When Risks Outweigh Benefits: New Guideline on Benzodiazepine Tapering

This abbreviated article is edited for length and reprinted without references from the Cleveland Clinic Journal of Medicine (June 2026, 93(6) 347-352 doi.org/10.3949/ccjm.93a.25102). The open-access and fully referenced original article is available at ccjm.org/content/93/6/347.

By Hannah Snyder, MD; David Streem, MD; Akhil Anand, MD; and Adele C. Viguera, MD

About 1 in 10 adults in the United States report having used benzodiazepines in the past year. These medications carry substantial risks, including falls, cognitive impairment, overdose, and death, particularly when combined with alcohol or opioids. The American Society of Addiction Medicine, in collaboration with nine other professional societies, has issued recommendations on when and how to taper and discontinue benzodiazepines.

The guideline provides a systematic framework for deciding when tapering is appropriate and for implementing safe, patient-centered discontinuation strategies. It emphasizes shared decision-making, gradual dose reduction, psychosocial support, and ongoing monitoring.

Before these guidelines were developed, existing guidance was fragmented and inconsistent, resulting in highly variable clinical practices. Growing evidence that poorly structured tapers — developed without clinical consensus or patient input — can cause significant harm, including symptom recurrence, severe withdrawal, and use of illicit or fentanyl-contaminated benzodiazepines, highlighted the need for a standardized, evidence-based framework.

What are the main recommendations?

Monitor and assess risk. Clinicians should evaluate benzodiazepine therapy at least every 3 months and at each prescription renewal, while concurrently reviewing prescription drug monitoring program data.

Taper gradually in patients at risk. Benzodiazepines should not be discontinued abruptly in patients likely to be physically dependent on them, as doing so can precipitate severe withdrawal. All patients should be counseled about withdrawal or rebound symptoms such as anxiety, insomnia, tremors, diaphoresis, and gastrointestinal upset, and, if significant symptoms arise, the taper can be slowed or briefly reversed.

Use shared decision-making. Tapering strategies should be developed collaboratively with patients and, when appropriate, their care partners. If patients will not consider tapering, clinicians can inform them that benzodiazepines lose their benefits over time, while their adverse effects persist or increase.

Go slowly and individualize. Initial dose reductions should range from 5% to 10% of the total daily dose, with reductions not exceeding 25% every 2 weeks. Transitioning to a longer-acting benzodiazepine may help. Tapering should be individualized and adjusted based on tolerance, functioning, and emerging symptoms.

Level-of-care considerations. Most tapers can be managed safely on an outpatient basis. Inpatient or residential care should be considered when continued use poses imminent risk not mitigated by dose reduction, co-occurring medical or psychiatric conditions make outpatient care unsafe, or the patient experiences or is at high risk for severe or complicated withdrawal.

Adjunctive and supportive interventions. Behavioral interventions are strongly encouraged. Clinicians should offer patients evidence-based therapies, such as cognitive behavioral therapy or cognitive behavioral therapy for insomnia, to address underlying anxiety or sleep disturbance.

Management of complicated withdrawal. Severe or complicated withdrawal symptoms such as seizures or delirium require inpatient or residential medically supervised care with continuous monitoring, vital sign checks, and seizure risk assessment.

How will this change daily practice?

The guideline shifts clinical practice from a “stop prescribing” mentality to a structured, patient-centered tapering approach. For primary care clinicians managing long-term benzodiazepine use—often inherited from previous clinicians or specialists—the guideline provides a clear, stepwise roadmap for safe management.

The guideline’s emphasis on collaborative decision-making formalizes what should already be routine practice, and it validates slower, flexible tapering processes responsive to patient needs. Thorough shared decision-making documentation is essential for patient safety and medicolegal protection.

Detailed guidance for special populations helps address common clinical dilemmas. For patients prescribed both opioids and benzodiazepines, the guideline provides clear directives for frequent monitoring, universal naloxone provision, and robust risk-mitigation strategies.

A particularly important component of the guideline is its explicit recommendation against discontinuing opioid use disorder medications, such as methadone or buprenorphine, in patients concurrently receiving a benzodiazepine. This clarification addresses a previously widespread and harmful practice, underscoring that continuity of addiction treatment must remain a clinical priority.

Meeting an urgent need

This joint national guideline provides US clinicians with an urgently needed, structured framework for safe, patient-centered benzodiazepine tapering. The guideline emphasizes gradual dose reductions after collaborative risk-benefit discussions between patient and clinician, psychosocial support, and ongoing monitoring, bridging the gap between indefinite continuation and forced discontinuation of benzodiazepines.

Implementation will require enhanced access to behavioral health services, workflow adjustments, increased resources and tools for clinicians and sufficient time for patient engagement. Despite these challenges, the guideline marks a major advance in patient safety and clinical consistency around benzodiazepine prescribing.