National Practice Guidelines for Safe Tapering of Benzodiazepines

安全减少苯二氮卓类药物国家实践指南

• 批准号: 10676509
• 负责人: Maureen Patricia Boyle
• 金额: $ 167.06万
• 依托单位: AMERICAN SOCIETY OF ADDICTION MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676509
• 关键词: National; Practice; Guidelines; Safe; Tapering

Abstract Benzodiazepine medications are commonly prescribed to treat a wide range of conditions including anxiety and mood disorders, insomnia, and seizure disorders. These medications represent important therapeutic tools; however, they are associated with significant adverse events including potentially life- threatening withdrawal, substance use disorder, and overdose (particularly when combined with alcohol, opioids, or other central nervous system depressants). Over the past two decades, fatal overdoses involving benzodiazepines have increased more than 10-fold, often involving the combination of opioids and benzodiazepines.1 Benzodiazepine prescribing rates are highest2 for older adults, among whom these medications pose additional risk for falls, hip fractures, and cognitive impairment.3 While there is little research on the efficacy of benzodiazepine use for longer than three months and the risk for adverse events increases with duration of use, long-term use is common.3 Despite the prevalence of prescribing and the significance of the risks, there are currently no national clinical guidelines to inform clinicians in determining when and how to taper benzodiazepine medications. Safe tapering of benzodiazepines can be clinically complex since rapid dosage reductions may precipitate acute withdrawal, which can be life- threatening. Patients are also at risk for recurrence and exacerbation of the symptoms for which the benzodiazepine was prescribed (e.g., anxiety, seizures, insomnia). In addition, inadequate tapering strategies may push patients to the illicit drug market where counterfeit pills laced with fentanyl and other opioids are common, presenting a risk for overdose and overdose death.4 To support the FDA’s goal of “safely reducing inappropriate prescribing of medications with potential for misuse and dependence”, the American Society for Addiction Medicine (ASAM) will develop a clinical practice guideline (CPG) to guide clinicians in determining when and how to taper benzodiazepine medications. ASAM has significant expertise developing CPGs and established partnerships with other medical societies with expertise relevant to this topic including the American Psychiatric Association, the American Academy of Neurology, the American Society for Geriatrics, and the American College of Gynecology and Obstetrics, among others. ASAM will work with these partners to convene an expert panel with multidisciplinary medical expertise to develop a CPG using a modified GRADE methodology. A systematic review of the evidence related to benzodiazepine tapering will be conducted to inform the work of the expert panel. People with lived experience will be engaged throughout the process to ensure that the CPG addresses patient concerns and needs. Once the guideline is complete, ASAM will work with the FDA and our partners to widely disseminate the guidelines as well as training and clinical decision support tools to facilitate improvements in benzodiazepine prescribing practices.

摘要 苯二氮卓类药物通常用于治疗多种疾病，包括 焦虑和情绪障碍、失眠和癫痫症。这些药物代表着重要的 治疗工具;然而，它们与重大不良事件相关，包括潜在的生命， 威胁性戒断、物质使用障碍和过量（特别是与酒精结合时， 阿片类药物或其他中枢神经系统抑制剂）。在过去的二十年里，致命的过量服用 涉及苯二氮卓类药物增加了10倍以上，通常涉及阿片类药物的组合 1老年人的苯二氮卓类处方率最高2，其中， 药物会增加福尔斯、髋骨骨折和认知障碍的风险。 关于苯二氮卓类药物使用超过三个月的疗效和不良反应风险的研究 事件随着使用时间的增加而增加，长期使用是常见的。 和风险的重要性，目前没有国家临床指南告知临床医生， 确定何时以及如何逐渐减少苯二氮卓类药物。苯二氮卓类药物的安全减量可以 临床上很复杂，因为快速减少剂量可能会导致急性戒断，这可能是终身的， 威胁。患者也有复发和加重症状的风险， 开了苯二氮杂（例如，焦虑、癫痫、失眠）。此外，不适当的锥度 这些策略可能会把病人推向非法药物市场，在那里，假药含有芬太尼， 其他阿片类药物也很常见，存在过量和过量死亡的风险。 目标是“安全地减少可能误用的不适当药物处方， 依赖”，美国成瘾医学会（ASAM）将制定一项临床实践， 指南（CPG）指导临床医生确定何时以及如何逐渐减少苯二氮卓类药物。 ASAM拥有开发CPG的重要专业知识，并与其他医疗机构建立了合作伙伴关系。 与此相关的专业知识，包括美国精神病学协会， 美国神经病学学会、美国老年医学会和美国老年医学院 妇产科等等。ASAM将与这些伙伴合作，召集一名专家， 一个具有多学科医学专业知识的小组，使用改进的GRADE方法制定CPG。 将对与苯二氮卓类药物逐渐减量相关的证据进行系统综述，以告知 专家组的工作。具有生活经验的人将参与整个过程，以确保 CPG解决了患者的担忧和需求。一旦指南完成，ASAM将工作 与FDA和我们的合作伙伴一起广泛传播指南以及培训和临床 决策支持工具，以促进改善苯二氮卓类处方做法。