What is it?
Since 2022, the American Society of Addiction Medicine (ASAM) has been working on producing a set of recommendations to guide practitioners in the often-difficult task of helping benzodiazepine-dependent patients discontinue this medication. The ASAM Clinical Practice Guideline on Benzodiazepine Tapering has gone through several iterations and reviews. Even before being written, this guideline received the endorsement of nine professional medical societies.
How does it affect you?
This guideline will set the standard for clinical practice for discontinuation of benzodiazepines for at least the next decade. It will determine how patients are treated. It is therefore imperative that the guideline accurately represent the best evidence-based practice for deprescribing benzodiazepines.
Who is developing it?
Under contract to FDA, ASAM established a working group chartered with producing the guideline (the Clinical Guideline Committee, or CGC). The CGC consists of an ASAM panel of addiction medicine subject matter experts (SMEs) plus several other consulting experts. Several of the Alliance’s own SMEs who have vast patient experience with benzodiazepine discontinuation, including Drs. Ritvo, Blazes, Podesta, Madhava and Witt-Doerring, plus benzodiazepine expert Dr. Christy Huff applied to be part of the CGC or its consulting experts. All were rejected.
How is it being developed?
The CGC did an extensive literature review on the topic and used it to draft a set of guidelines. To their credit, the CGC has solicited several levels of input on the draft guidelines. They convened a Patient Panel of people affected by benzodiazepine dependence, which met several times to relate personal experience and provide a variety of inputs for the guideline. Several of these inputs were incorporated into the draft Clinical Practice Guideline on Benzodiazepine Tapering. A summary of the guideline was opened for public comment on June 17, 2024. The public comment mechanism allowed anyone to comment on the specific guidelines, but only as to the degree to which they agreed with a given guideline or not. The comment period closed July 19, 2024.
What is the Alliance doing about the proposed guideline?
A lot!
- Several Alliance members were part of the Patient Panel.
- Once the guideline draft was released, the Alliance realized that the public comment mechanism was inadequate and petitioned ASAM to be able to thoroughly review the complete guidance document, including its scientific underpinnings and the rationale for its recommendations. ASAM graciously accommodated this request and provided the entire document in a form in which the Alliance could provide comment as a peer organization.
- The Alliance provided over 200 unique, detailed comments on the proposed guideline with dozens of supporting references. The total markup text is approximately the same size as the draft guideline text!
- The Alliance wrote a letter to ASAM and the CGC, listing the top 10 concerns with the guidelines that are likely to cause the most patient harm. The letter had 16 medical professional co-signers representing medical institutions across the United States, Canada, Ireland and Australia.
- To help the CGC find the Alliance-proposed guideline changes needed to address the top 10 concerns among the hundreds of comments, the Alliance provided a second marked-up document which highlighted those the mark-ups for the top 10 concerns.
- Director Jaden Brandt of the Alliance put together a rigorous list of top recommendations for discontinuation of benzodiazepines. This is a consensus document, representing the experiences of the top experts on discontinuing benzodiazepines and leaders in the support community for benzo-affected individuals, including the Benzodiazepine Information Coalition, BenzoBuddies, Benzo Warriors and Easing Anxiety. These recommendations are consistent with the Alliance feedback to the CGC noted above. The consensus document is targeted for publication in a medical journal prior to the publishing of the ASAM guideline.
- ASAM is holding its annual conference on April 24-25, 2025. The Alliance has defined a session on the tapering guideline to discuss the top areas of disagreement. It has requested ASAM to include it in the agenda for this conference. Check back here to see how ASAM responds to this request.
What is the guideline’s current status?
ASAM’s CGC received over 3000 comments on the draft guideline. It is working on processing those comments and has committed to providing an “update” by the end of October 2024. ASAM’s contract with the FDA expires at the end of August 2025 and the guideline must be published before then.