Benzodiazepine Tapering & Deprescribing
in Orlando, FL

Can you taper off of a benzodiazepine in Orlando without leaving home?

Yes. Dr. Leeds is an osteopathic physician and deprescribing specialist whose office is in Fort Lauderdale, and he sees patients throughout Florida by secure video, Orlando included. Benzodiazepine tapering is the lead service, psychiatric medication deprescribing is the second, and buprenorphine treatment for opioid dependence and the Sinclair Method for alcohol are described further down this page.

Orlando is the center of Central Florida, and it is a big medical town. Yet, a patient who has taken Klonopin for ten years and wants off of it often finds that nobody nearby knows how to help. This is not an Orlando problem. It is a medicine problem: doctors are trained to start these medications and rarely trained to stop them.

So, the patient is handed a two-week taper, or a referral to a treatment center, or a shrug. What does a safe taper actually look like, and why does it not fit inside a 30-day program?

Physical dependence is not addiction.

When you take Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), or Valium (diazepam) every day as prescribed, your brain adapts. It turns down its own GABA-A receptors, the gamma-aminobutyric acid receptors through which the drug does its calming, and after a while the drug is needed just to feel normal. That adaptation is physical dependence, and it happens to people who never took one pill more than the label allowed.

Addiction is something else. It is a pattern of behavior, compulsive use despite harm, and most patients who come for a benzodiazepine taper have never shown it. In fact, in September of 2020 the U.S. Food and Drug Administration, or FDA, updated the boxed warning on every benzodiazepine to say plainly that these drugs cause physical dependence and withdrawal reactions, including ones that last many months, and that the dose should be reduced gradually.

The treatment has to match the condition. A gradual, medically supervised taper treats a receptor change. A group meeting and a workbook do not, although they may be helping the same patient with a drinking problem, and a patient who attends meetings is respected; that choice is theirs. Of course, addiction and dependence can exist in the same person, and even then the dependence is treated medically, by a taper, never by an abrupt stop. Get that distinction wrong, and everything that follows is wrong with it.

Why does a benzodiazepine taper take months instead of 30 days?

Because of how the dose and the brain are related. At a high dose, a cut of a few milligrams removes only a small share of the drug’s effect, and the brain barely notices. At a low dose, the same cut removes most of what is left, and the brain notices everything. The Maudsley Deprescribing Guidelines describe this as a hyperbolic relationship, and it is the reason the reductions have to get smaller as the dose gets lower.

Imagine a ladder leaning against a house, with the rungs near the top spaced far apart and the rungs near the bottom spaced close together. Up high, a big step is fine. Near the ground, every step is small, because that is where a misstep would hurt the most. While this is not a perfect analogy, it is how a taper is built: larger steps while the dose is high, smaller and smaller steps as the dose falls, and no jumping from the last rung.

So, add it up, and a taper often extends over many months. While a year is not unusual, a taper that runs longer is not a failed one. That expectation is set from the start, because the alternative, promising a fast finish, is how patients end up back on the drug.

One warning stands above everything else: never stop a benzodiazepine suddenly, and never let a taper turn into an abrupt stop. Sudden discontinuation can trigger seizures and can be life-threatening. However a taper is shaped, it should be gradual and medically supervised.

What happens when a 30-day program tries to do it anyway?

Unfortunately, the length of a rehab taper is usually set by the length of the stay, 7, 10, 14, or 30 days, and not by what the patient’s nervous system can tolerate. While “substance free by discharge” is a sensible goal for a drinking problem, it is a medically inappropriate one for a receptor change that took years to develop. The patient goes home with a nervous system that has not caught up.

Each rushed attempt makes the next one harder, a phenomenon known as kindling, in which repeated withdrawals leave the brain more sensitive to the next one. It is a common pattern: a first taper in a facility that was tolerable, a return to the medication within weeks, and a second attempt that was far worse. The facility did not fail the patient out of malice. It failed them on a calendar.

Orlando’s version of this is the executive or VIP program. A luxury rehab adds a pool and a chef. It does not add time. The medical approach to the taper is often no different from the standard program down the road, and a beautiful room does not make a two-week benzodiazepine taper safe.

