Her Doctor Told Her to Take More. It Took 38 Months to Get Off Them.

In 2011, a nurse named Carrie Silvernail told her doctor she was thinking about killing herself. She had been on a low dose of alprazolam, the generic name for Xanax, for anxiety and back pain since 2008. Her symptoms had gotten much worse, not better: panic, night sweats, insomnia, ringing in her ears, dizziness. Her doctor’s answer, as she later wrote in a peer-reviewed article, was to raise the dose.

It took her 38 months to get off it.

Nobody in the benzodiazepine story is lying, and nobody is safe from it: the pills that were handed out too easily are now being cut off too bluntly, and the fake ones are filling the gap.

That is Rize’s read on depressants this week, and it comes straight out of two things published within a few months of each other: a decade of prescribing data, and a patient’s own account of what it costs to come off.

The number that looks like good news

This week, researchers at Rutgers and Columbia reported in the American Journal of Psychiatry that benzodiazepine prescriptions in the United States fell 26.7% between 2013 and 2024. The team, led by Naomi Cruz and including Mark Olfson of Columbia, looked at more than 1.1 billion filled prescriptions. The average dose per prescription also fell, by 18.3%. The steepest drop was among adults ages 18 to 29. Fewer of the remaining prescriptions come from primary care doctors and psychiatrists; more come from nurse practitioners and physician assistants.

Cruz put the balance carefully: “Benzodiazepines provide meaningful benefits for many patients, but carry risks particularly when used with other drugs or over long periods.” The paper credits more cautious prescribing, likely nudged by FDA warnings in 2016 and 2020 about combining benzodiazepines with opioids.

That is real progress, and it deserves to be said plainly. Fewer people are being started on a class of drug that was never meant to be taken for years.

Here is what the number cannot tell you. It counts scripts written. It does not count the person who has been on the same dose for fifteen years and was just told the clinic doesn’t prescribe it anymore. It does not count the 24-year-old who couldn’t get a script and found a pill on the internet. A falling curve and a rising danger can be the same curve, seen from two sides.

What a 38-month taper actually is

Start with a plain-language fact most prescribers still do not say out loud: your body adapts to these drugs fast. Dr. Steven Wright, the physician who co-wrote Silvernail’s article, says physical dependence is expected after one to two weeks of exposure, even at doses a doctor prescribed. That is not addiction. It means your nervous system has turned its own volume down to match the drug, and when the drug leaves, the volume snaps back up too loudly. Sleep goes. Panic returns, often worse than the panic you were treated for. Seizures are possible if the drug stops suddenly, which is why you never stop alone and cold.

Wright’s line is one every treatment program should read twice: “The vast majority of those struggling with BZDs are not addicted to them, and for them traditional addiction treatment approaches are unsuccessful.” A person who took a pill exactly as directed for a decade and a person who is chasing a high are not the same patient. Treating them identically, with a shaming conversation or an abrupt cutoff, hurts the first without helping the second.

Silvernail’s taper lasted 38 months with a healthcare team she assembled herself. She reports more than 100 physical and mental symptoms, and often being bed- or couch-bound. Six years after her last dose she still lived with dizziness, pain, fatigue and ringing in her ears. What changed her care was one physician who said, in her words, “First, I believe you. Second, how can I best support you?”

Six years after her last dose she still lived with dizziness, pain, fatigue and ringing in her ears.

If you are on one of these medications now and the thought of stopping scares you, that fear is not weakness. It is an accurate read of what the drug has done to your nervous system. Wright and Silvernail’s recommendation is a taper “anticipating 12–18 months or more,” slowing as the dose gets smaller, with the patient’s own read of their body outranking the prescriber’s schedule. Thirty-eight months was Silvernail’s number. Yours may be shorter. It will not be fast.

We have run this experiment before

By 1968, Valium was the best-selling medication in America, and it stayed on top until 1982. In 1978 alone Americans took nearly 2.3 billion tablets. The Rolling Stones put the suburban prescription into a song in 1966, and for a while the culture treated it as a joke. Then the dependence stories piled up, the pendulum swung, and doctors who had handed the pills out like aspirin started refusing them like contraband. Patients who had done nothing but follow instructions found themselves pushed off a drug their bodies now needed, and into the wait for a taper no one had been trained to run. We are watching the second swing of the same pendulum, and the same people are standing where it lands: long-term patients with no taper plan, and young people with no legal supply.

The fake pill is the thing that didn’t go down

The people the prescribing curve left behind did not stop wanting relief. The DEA said so when it placed bromazolam in Schedule I in March: the drug is a designer benzodiazepine with no approved medical use, one of the most frequently identified benzodiazepines in seizures, and a common ingredient in counterfeit Xanax. Assistant Administrator Cheri Oz called the move “a decisive step to get ahead of a rapidly evolving threat,” according to a summary of the DEA announcement.

Scheduling a chemical does not schedule the pill that contains it. A counterfeit bar can hold bromazolam, fentanyl, xylazine or all three. A case report in the Primary Care Companion describes a 35-year-old man hospitalized after an opioid overdose who told staff he was in withdrawal. Nothing fit the picture, so no one treated it, and he had a seizure. His supply, when tested, held xylazine, fentanyl and bromazolam. The authors say it is possibly the first documented case of xylazine masking benzodiazepine withdrawal. The sedative in the mix hid the very syndrome that was about to hurt him.

What providers can do this week

If you run a clinic or a caseload, three moves are available now. First, put a question about sedatives, prescribed or bought, on your intake form, and add a line asking how long and how much, because tapering decisions depend on both. Second, when a patient reports withdrawal that does not match their drug-test results, take them at their word and call poison control at 1-800-222-1222 rather than waiting for the labs to agree. The CDC says the same hotline is the right call when an unfamiliar sedative like medetomidine is in play. Third, bring the 12-to-18-month taper figure to your next team meeting and ask who in your network can actually run one. If the answer is nobody, that is your referral gap.

The doors still open tonight

You are not out of options if you are on these drugs or buying them. Naloxone still works on the opioid part of a mixed supply, and it is still available without a prescription. Poison control is free and staffed around the clock. The old Ashton Manual, the taper guide written by a British clinician and long used by people coming off benzos, is free online at benzo.org.uk. And Silvernail got off. She did it slowly, with people who believed her, and she wrote it down so the next person would not have to prove they were suffering.

The old Ashton Manual, the taper guide written by a British clinician and long used by people coming off benzos, is free online at benzo.org.uk.

The prescribing curve says fewer people are being started on these drugs. It says nothing about whether the ones already on them get a doctor who says the second sentence: how can I best support you?