Benzodiazepine Tapering & Deprescribing
in Miami, FL

Many people in Miami-Dade have been taking a benzodiazepine, a sleeping pill or an antidepressant for years on a prescription that no one ever planned to end. Dr. Leeds, an osteopathic physician in Fort Lauderdale, works with those patients by concierge telemedicine: weekly video visits from home, and a single physician who follows the whole taper from the first cut to the last. Most of his work is helping people come off benzodiazepines and sleeping pills, and much of the rest is tapering psychiatric medications. Buprenorphine treatment for opioid dependence and the Sinclair Method for alcohol are smaller parts of the practice, described further down.

One idea sits underneath the whole approach: physical dependence is not addiction. If you took alprazolam exactly as prescribed for ten years and now cannot stop without becoming ill, you have done nothing wrong. Your nervous system has adapted to the drug, and the way out is a slow, physician-guided reduction.

How does a telemedicine taper work from Miami-Dade?

The office is in Fort Lauderdale, about 30 miles north of downtown Miami by I-95 or the Florida Turnpike. Realistically, that is 45 minutes on a good day and well over an hour at rush hour, which is why video visits are the routine for Miami patients and in-office visits are an option rather than a requirement. A taper does not go better for having sat on I-95 first. Some patients prefer to make the drive once for a first visit and then continue by video. Others never set foot in the office.

A video visit is a scheduled appointment with Dr. Leeds himself, weekly during an active taper and often up to an hour long. The patient joins from a phone or computer at home, or from anywhere private, such as an office in Brickell with the door closed. And, between visits there is text access around the clock for urgent questions, which matters most in the first days after a reduction, when a symptom appears at night and the patient needs to know whether it is expected.

A prescription is transmitted electronically to the Miami pharmacy the patient already uses, so nothing about filling it requires a trip north. The office takes calls Monday to Friday, 10 AM to 2 PM. Dr. Leeds prescribes for patients in Florida. For someone outside Florida, a consultation may still be possible. Of course, when a hurricane evacuation or another emergency disrupts the week, the dose is held rather than cut, and keeping a reserve of medication for natural disasters is good planning in South Florida.

A spouse, adult child or patient advocate is welcome to sit in on a video visit when the patient wants them there. It is never required, and the patient decides who attends.

Where does the liquid or compounded diazepam come from?

The hardest part of a benzodiazepine taper is the end, where the cuts have to be far smaller than any tablet allows. Tablets can be split into halves and quarters. Yet, once a taper has reached a fraction of a milligram, the dose has to come in a form that allows precise measurement. Two routes exist in Florida.

The first is diazepam oral solution, a manufactured product at 1 mg/mL. Chain and independent pharmacies alike can order it. Unfortunately, few keep it in stock, so the usual experience at a pharmacy counter in Coral Gables or Aventura is a pharmacist saying it is not on the shelf. That is not a refusal. It is a stock question, and the answer is to order it. The pharmacy can order it from its wholesaler, and the patient can ask for that before the current supply runs low. If a particular pharmacy will not order it, or a pharmacist unfamiliar with the product declines to fill it, the prescription can be sent to a different pharmacy instead.

The second route is a compounding pharmacy. Compounding pharmacies exist across Florida and ship to patients, and they can prepare custom strengths of a benzodiazepine in capsules or as a liquid suspension when no manufactured form exists at the strength needed. The patient chooses the pharmacy, and the prescription goes wherever it can reliably be filled.

With the 1 mg/mL solution, the end of a diazepam taper is usually taken below 0.5 mg and continued to about 0.1 mg before the last dose is stopped. The Ashton Manual describes stopping at 0.5 mg, and that remains an option. Still, the smaller final steps are gentler for many patients. The evening dose is reduced last, and when a cut proves too large, a small step back up to the previous dose, made with Dr. Leeds, is a legitimate move.

What do Miami patients typically arrive with?

Miami-Dade is a large bilingual metro, and a prescription there often began years ago, sometimes in another country, and has been renewed by a succession of doctors since. The pattern is often a benzodiazepine, most commonly alprazolam or clonazepam, with a z-drug such as zolpidem added for sleep at some point, and sometimes an antidepressant layered on top when the original anxiety returned despite the benzodiazepine. So, by the time someone searches for a tapering physician, the medication has usually stopped working as it once did, and the prescriber who started it may be retired, relocated or abroad.

