Benzodiazepine Tapering & Deprescribing
in Jacksonville, FL

Why is a careful benzodiazepine taper so hard to find in North Florida?

Jacksonville has a large medical workforce, yet a person who wants to come off alprazolam (Xanax), clonazepam (Klonopin) or lorazepam (Ativan) slowly and safely can still struggle to find a physician willing to supervise it. The fact is that tapering is barely taught in medical training, and the few physicians in Florida who concentrate on it are not spread evenly across the state. Unfortunately, what a North Florida patient is usually offered instead is a short printed schedule that lowers the dose far faster than the nervous system can follow, or plain advice to stop.

Dr. Leeds is an osteopathic physician whose Fort Lauderdale practice is built around benzodiazepine tapering and the deprescribing of psychiatric medications. Patients anywhere in Florida see him by secure video. So, for Jacksonville the distance between a patient on the St. Johns River and a tapering physician 320 miles to the south is covered by a video link rather than a drive. This page explains how the specialist gap shows up in practice, how a telemedicine taper works from Duval County and the counties around it, and what veterans and military families near Naval Station Mayport and Naval Air Station Jacksonville should know.

The starting point is a distinction that many Jacksonville patients have never heard from a doctor. If you took a benzodiazepine exactly as prescribed, for years, and now feel unwell when a dose is late or lowered, you have developed physical dependence. Physical dependence is not addiction. In fact, the nervous system has simply adapted, as expected, to a medication taken every day, and the treatment is a slow medical taper, not a program designed to change behavior.

Where does Jacksonville stand in relation to the Fort Lauderdale office?

Jacksonville is Florida’s largest city, the seat of Duval County and the anchor of the First Coast, spread along the St. Johns River from the western suburbs to the Atlantic beaches. People in Jacksonville Beach, in St. Augustine across the St. Johns County line, in Orange Park in Clay County and in Fernandina Beach in Nassau County face the same gap.

The Fort Lauderdale office sits about 320 miles south, roughly five hours each way on Interstate 95 and often more. For a weekly appointment that drive is out of the question, so care for Jacksonville patients is built on telemedicine from the first day. Of course, anyone who wants to make the trip can arrange an in-office visit in Fort Lauderdale, and no one is required to. Prescriptions are written for Florida patients. For someone outside Florida, a consultation may still be possible.

How does a telemedicine taper work from Jacksonville?

A Jacksonville patient starts by writing through the contact form, and the office replies to arrange a consultation. The consultation takes place by video and covers the medication history: which benzodiazepine, at what dose and for how long, what earlier attempts to stop were like, and what the patient wants from a taper. Once treatment begins, visits are weekly, and often run up to an hour, and every one of them is with Dr. Leeds. No team, coach or substitute physician ever stands in for him.

Dr. Leeds is reachable by text 24/7 for an urgent question, and that access counts most in the days after a dose change. Prescriptions go electronically to a pharmacy of the patient’s choice in Duval, St. Johns, Clay or Nassau County when that works out, so the distance rarely affects filling them. The practice runs on a concierge basis, not on insurance, and the office takes calls from 10 AM to 2 PM, Monday to Friday.

Much of Jacksonville works in shifts, at the port, in the hospitals and on the bases. Fortunately, a video visit from home removes the travel time that a clinic appointment would add to a working day, and a patient who is well enough to work usually keeps working through a taper. A relative whom the patient invites may sit in on a video visit. No one is ever required to.

What does the taper itself look like?

The practice leads with the tapering of benzodiazepines and z-drugs. That covers alprazolam, clonazepam, lorazepam, diazepam (Valium) and temazepam (Restoril), and the z-drugs zolpidem (Ambien) and eszopiclone (Lunesta), which work at the same receptors and come off by the same method. Most tapers begin with a gradual crossover to diazepam, following the Ashton Manual, which Professor C. Heather Ashton wrote, because diazepam’s long half-life gives steadier blood levels and it comes in forms small enough to reduce by tiny steps.

The reductions follow the hyperbolic pattern the Maudsley Deprescribing Guidelines describe: each step should have about the same effect at the brain’s receptors, which means the steps in milligrams keep getting smaller as the dose comes down. In Dr. Leeds’ practice a cut is usually no more than about 10 percent of the current dose. In fact, the last milligrams of a benzodiazepine matter far more to the nervous system than the first. The pace is set by symptoms rather than by a calendar. Of course, a hold at the current dose after a difficult step is normal, and from start to finish a taper usually needs a year to 18 months or longer.

