Benzodiazepine Tapering: Evidence Limitations and Research Recommendations.

Abstract

Current guidelines often recommend limiting benzodiazepine (BZD) use to 2-4 weeks. However, long-term use remains common, in part due to the challenges of tapering BZDs in the context of physical dependence and withdrawal risk. This publication aims to evaluate the current evidence on BZD tapering and outline key research recommendations. In the process of developing the Joint Clinical Practice Guideline on Benzodiazepine Tapering, which included a systematic review (SR), we identified important research gaps in the literature on BZD tapering. We used the guideline development process, SR, other overlapping reviews, and feedback collected during guideline development to inform proposed research recommendations. Our review identified wide variability in tapering strategies and outcome measures, significant methodological limitations, and a lack of safety and patient-reported outcomes in the literature. Based on this knowledge, we propose research recommendations to address key gaps in the existing evidence base, including (1) comparative effectiveness and pragmatic trials; (2) adjunctive interventions; (3) adaptive approaches; (4) use of very long-acting agents for tapering; and (5) shared decision-making strategies. We also highlight 5 methodological recommendations, including the importance of collecting standardized data on patient-centered outcomes, safety, BZD use history, at-risk populations, and the use of consistent terminology. There is a critical need for rigorous, standardized, and patient-centered research on BZD tapering. Addressing the identified research gaps will improve the quality of evidence supporting clinical decision-making, thereby enhancing the safety and effectiveness of tapering strategies for diverse patient populations.