Where do you want to start? If you are like many of my patients, roll the dice and pick one. Caffeine? Chocolate? Alcohol? Valium? Opiates?  Let’s start with a class that is one of the most dangerous. Benzodiazepines.

Benzodiazepines like Valium came on to the market in the US in 1959 and were commonly prescribed as the cure for emotional problems. In fact, by the 1970’s and early 1980’s benzos had become the most commonly prescribed class of drug in the entire world. Despite what we have learned about benzos over the past 30 plus years they continue to be one of the most widely prescribed classes of medication. 

You’ve probably heard of most of these medications: Xanax, Valium, Klonopin, Ativan. There are others as well. Patients most commonly use them for anxiety and muscle relaxation, though there are other uses as well. These medications are easily abused. In fact, in 2010 there were close to 500,000 emergency room visits for involved benzo misuse or abuse, with abuse rates second only to narcotic pain relievers. As with narcotic pain pills, benzos are one of the most commonly used medications involved in drug-related suicide attempts, and the most commonly involved benzo involved is Xanax (alprazolam). 

Abuse and misuse of this class of medication is common. MUCH MORE common however is benzodiazepine dependence. Once you start, you just can’t stop. Mostly this is due to the withdrawal symptoms patients get when they try to stop. These symptoms include an uncomfortable increase in heart rate, severe agitation and anxiety, insomnia, irritability and tremor. Withdrawal can even include seizures, delirium and death. 


No one wants to withdrawal from benzos. It is extremely uncomfortable and can be dangerous, even life-threatening. Most of the time the only option presented to patients is a long and slow taper. This can take several months, even up to a year. During this entire period the patient is going to have waxing and waning uncomfortable withdrawal symptoms. Studies have been done on the effectiveness of taper programs and the data are discouraging. Most patients cannot taper. Perhaps there is a better and quicker way….

Enter flumazenil. Flumazenil is a benzodiazepine receptor antagonist/partial agonist. That is a mouthful, and the easiest way to think about how flumazenil works is that is attaches to the same receptor in the brain to which the benzos attach. In doing so, it competes with the benzodiazepine medication for that receptor. It is a unique substance in that it can remove the dangerous benzodiazepine from the receptor and at the same time activate the receptor to prevent severe withdrawal symptoms from developing. Patients can safely discontinue benzodiazepines abruptly and be administered flumazenil for 7 to 8 days as well as an additional anti-seizure medication for about 4 weeks. With this protocol patients can more easily and more successfully cease their use of dangerous benzodiazepines.

MedNOW Clinics has adopted the use of this benzodiazepine discontinuation protocol with the goal of providing a more successful way for patients to stop using these dangerous drugs. We are having great success with this protocol which was developed by Dr. Peter Coleman of The Coleman Institute in Richmond, VA. For more information, please reach out to us at our affiliate ARCHDetox, or visit The Coleman Institute.