Stopping a benzodiazepine suddenly is never safe after regular use. The Food and Drug Administration (FDA) updated the boxed warning on every benzodiazepine label in 2020 to warn of physical dependence, of withdrawal reactions severe enough to threaten life, seizures among them, and of symptoms that may persist for months once the drug is gone. Any seizure or other medical emergency means calling 911, and a person with thoughts of suicide during withdrawal can reach the 988 Suicide and Crisis Lifeline at any hour by calling or texting 988.

Where does a Jacksonville patient get liquid or compounded diazepam?

The smallest diazepam tablet is 2 mg, and a quarter of one is still a large step late in a taper. So, the lower part of the taper is usually done with a liquid. A manufactured oral solution of diazepam, 1 mg/mL, exists under its own FDA label, and chain and independent pharmacies in the Jacksonville area can order it, though it is rarely on the shelf and usually has to be ordered in. Patients measure each dose with an oral syringe, which makes a step of a tenth of a milligram practical at the kitchen counter.

When a patient cannot use diazepam, or when a different benzodiazepine or a psychiatric medication has no manufactured liquid, a compounding pharmacy can prepare one at the exact strength prescribed. Compounding pharmacies operate across Florida and ship to Jacksonville. The prescription goes electronically to the patient’s preferred pharmacy when that works out, though for compounding Dr. Leeds may insist on a more reliable or better-credentialed one. Or, compounded capsules are an option when a liquid is impractical.

In Dr. Leeds’ practice the end of a diazepam taper is taken on the 1 mg/mL solution, continuing below 0.5 mg to about 0.1 mg before stopping, with the evening dose reduced last. Still, the Ashton Manual’s suggestion of stopping from 0.5 mg remains an option for someone who is doing well and chooses it. A small, physician-guided increase after a step that went badly is legitimate and is not a failure.

What should veterans and military families near Mayport and NAS Jacksonville know?

Naval Station Mayport and Naval Air Station Jacksonville make the city one of the largest military communities in the Southeast, and among the people who look for a taper from Jacksonville are veterans, Navy retirees and military spouses. Benzodiazepines are sometimes started through the Department of Veterans Affairs (VA) or military health care for anxiety, insomnia or post-traumatic stress disorder (PTSD), and a prescription that began as a short course can run on for years. Unfortunately, the person who then wants to come off it often finds that the doctors available to them have little training in slow tapering.

Veterans, service members and military families in Florida can see Dr. Leeds by telemedicine like any other patient. The practice does not bill the VA or TRICARE. It is a concierge arrangement, and the taper is planned around the patient’s own history: medication, dose, years of use, earlier attempts to stop, and the other conditions being treated.

Sleep is often the thread through these histories: a benzodiazepine or z-drug started for insomnia around a deployment keeps working for a while, then stops working at the same dose, which is tolerance. Symptoms that surface while the dose is unchanged are called tolerance withdrawal, and they are part of BIND, the condition described in the next section. Interestingly, they are often what first makes a veteran suspect the medication rather than the original diagnosis.

What is BIND, and what happens after the taper ends?

Benzodiazepine-induced neurological dysfunction, BIND for short, is the term for the neurological symptoms that can surface while a person still takes the same daily dose, the tolerance withdrawal described above, as well as during a taper and after it: sensory disturbances, muscle and nerve pain, trouble with sleep, memory and balance, and swings in heart rate and blood pressure that resemble autonomic conditions. These symptoms reflect a nervous system that is readjusting, not one that is broken, and they tend to recede on the nervous system’s own schedule, measured in months rather than weeks. Yet, fear makes them worse, which is why an explanation from a physician who recognizes them is itself part of the treatment.

Dr. Leeds manages BIND-related conditions himself, within the taper, instead of sending patients elsewhere for them, and he continues to see patients through protracted withdrawal after the last dose. A fuller description is on the BIND page. For Jacksonville patients the practical point is that the physician who supervised the taper stays reachable afterward, the very thing the local specialist gap otherwise denies them.

Which other medications does Dr. Leeds taper, and what else does the practice treat?