A hospital is the right place for some situations: severe alcohol withdrawal on top of a benzodiazepine, a medical crisis, or a seizure. Those are emergencies, and they come before any taper. If you are in danger, call 911 or go to the emergency room, and let the taper wait. For physical dependence on a prescribed medication, the right setting is the one where the months can actually pass. That is your home.

What does an outpatient taper look like for an Orlando patient?

Orlando runs on shifts. Theme parks, hotels, hospitals, and the airport keep people on schedules that do not allow a month away, and a 30-day stay means explaining an absence to an employer. Fortunately, none of that is medically necessary for physical dependence on a prescribed medication. You keep your job, your own bed, and your routine, and the taper happens around them.

The work happens in a weekly video visit with Dr. Leeds, often up to an hour, where the past week is reviewed and the next step is agreed on. Between visits you have text access for urgent questions, day or night. There is no driving across the I-4 corridor to see a specialist, and no waiting room.

The pace belongs to the patient. If a step was too hard, the doctor must advise a smaller one. If the steps have been easy, patient and doctor may agree to go a bit faster, as tolerated. Nobody is held to a schedule that was written before the taper began.

How does Dr. Leeds build the taper itself?

The usual method is the crossover taper from the Ashton Manual, written by the late Professor C. Heather Ashton. The patient’s short-acting benzodiazepine, such as Xanax or Ativan, is gradually replaced with diazepam, which lasts much longer in the body, and the diazepam is then tapered.

In fact, in Dr. Leeds’ experience, patients who can taper on diazepam tend to have a more comfortable taper and function better day to day. Not everyone can. A patient who processes diazepam unusually fast or slowly, or who reacts badly to it, tapers on the medication they are already taking. Or, in the case of Xanax, the usual alternative is a crossover to Klonopin.

The small steps near the bottom of the ladder need a form of the drug that can be measured precisely. A compounding pharmacy can prepare a liquid that allows reductions of a fraction of a milligram, and diazepam also comes as a manufactured oral solution with its own FDA label that can be ordered through major retail pharmacies such as Walgreens and CVS.

Sleep medications such as Ambien (zolpidem) and Lunesta (eszopiclone) act on the same receptors and are tapered by the same principles. That is why Ambien tapering sits beside benzodiazepine tapering in the practice.

Nothing here is a schedule to copy. Every number in a taper belongs to the patient it was written for, and it is worked out with your prescriber.

What is BIND, and does a slow taper prevent it?

BIND, or benzodiazepine-induced neurological dysfunction, is the name for the cluster of symptoms that can appear while a person is taking a benzodiazepine, while they are tapering, and after the last dose. Patients describe surges of adrenaline that have nothing to do with their original anxiety, burning skin, ringing in the ears, air hunger, a bloated and painful gut known as benzo belly, insomnia, brain fog, and akathisia, a terrifying inner restlessness that will not let a person sit still. It can look like a dozen separate illnesses, when it is one destabilized nervous system.

The honest answer to the question in the heading is no, not reliably. A slow, patient directed taper is the best protection we have against the worst of it. Yet, it is not a guarantee. BIND can begin while a person is still taking the same dose, a state known as tolerance withdrawal, and it can show up despite a careful taper. Still, what a slow taper does reliably is to avoid piling a rapid withdrawal on top of an injury the drug has already caused.

Many patients arrive having been told by a doctor that these symptoms are “just your anxiety coming back.” They are understandably slow to trust the next doctor. Dr. Leeds treats the conditions that travel with BIND, the racing heart on standing, the air hunger, the histamine-like reactions, as medical problems in their own right and as part of the taper, rather than referring them out.

When symptoms persist for months after the last dose, the term is protracted withdrawal. It generally improves with time. Yet, nobody can promise how much time, and anyone who does is guessing.

Can antidepressants, gabapentin, and antipsychotics be tapered the same way?

Yes, by the same principles. Dr. Leeds helps patients taper off of the SSRIs, or selective serotonin reuptake inhibitors, such as Lexapro (escitalopram), Zoloft (sertraline), Paxil (paroxetine), and Prozac (fluoxetine), and the SNRIs, or serotonin-norepinephrine reuptake inhibitors. He also tapers the gabapentinoids, gabapentin (Neurontin) and Lyrica (pregabalin), and antipsychotics such as Seroquel (quetiapine) and Zyprexa (olanzapine), which are often prescribed for sleep and quietly create a dependence of their own. The Maudsley Deprescribing Guidelines lay out hyperbolic reductions for the antidepressants and the gabapentinoids, the antipsychotics come off by the same principle, and compounded liquids make the small steps possible.

