Weaning schedules that can be undertaken wholly in the community

Patients without features that require specialist advice can undergo dose stabilisation and weaning in the community over about 2 to 4 weeks.

See Overview of weaning of benzodiazepines, zolpidem or zopiclone for considerations before starting treatment. These include identifying underlying reasons for use and agreeing a treatment plan that specifies how dispensing and monitoring (including fitness to drive) will occur.

During dose stabilisation in the community, the oral daily diazepam equivalent should be given in a single daily dose, with frequent oversight (supervised dosing or staged supply) from a community pharmacist. Review patients regularly for signs of withdrawal, intoxication, substance use and assessment of general health. The Clinical Institute Withdrawal Assessment Scale-Benzodiazepines (available at the Insight website) can be used in conjunction with clinical reviews to monitor the progress of withdrawal and the response to treatment. Risk of harms may fluctuate over the course of treatment and should be regularly reassessed; if features outlined in Features requiring specialist advice in weaning benzodiazepines, zolpidem or zopiclone develop, closer monitoring will be indicated. Dose reductions in the community often require months. Slower tapering may be needed if a patient develops intrusive withdrawal symptoms.

Offer psychosocial interventions concurrently as part of long-term care.