National Practice Guidelines for Safe Tapering of Benzodiazepines

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。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有关，包括潜在的生命- 威胁性戒断、药物使用障碍和服药过量(尤其是当与酒精结合时， 阿片类药物或其他中枢神经系统镇静剂)。在过去的二十年里，致命的药物过量 涉及苯二氮卓类药物的人数增加了10倍以上，经常涉及阿片类药物的组合 1老年人使用苯二氮卓类药物的比例最高2，其中 药物治疗会增加跌倒、髋部骨折和认知障碍的风险。 苯二氮卓类药物使用3个月以上的疗效及不良反应风险研究 事件随着使用时间的延长而增加，长期使用是常见的。3尽管处方盛行 以及风险的重要性，目前还没有国家临床指南来告知临床医生 确定何时以及如何减少苯二氮卓类药物的使用。安全地缩减苯二氮卓类药物可以 临床上很复杂，因为快速减少剂量可能会导致急性戒断，这可能是生命- 具有威胁性。患者还面临复发和症状恶化的风险，这些症状是 服用苯二氮卓类药物(如焦虑、癫痫发作、失眠)。此外，不充分的缩减 策略可能会将患者推向非法药物市场，在那里假药中掺有芬太尼和 其他阿片类药物很常见，存在过量和过量死亡的风险。4支持FDA的 目标是“安全地减少可能误用和滥用的药物的不适当处方” 美国成瘾医学会(ASAM)将开发一种临床实践 指南(CPG)，以指导临床医生确定何时以及如何缩减苯二氮类药物。 ASAM拥有开发CPG的丰富专业知识，并与其他医疗机构建立了合作伙伴关系 与这一主题相关的专门知识的学会，包括美国精神病学协会， 美国神经病学学会、美国老年医学学会和美国医学院 妇产科等。ASAM将与这些合作伙伴合作，召集一名专家 具有多学科医学专业知识的专家小组，使用修改后的评分方法制定CPG。 将对与苯二氮卓类药物缩减有关的证据进行系统审查，以向 专家小组的工作。有生活经验的人将在整个过程中参与进来，以确保 中央人民政府满足了患者的关切和需求。一旦指导方针完成，ASAM就会奏效 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 促进改进苯二氮类药物处方实践的决策支持工具。

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.