Benzodiazepine Tapering & Deprescribing
in Tallahassee, FL

Can a patient in Tallahassee taper off a benzodiazepine while keeping a full-time job?

Yes, and for most people in Leon County that is the real question. Dr. Leeds, an osteopathic physician who specializes in deprescribing, keeps his office in Fort Lauderdale. He prescribes for patients in Florida and sees them by secure video wherever in the state they live. Benzodiazepine tapering leads the practice and psychiatric medication deprescribing comes second. This page is written for Tallahassee’s working day: state employees, university faculty and staff, hospital workers, and the student who was handed a benzodiazepine for anxiety during a bad semester and is still taking it.

In short:

• Patients in Tallahassee and the surrounding Big Bend counties meet with Dr. Leeds by video. The office is in Fort Lauderdale, and no visit requires the drive.
• Visits are weekly, often up to an hour, inside the hours of Monday to Friday, 10 AM to 2 PM Eastern, with 24/7 text access for urgent questions between them. Every visit is with Dr. Leeds.
• A taper is a prescription change, not a treatment program: no absence to explain, no interruption to a career.
• Physical dependence is not addiction. The pace follows the patient, with holds planned around deadlines rather than steps skipped to meet them, and a taper commonly takes a year to 18 months or longer.

Who in Tallahassee is asking for help coming off a benzodiazepine?

Tallahassee is a government and university town. Its agencies, the Capitol complex, two universities, a state college and the hospitals employ much of Leon County, and that shapes who looks for help. Two situations are common. One is a working adult who has taken Klonopin (clonazepam) or Xanax (alprazolam) every day for years, exactly as prescribed, and who now cannot miss a dose without feeling ill. The other is younger: a first prescription at 19 or 20 for panic attacks or exam anxiety, and, two or three years later, a graduate in a state office who has found that the medication no longer feels optional.

Both share a starting point: physical dependence is not addiction. A person who takes a benzodiazepine daily for more than a few weeks adapts to it, and the body then needs the drug to feel ordinary. Addiction is a pattern of compulsive use in spite of harm, and most people who ask for a taper have never shown it. In 2020, the U.S. Food and Drug Administration (FDA) revised the boxed warning on every benzodiazepine label to say that these drugs produce physical dependence and withdrawal reactions, some lasting months, and that stopping calls for a gradual reduction. Nothing in it requires a residential program or a leave of absence. What it rules out is an abrupt stop: stopping suddenly after months or years of daily use can cause seizures and can be fatal, and a taper rushed to meet a date is a slow stop pretending to be a safe one.

How does a months-long taper fit around a full-time job?

With some planning and an honest look at the hours. The practice’s hours are Monday to Friday, 10 AM to 2 PM, and the weekly video visit falls inside them. For a state employee or a faculty member that usually means a lunch hour, a flexible morning, or a telework day.

The visit, often up to an hour, reviews the week just finished and settles the next. Between visits, patients have text access to Dr. Leeds for urgent questions, 24 hours a day, so a step that is going badly on a Tuesday evening does not wait for the next appointment. A seizure, chest pain or thoughts of suicide mean calling 911 or going to the nearest emergency room before anything else; the taper can wait, and the 988 Suicide and Crisis Lifeline answers around the clock by call or text.

Nothing about the taper has to reach an employer. A video appointment is a medical appointment like any other, and the prescription is filled at a pharmacy of the patient’s choosing. Whether to tell a supervisor is the patient’s decision and never a condition of care. People work, teach, finish degrees and raise families on the way down, and the taper is paced so that they can.

What about driving, concentration and meetings during a taper?

Benzodiazepine labels already caution patients about driving and operating machinery, and that caution holds during a taper. The added difficulty is that in the days after a reduction some people feel foggy, jittery or unrested, and Tallahassee is a city where almost everyone drives, along Capital Circle, Apalachee Parkway or Thomasville Road, to get to work. A day when a patient feels unsafe to drive is a day to get a ride, and a reduction that leaves someone unable to drive for most of a week was too large. The next one is smaller.