What the first consultation needs is simple: the current bottles with their labels, a list of every psychiatric and sleep medication taken in the past, the patient’s own account of earlier attempts to stop and what happened, and any pharmacy printout that shows fill history. The decision to taper belongs to the patient. The decision about how fast is made with Dr. Leeds, visit by visit, and it can change in either direction.

Why does a benzodiazepine taper need to be slow?

Benzodiazepines (alprazolam, clonazepam, lorazepam, diazepam) and the z-drugs (zolpidem, eszopiclone, zaleplon) act on the same receptor system, and the nervous system adapts to both. After months or years of daily use, stopping suddenly is dangerous. Seizures can occur, and an abrupt stop can leave lasting symptoms that a gradual reduction would have avoided. In fact, the Food and Drug Administration (FDA) changed the labels of every benzodiazepine in 2020 to warn about dependence and withdrawal even when the drug is taken as prescribed. Stopping abruptly is never safe, and no taper begins with it. If someone has a seizure, stops breathing or cannot be roused, call 911. Anyone with thoughts of suicide can reach the 988 Suicide and Crisis Lifeline by call or text at any hour.

The taper itself is built on the Ashton Manual and on the Maudsley Deprescribing Guidelines: small, proportional reductions, each one decided at a visit according to how the patient has fared since the last, rather than set out in advance on a schedule. Proportional, or hyperbolic, tapering means each step is a fraction of the current dose, so the cuts get smaller in milligrams as the dose falls, which is exactly why the liquid and compounded forms above matter. Most often, Dr. Leeds first switches the patient to diazepam, a longer-acting drug that is easier to divide finely, and tapers from there. The reasoning behind that crossover is explained in the page on the diazepam crossover. When diazepam does not suit a patient, the taper usually runs on the current medication instead.

Keep in mind that a realistic timeline for a long-standing prescription is a year to 18 months, often longer, and the pace stays flexible throughout. Patients direct their own care: the right to slow down, to pause, or to decline a change belongs to them, and informed consent begins with the risks, the alternatives including no change at all, and an exit plan discussed from the first visit. The approach is described in full on the benzodiazepine dependence and tapering page.

What are benzodiazepine-induced neurological dysfunction (BIND) and protracted withdrawal?

BIND is the term now used for the cluster of symptoms, cognitive, sensory, emotional and physical, that can persist after a benzodiazepine is stopped or reduced, sometimes for months and in some people longer. Protracted withdrawal is the older name for much the same thing. Neither means the drug is still present. Both reflect a nervous system that is slow to return to its previous state after adapting to the drug.

BIND belongs in the first conversation, not the last, because a patient who knows the possibility exists is better prepared when a symptom lingers and less likely to blame themselves for it. So, the practical consequence is the slow pace described above: the gentler the reduction, the better the chance of a smooth recovery. Of course, no pace guarantees one. A Miami patient who is already past the last dose and still unwell can raise this at a consultation, and the site’s BIND guide is the place to start reading.

Which psychiatric medications can be tapered the same way?

Psychiatric medication deprescribing is the practice’s second focus. Gabapentinoids such as pregabalin and gabapentin, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) all produce withdrawal symptoms when stopped too quickly, and all can be reduced with the proportional method the Maudsley Deprescribing Guidelines describe. Antipsychotics may be tapered in a similar way. In fact, it is common for someone to be taking two or three of these at once, accumulated over years. They are tapered one at a time, with the others held steady, so that any new symptom can be read clearly.

Dr. Leeds typically does not bring in a gabapentinoid to smooth a benzodiazepine taper or a psychiatric drug taper. In general he avoids adding any medication that would itself need a taper later because it causes physical dependence. The hub for this work is the psychiatric drug tapering page.

What about opioid dependence, alcohol and other substances?

Opioid dependence is treated as a secondary service, with buprenorphine (Suboxone, ZubSolv) prescribed for patients who want to stabilize and, when they are ready, taper. Visits are monthly, and weekly when needed. Buprenorphine is a partial opioid agonist, and it carries less risk of slowed breathing than a full agonist, although that margin narrows when it is combined with a benzodiazepine or another sedative.

