RETRACTED: Data-based Individualised Detoxification From Benzodiazepines and Other Gaba-a Agonists Driven by Serum-concentration Feedback: Presentation of the Saer Method

Abstract

OBJECTIVE pharmacokinetics (PK)-related issues hinder detoxification from benzodiazepines (BZDs). Unrecognised overaccumulation of a long-acting substitute, the consequent delay in effective elimination, excess concentration relative to dose, and high drug concentration upon discontinuation distort clinical judgement and mimic patients’ good adaptation to ‘abstinence’. Low-concentration crises surprisingly occur after treatment conclusion, causing relapses of drug intake. The presented novel detoxification method employs preventive actions driven by concentration feedback. METHODS Assuming standard initial conversion to a long-acting BZD, the method involves 4 stages referring to serum BZD evolution: Substitution, Anti-accumulation paradigm, Elimination, and Readaptation (SAER). Substitution by titration using diazepam or clorazepate (well read by immunoassays) ends with a satiation state. The corresponding BZD concentration and withdrawal-symptom scoring make up the PK and adaptation baselines, respectively. During the A stage, doses are reduced daily, and laboratory feedback determines the need and estimated size of the next dose-reducing step. The cycle continues until accumulation stops, revealing an individual maintenance dose. Further dose reduction begins the E (real detoxification) stage, and tapering steps depend on the patient’s condition and elimination rate. Elimination is tracked every 3–7 days until its completion, including after drug withdrawal. During the postelimination R stage, after the ‘zero-concentration crisis’, patients adapt to true abstinence. Recovery is assessed against the clinical-state baseline. RESULTS The SAER method, using serum-BZD feedback, minimises the initial, commonly unrecognised and long-lasting overaccumulation. A forced concentration plateau sets rational initial conditions for the elimination process. During elimination, patients are adjusted not to doses but to actual concentrations. Sustained postwithdrawal assistance secures key low-concentration crises, especially the one coinciding with elimination completion. Within the typical treatment duration, cutting the irrelevant high-concentration phase creates more time for a crucial low-concentration period. CONCLUSIONS The SAER method prevents overaccumulation-related errors resulting in posttreatment crises, providing a credible, data-driven, individualised detoxification method.