great coping strategies. She'll use really cold water on her neck to distract her when she's got a really bad anxiety attack and she's now completely benzodiazepine free. But there was a point where I was only giving her basically four doses of lorazepam a week. As she was building her skills, I needed her to start triaging her anxiety. Oh, I'm anxious, but it's only a little bit. I'm going to do some breathing exercises or I'm going to meditate. But when she was just losing it she had a little bit of lorazepam that she could take as we were building her mental health skill set.

Speaker 1:

And then, unfortunately for the chronic benzodiazepine patients, it's just tapering over several months and it's a really frustrating problem. Again, if one of my patients comes to me and says, dr Grover, I want you to get me on Suboxone for my opioid use disorder and they've got a psychiatrist who's managing them on benzos, that's between them and the other doctor. If they want me to take it over, I tell them the only way I can offer you benzodiazepines is to taper you off of them. And I've had patients fire me. They don't want to come off of them. And what's really frustrating for me as a doctor is, let's say, somebody is sober and their drug of choice is opiates. When they have a slip-up we can stabilize them on suboxone or methadone or, if it's alcohol, we'll do a quick course of medications to manage their withdrawal. Getting people off of benzos takes so long and it's so uncomfortable for the patient. If people relapse and they tell me they relapse on benzos, I just know it's going to be months of work for the patient and I. And then again, just because weaning involves dropping the dose. People feel benzodiazepine withdrawal pretty regularly throughout the weaning process. It's a really frustrating problem.

Speaker 1:

Okay, I don't know if anyone gets my joke from Saturday Night Live, but let's stop here and we will do some questions Before we wrap up. A huge thank you to the Montage Health Foundation for backing my mission to create fun, engaging education on addiction, and a shout out to the nonprofit Central Coast Overdose Prevention for teaming up with me on this podcast. Our partnership helps me get the word out about how to treat addiction and prevent overdoses To those healthcare providers out there treating patients with addiction. You're doing life-saving work and thank you for what you do For everyone else tuning in. Thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Thanks for listening and remember treating addiction saves lives.