Dependence at the prescribed dose: what holds for each drug

Benzodiazepines cause dependence at the dose you were prescribed

Alprazolam (Xanax), bromazepam (Lexotanil), diazepam, lorazepam: all carry the same FDA boxed warning since September 2020 — physical dependence develops within a few days to a few weeks of steady use, at the prescribed dose, without any misuse.

Physical dependence is not addiction and not a personal failure. It means the body has adapted — and that stopping needs a plan, not a snap decision: abrupt discontinuation after prolonged use can cause seizures.

The approved duration of use is short: the UK Committee on Safety of Medicines set it at 2–4 weeks in total, including the tapering period, as far back as 1988 — a recommendation since embedded in European product information. If you have been taking the same pill for months or years, that alone is a reason to discuss the treatment with your doctor — not a reason to panic, and never a reason to stop abruptly.

[7] FDA Drug Safety Communication, 23.09.2020 · [51] UK Committee on Safety of Medicines, Current Problems 21 (1988)

Zolpidem (Stilnox/Ambien) in Greece: approved for weeks, dispensed for years

The newer hypnotics — chiefly zolpidem (Stilnox/Ambien), which accounts for 89.7% of the class in Greece — were approved for short-term treatment of insomnia. The national prescription database shows a different picture: 1,229,842 prescriptions to 156,554 patients in three years, with a median of 8 prescriptions per patient.

The most critical finding concerns age: 73.1% of patients were 65 or older, with a median age of 77. In older people, however, this class is listed among potentially inappropriate medications under the Beers Criteria, because of the increased risk of falls and hip fractures. In other words: the drug concentrates in exactly the population the guidelines say should avoid it.

If this concerns someone in your family, the right question for the doctor is not "should they quit?" but "is there a tapering plan, and what is the non-drug alternative for sleep?" — for chronic insomnia, cognitive behavioural therapy (CBT-I) is recommended as first-line treatment, ahead of hypnotics.

[11] Siafis S et al. BMC Psychiatry 2023;23:370 · [18] AGS Beers Criteria®, 2023 update · ACP 2016 on CBT-I

Pregabalin (Lyrica): the "non-psychiatric drug" that joined the same list

Pregabalin (Lyrica) and gabapentin (Neurontin) are widely prescribed for neuropathic pain and anxiety — and most patients do not think of them as psychiatric drugs at all. In January 2026 the UK regulator (MHRA) placed them in the same decision as benzodiazepines and Z-drugs: packaging will now state explicitly that the medicine "may cause addiction, dependence and withdrawal reactions".

The practically important part of the decision: before treatment begins, a strategy for reducing and stopping must be agreed with the patient. The exit plan is part of the prescription — not a problem to be solved "someday".

An updated systematic review of 100 studies (2026, the third in a decade-long series on the same research question) strengthens the finding: overdose risk rises particularly in combination with opioids or benzodiazepines, with new evidence now also from adolescents and chronic-pain patients.

And the deaths, from the official statistics. The UK Office for National Statistics records the substances named on death certificates for drug poisoning in England and Wales. Pregabalin appeared in 4 deaths registered in 2012 and in 617 registered in 2024 — 11.1% of all drug-poisoning deaths of the year; gabapentin went from 8 to 160. These are years of registration, not of death, and the ONS notes that its per-substance figures “are often underestimates” — part of the rise is better recording. The ONS definition itself demands care: a “death involving” a substance means the substance is mentioned on the certificate, often alongside others — more than half of these deaths involve more than one substance, and “it is not possible to identify which was primarily responsible”. In 2024 pregabalin was the only substance in 16 deaths. It is, in other words, a curve of co-involvement, not a count of deaths the drug “caused”; but it rises year on year, in a country with 9.9 million pregabalin prescriptions a year (England, 2025) — and since 1 April 2019 both drugs are Class C controlled substances there. And one practical point for anyone taking them: pregabalin and gabapentin are also anti-epileptics — they are stopped only gradually and only with the treating doctor, never abruptly.

[19] MHRA Drug Safety Update, 08.01.2026 · advice of the Commission on Human Medicines · [63] Evoy KE et al. Drugs 2026;86(8):1365–1378 · doi:10.1007/s40265-026-02342-w · [83] ONS, Deaths related to drug poisoning by selected substances, 2024 registrations · [84] ONS statistical bulletin, 17.10.2025 · [85] S.I. 2018/1356 · [86] NHSBSA, Prescription Cost Analysis 2025

If you have been on them for a while: a plan, not abrupt stopping

Nothing on this page says to stop your medication. It says the opposite: abruptly stopping benzodiazepines is dangerous, and the safe exit is gradual, at a pace set by your symptoms — always with communication, monitoring and guidance from your treating doctor.

Three questions worth asking at your next appointment: for how much longer is this treatment intended; what is the tapering plan and when does it start; and what non-drug alternative exists for the problem that started it. For how often withdrawal occurs and what the studies show, see Antidepressant withdrawal; for services specialising in deprescribing, the directory of independent organisations.

[19] MHRA 08.01.2026 · [18] NICE NG215 (2022)