His relationship to these drugs runs in one direction. He tapers patients off of them. He does not start them, and he does not use them to treat withdrawal from something else. More is on the pages for psychiatric medication deprescribing, gabapentin and Lyrica tapering, and Seroquel tapering.

What else does the practice treat?

Opioid dependence is treated with buprenorphine, the medication in Suboxone, in ZubSolv, and in the generic buprenorphine and naloxone films and tablets, by telemedicine for patients in Florida. The first doses are taken at home with phone support, starting low when fentanyl is involved, and the plan afterward, long-term maintenance or a gradual taper, is the patient’s to choose. Details are on the buprenorphine treatment page.

Alcohol use disorder, and the gray area drinking that never quite earns the label, is treated with the Sinclair Method: naltrexone taken about an hour before drinking, so that over time the brain unlearns the reward and drinking fades, with no requirement to be abstinent on day one. For a patient who needs to stop drinking entirely and safely, the practice supervises alcohol withdrawal at home, with a nurse on site around the clock.

Other addictions are discussed at a consultation. There is no medication for stimulant addiction, and whether Dr. Leeds can help depends on the person. Low dose naltrexone, compounded at a fraction of the usual dose, is also available for autoimmune-related pain.

What does concierge telemedicine mean for a patient in Orlando?

It means one doctor, every time. Dr. Leeds runs a concierge practice, outside the insurance system, and every visit is with him, never a substitute, a coach, or a nurse practitioner. Visits are by secure video from wherever you are, Winter Park, Lake Nona, Kissimmee, or downtown Orlando. And, prescriptions go electronically to the pharmacy you choose.

The first step is a consultation, which can stand on its own. It is not a medical visit and does not create a physician-patient relationship. A spouse, parent, or advocate is welcome at any visit if you want one there, and never required. The office at 3290 NE 33rd Street in Fort Lauderdale is there for anyone who wants an in-person visit.

Dr. Leeds is an osteopathic physician with over 26 years of experience in family medicine and over two decades of experience in treating medication and drug dependence and addiction. He serves on the medical advisory board of the Benzodiazepine Information Coalition and hosts The Rehab Podcast, where deprescribing is a regular subject.

Orlando patients ask these questions before a first consultation.

My doctor in Orlando wants me off Klonopin in three weeks. Is that too fast?

For a person who has taken it daily for years, almost certainly. The Maudsley Deprescribing Guidelines warn against stopping a benzodiazepine abruptly after more than four weeks of use, and three weeks is not far from abrupt after years of daily use. It is not a bad idea to ask that doctor to slow down, and if the answer is no, that is what a consultation with Dr. Leeds is for.

Do I ever have to drive to Fort Lauderdale?

No. Orlando patients are seen by video, prescriptions go to a pharmacy near you, and a compounded liquid, when one is needed, comes from a compounding pharmacy. Of course, the Fort Lauderdale office is there for anyone who prefers to be seen in person, and the drive is optional.

I take Ambien, not a benzodiazepine. Does this page apply to me?

Yes. Zolpidem and its cousins act on the same GABA-A receptors, produce the same dependence with long-term use, and come off by the same gradual, hyperbolic steps. Years of nightly Ambien call for a taper, not a decision to tough out a few bad nights.

What happens if I have a bad wave between appointments?

You text. Urgent questions reach Dr. Leeds between visits, and a step that is not working does not have to wait for the next appointment. However, if the symptom is a seizure, chest pain, or a thought of harming yourself, that is a 911 call or the nearest emergency room first and the taper second. The 988 Suicide and Crisis Lifeline is also there around the clock.

Can I keep my regular doctor for everything else?

Yes. Dr. Leeds manages the taper and the medical problems that come with it, and there is no reason to leave your regular doctor.

Orlando patients who want to taper off of a benzodiazepine, a sleep medication, or a psychiatric medication at a pace their own nervous system can tolerate can request a consultation with Dr. Leeds through the contact form. Consultations are by telemedicine for patients throughout Florida.

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.