Weaning schedules to be started in hospital or a specialist outpatient clinic

People with features that require specialist advice can undergo dose stabilisation in hospital or a specialist outpatient clinic over 2 to 7 days, followed by dose reduction at a rate determined by symptom severity.

Regular clinical assessment of withdrawal, intoxication, substance use and general health is required. The Clinical Institute Withdrawal Assessment Scale for 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.

After stabilisation, reductions of 10% of the oral daily diazepam equivalent per day can be achieved in inpatient settings. In general, patients should be discharged only when the oral daily diazepam equivalent has reached 20 mg or less. Slower reduction over months can then take place in the community, at a pace that avoids significant withdrawal symptoms. As outlined in a treatment agreement, this requires supervised dosing or staged supply, and close clinical monitoring (including fitness to drive). Risk level may fluctuate over the course of treatment. A higher-risk patient with a history of unstable drug use should have closer monitoring, with regular review of the monitoring interval. Features of unstable use include illicit use, dose escalation, overdoses, and social or health harms from drug use.