For alcohol, Dr. Leeds uses the Sinclair Method: naltrexone taken before drinking, so that the reward that reinforces the habit is blocked and the drive to drink can fade over weeks and months. Interestingly, abstinence is not a precondition. The method starts while the person is still drinking, which is one reason it suits people for whom an all-or-nothing approach has not worked. Details are on the Sinclair Method page.

A different substance problem can be brought to a consultation, and whether his practice is the right fit is decided there, together. Low dose naltrexone (LDN) can also be discussed for autoimmune-related pain conditions.

What does concierge telemedicine mean in practice?

Concierge means the practice is built around time and access rather than volume. The practice is concierge and does not work through insurance, and the result is weekly video appointments that are often up to an hour, text access 24/7 for urgent questions, and one physician for the whole taper. There are no nurse lines, no coaches and no substitute physicians. The person who adjusted the dose last week is the person answering the text this week. The concierge telemedicine page describes the model in more detail. Dr. Leeds also serves on the medical advisory board of the Benzodiazepine Information Coalition (BIC), which educates patients and clinicians about benzodiazepine dependence and withdrawal.

Miami is full of luxury treatment programs that promise privacy and comfort. Unfortunately, a beautiful setting does not change how slowly a nervous system recovers, and a residential stay ends on the program’s schedule rather than when the patient is ready. Home, not a facility, is where a long taper is done well.

Which parts of Miami-Dade are served?

Everything from Aventura at the Broward County line to Homestead at the southern end of the county: Miami itself, including downtown and Brickell, Miami Beach, Coral Gables and Pinecrest, Hialeah and Doral to the west, and Kendall and the suburbs that run south toward Homestead. Patients receive the same unhurried, individualized care whether they live in a Brickell high-rise, a Kendall subdivision or a house in Homestead, because the visit comes to them.

Frequently asked questions

How long does cold turkey benzodiazepine withdrawal last?

It should never be tested. Stopping a benzodiazepine suddenly after months or years of daily use can cause seizures, and it can leave a person with symptoms that last far longer than the drug itself would have. The acute phase after an abrupt stop typically runs from weeks into months, and some people go on to a protracted syndrome measured in many months or more. A gradual taper avoids most of that. Anyone who has already stopped suddenly and is unwell should talk to a physician promptly rather than wait it out.

Is the first consultation for a Miami taper done in person or by video?

The patient chooses. Video is the routine, and a complete taper from the first consultation to the final dose can run without an in-office visit. Some Miami patients prefer to meet once in person at the Fort Lauderdale office before switching to video.

What if a Miami pharmacy will not fill the liquid diazepam?

The patient can first ask whether the pharmacy will order it. The 1 mg/mL solution is a standard product that pharmacies can order from their wholesaler even though it is rarely on the shelf. If the answer is still no, the prescription moves: to a different pharmacy, or to a Florida compounding pharmacy that ships. The practical point is to raise the question at a visit before the supply runs low, so there is time to move the prescription without a gap in doses. A gap is the one thing to avoid, because a missed day late in a taper is a sudden cut.

What if the doctor who started the prescription has retired, moved or is abroad?

That situation is common in Miami-Dade. Fortunately, it does not stand in the way of a taper. What a first consultation needs is the current medication, the current dose, how long it has been taken and what the patient has already tried, and most of that can be reconstructed from the bottles on hand and a fill history printed by the pharmacy. The original prescriber’s records are helpful when they exist but are not required, and no one needs to track down a physician who left years ago.

Can a prescription that began in another country be tapered here?

Yes. A benzodiazepine first prescribed abroad and then continued by physicians here for years can be tapered the same way as any other. What matters for the taper is the current medication, the current dose and how long it has been taken, not where it started. A patient who is unsure of the exact drug or strength should bring the packaging. Foreign brand names for alprazolam, clonazepam, diazepam and lorazepam differ, but the molecules do not.

A Miami patient who wants to start a taper, or who wants a second opinion on one already underway, can contact the office through the contact form, which is how every consultation starts. Contact the office today.

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.