I value the guidance on tapering benzodiazepines. But I strongly disagree with Ashton that tapering benzodiazepines is solely the patients decision. First, people with addiction and co-morbid mental illness with limited insight cannot be expected to think logically and clearly about how much their substance of choice is harming them on their own. Secondly, the patient is not the one who swore to do no harm and is certainly not the one held accountable both legally and professionally when injury or death occur as a result of prescribing benzodiazepines. Third, most patients I see who have dependence on benzos also have co-morbid dependence to prescribed opiates, alcohol, or other substances, thus increasing the likelihood of a bad outcome for which the physician will certainly be blamed. Fourth, patients, because they are not medically trained, don't even know where to start the process of weaning off benzos. So they do what people with anxiety usually do to cope: avoid confronting the issue.
This idea that the physician must prescribe a dangerous controlled substance unless the patient is completely free of any discomfort is backward, and exactly how epidemic over prescribing is enabled, as we are seeing with the opiate epidemic. The physician must lead the conversation toward health, not merely enable drug dependence. Collaboration is certainly the ideal, but it must be recognized that sometimes the best a doctor can do for his or her patient is to say "No."