The second service is the deprescribing of psychiatric medications. Antipsychotics such as quetiapine (Seroquel) and olanzapine (Zyprexa), the gabapentinoids pregabalin (Lyrica) and gabapentin (Neurontin), and the antidepressant classes known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are tapered one at a time, on the same hyperbolic principle, with compounded liquids when the tablets run out of usable sizes. Dr. Leeds tapers these medications rather than treating with them, and he steers away from starting any additional drug that would later need a taper of its own, so gabapentinoids are not brought in to smooth a benzodiazepine taper. The psychiatric drug tapering page covers each class.

Buprenorphine (Suboxone, ZubSolv and their generics) for opioid dependence is a secondary service, prescribed by telemedicine in Florida. Visits are monthly, and weekly when needed. To be clear, a person with opioid dependence after years of prescribed pain medication has a medical condition, and the treatment is medical. For alcohol use disorder the practice uses the Sinclair Method: naltrexone taken an hour before drinking blocks the reward that alcohol delivers, and over months the drinking fades, with no demand for abstinence first.

Low dose naltrexone is also available from the practice for pain conditions with an autoimmune basis. A consultation is also the place to raise any other substance problem. Whether Dr. Leeds can help is decided there.

What happens to a taper when a hurricane or evacuation order reaches the First Coast?

When a storm approaches and evacuation orders reach Jacksonville’s beaches and riverfront neighborhoods, a taper does not pause itself for the weather. Dr. Leeds’ guidance for any emergency is to hold the dose rather than make a planned cut, because coping with the emergency is already load enough for the nervous system. Additionally, holding some medication in reserve, so that a hurricane, a road closure or a pharmacy outage never leaves a patient without it, is sound preparation. Video visits and the text line can continue through the disruption, and the taper resumes once life has settled.

What does Dr. Leeds bring to a taper from 320 miles away?

Dr. Leeds is an osteopathic physician, and his practice is devoted to helping patients reduce and stop medications that have caused physical dependence. He is a member of the Benzodiazepine Information Coalition (BIC) medical advisory board. BIC is a nonprofit that teaches the public and clinicians about the harms of long-term benzodiazepine use.

The model is laid out on the concierge telemedicine page, and the benzodiazepine tapering service page describes the clinical approach. Fortunately, the shortage of tapering physicians in Jacksonville stops mattering when the physician is on the screen every week, the prescription reaches a pharmacy that can fill it, and a question late at night gets an answer.

Frequently asked questions

Is a trip to the Fort Lauderdale office ever necessary for a Jacksonville patient?

No. The consultation, the weekly visits and the prescriptions are all handled by video and electronic prescribing, and the 320-mile drive is never part of the plan. An office visit in Fort Lauderdale can be arranged for anyone who wants one, as a choice rather than a requirement.

Can a veteran whose benzodiazepine was prescribed through the VA see Dr. Leeds?

Yes. Veterans and military families in Florida can see Dr. Leeds by telemedicine like any other patient, and the taper is planned around their own history. It is a concierge practice. It does not bill the VA or TRICARE.

Where does a Jacksonville patient fill a prescription for liquid diazepam?

The manufactured 1 mg/mL diazepam solution can be ordered by chain and independent pharmacies throughout Duval, St. Johns, Clay and Nassau counties, though it usually has to be ordered in, and compounded liquids ship from compounding pharmacies within Florida. Prescriptions go electronically to the pharmacy the patient names when that works out. For compounded liquids Dr. Leeds may choose a more reliable compounding pharmacy.

What happens if an earlier benzodiazepine taper did not work?

A taper that failed was usually a taper that moved too fast. A slower, symptom-guided taper that starts from a stable dose, with a crossover to diazepam and liquid doses for the small steps, gives the nervous system the time it was not given before.

Can a person keep working at the port, a hospital or a base during a taper?

Usually yes. Outpatient telemedicine care is designed so that patients stay at home, keep working and keep their routines, with weekly video visits that need no travel. Holds and smaller steps are used when a demanding stretch at work calls for them.

Is an inpatient program ever required to come off a benzodiazepine?

Almost never. Coming off a benzodiazepine properly is a matter of a year to 18 months or longer. No residential stay can hold a reduction of that length, and rapid inpatient tapers tend to end in severe withdrawal and a return to the original dose. The safe route is a slow outpatient taper supervised by a physician who remains reachable between visits.

Jacksonville, Jacksonville Beach, St. Augustine, Orange Park and Fernandina Beach are all within reach of the practice by video, and the first step is a message through the contact form, which the office will answer to arrange a consultation. 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.