Concentration is the symptom working people worry about most, and the protection is the size of the step. Reductions that get smaller as the dose falls, which the Maudsley Deprescribing Guidelines describe as hyperbolic tapering, keep each change small enough that most patients keep working throughout. Meetings and presentations are a matter of timing: a reduction goes at the point in the week that leaves a buffer before the hardest obligations, and a patient who knows a difficult week is coming says so at the visit.

Can a taper be planned around the legislative session, exams and deadlines?

It has to be, in a city whose calendar is set by the Legislature, the university term and the state’s fiscal year. Session brings 60 days of long hours for agency staff and everyone around the Capitol; the end of June closes the books for much of state government; finals take over the campuses twice a year.

The tool is the hold. Holding the dose steady for a week or several weeks gets a patient through session or a grant deadline at full capacity, and the taper resumes from the same place afterward. A hold is agreed at the visit before the busy stretch begins. Hurrying a step before a deadline, or skipping one to catch up afterward, is how tapers fall apart and how people end up back at their starting dose.

What should a young adult expect compared with a long-term patient?

The student who started alprazolam at 19 and the employee who has taken clonazepam for twenty years are both physically dependent, and both need a gradual reduction. The Maudsley Deprescribing Guidelines advise against stopping a benzodiazepine abruptly after more than about four weeks of regular use, a bar nearly everyone asking for help has already passed.

A short history, two or three years at a modest dose, often means a shorter taper, though nobody can promise a timeline in advance. What a young patient should not expect is to be done in a month; the lower part of any taper, where each step removes a larger share of what remains, is slow for everyone.

The long-term patient brings different questions. Decades of use often mean the medication was started for a reason that has since changed, and the anxiety felt now may be the drug wearing off between doses rather than the original condition. Other medications have often accumulated along the way, and the order in which they come off matters. The taper is longer, and many patients describe a clearer mind at the end of it. Neither patient is told to just stop.

How is the taper built, and where does the medication come from in Tallahassee?

The method follows the Ashton Manual, written by Professor C. Heather Ashton, and the Maudsley Deprescribing Guidelines. For most patients on a short-acting benzodiazepine such as alprazolam or lorazepam, the first phase is a gradual switch to diazepam (Valium), which lasts longer in the body; the diazepam is then reduced in steps that shrink as the dose falls. Patients who do poorly on diazepam taper on the medication they already take. Ambien (zolpidem), Lunesta (eszopiclone) and the other sleep medications work at the same receptors, so they are reduced the same way. More is on the benzodiazepine tapering page.

The low end of a taper needs doses a tablet cannot deliver. Diazepam is manufactured as a 1 mg/mL oral solution with its own FDA label, and the chain and independent pharmacies in Tallahassee, Crawfordville, Quincy and Monticello can order it when they do not stock it. For other medications, or a custom strength, a compounding pharmacy prepares a liquid or capsules to the exact dose prescribed, and compounding pharmacies operate across Florida. Prescriptions go electronically from Dr. Leeds to whichever pharmacy the patient chooses. No dose on this page is a schedule to copy.

What is BIND, and what if symptoms outlast the taper?

Benzodiazepine-induced neurological dysfunction, or BIND, is the name for the wider set of symptoms that long-term benzodiazepine use can produce during use, during the taper and after the last dose: insomnia, muscle pain, sensory disturbances, gut symptoms and an inner restlessness that makes sitting through a meeting hard. They can appear while a patient is still taking a steady dose, a state called tolerance withdrawal. More is on the benzodiazepine withdrawal page.

A slow taper is the best available protection against the worst of it, but not a guarantee. Symptoms that persist for months after the final dose are called protracted withdrawal; they generally improve with time, although no honest physician will promise how much, and recovery often moves in windows and waves. Within the taper, Dr. Leeds treats these symptoms as the medical problems they are rather than labelling them a return of anxiety. A longer view is on life after benzos.

Can the same approach take someone off an antidepressant, gabapentin or an antipsychotic?

Yes, and for some patients it is the second half of the same plan. The selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft), escitalopram (Lexapro) and paroxetine (Paxil), the serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin (Neurontin) and pregabalin (Lyrica), and the antipsychotics, quetiapine (Seroquel) among them, prescribed for sleep all produce withdrawal of their own when stopped too fast. The Maudsley Deprescribing Guidelines set out hyperbolic reductions for these drugs as well, compounded liquids make the small steps possible, and one medication is reduced at a time so a symptom can be traced to its cause. Dr. Leeds tapers patients off these medications; he does not start them. The psychiatric medication deprescribing page covers each class.

Which other conditions does the practice treat?

For opioid dependence the practice prescribes buprenorphine, the active ingredient of Suboxone, ZubSolv and their generic films and tablets, by telemedicine to patients in Florida. Induction happens at home with phone support, and the first dose is kept low when fentanyl makes that necessary. Visits for buprenorphine are monthly, and weekly when a patient needs them; whether to stay on the medication long term or taper later is the patient’s choice.

For alcohol use disorder the practice uses the Sinclair Method, in which naltrexone is taken roughly an hour before drinking so that, month by month, the reward fades and the drinking with it; abstinence is not required at the start. For a patient who needs to stop drinking entirely, withdrawal can be supervised in the patient’s home with a nurse present 24 hours a day, since a sudden stop after heavy daily drinking is dangerous. Other addictions are a question for a consultation; there is no medication for stimulant dependence, and whether Dr. Leeds can help is decided there.

Why does the distance between Tallahassee and Fort Lauderdale not matter?

Fort Lauderdale is about 470 miles from Tallahassee, seven hours or more of driving. Nobody in the Big Bend is expected to make that trip. The consultation, the weekly visits and the between-visit texts all happen from Tallahassee, and prescriptions arrive at a pharmacy in town. The Fort Lauderdale office remains available to anyone who prefers an in-person visit, but nothing in the care depends on it.

The same holds across the region: Midtown, Killearn and SouthWood; Crawfordville and the rest of Wakulla County; Quincy, Havana and Gadsden County; Monticello and Jefferson County; and the smaller towns of the Big Bend.

What does concierge telemedicine mean for a patient in Leon County?

It means the same physician at every visit. Dr. Leeds works as a concierge practice, outside the insurance system, and no substitute clinician ever stands in for him. Care starts with a consultation, which can stand alone; it does not create a physician-patient relationship. If the patient wants a spouse, parent or friend in the room, they are welcome, and nobody is required.

Dr. Leeds is a member of the Benzodiazepine Information Coalition’s medical advisory board and the host of The Rehab Podcast, where tapering and deprescribing come up often.

Frequently asked questions

I work for the state and my only free time is lunch. Can a weekly visit really fit?

Usually, yes. The visit hours overlap a standard state workday, and a lunch hour or a flexible morning is enough. When a week truly has no room, the sensible course is to say so at the previous visit and hold the dose until the next.

Does my agency, my department or my employer need to know I am tapering?

No. A taper is a change to a prescription made between a patient and a physician, not a treatment program, and the practice requires no leave and no disclosure. Whether to tell a supervisor is the patient’s choice alone.

I was prescribed Xanax as a student and have taken it for three years. Do I really need a slow taper?

Yes. After more than a few weeks of regular use, the Maudsley Deprescribing Guidelines advise against stopping abruptly, and three years is well past that. A shorter history often means a shorter taper, but the lower part is slow for everyone, and stopping over a weekend risks seizures and a hard withdrawal.

I live in Panama City or Pensacola, on Central time. What are the visit hours for me?

The practice keeps Fort Lauderdale time, so Monday to Friday, 10 AM to 2 PM Eastern is 9 AM to 1 PM Central for Panama City, Pensacola and the rest of the Panhandle that keeps Central time. Nothing else is different: video visits, text access and prescriptions to a local pharmacy work the same at the far end of the Panhandle as in Tallahassee, and Gainesville, on Eastern time, needs no conversion at all.

I live in Crawfordville, Quincy or Monticello rather than Tallahassee. Is that a problem?

No. Everything here applies to Wakulla, Gadsden and Jefferson counties and the rest of the Big Bend as it does to Leon County: visits by video, prescriptions to the nearest pharmacy, and no drive to Fort Lauderdale.

Patients in Tallahassee and the Big Bend who want to come off a benzodiazepine, a sleep medication or a psychiatric medication without putting their work or their studies on hold can send Dr. Leeds a consultation request using the contact form. Consultations and treatment happen by telemedicine for patients anywhere in 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.