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The lack of approved long-acting benzodiazepine equivalents for bromazolam and flubromazolam and kratom\u2019s inhibition of benzodiazepine metabolism eliminated utilisation of the conventional withdrawal management strategy. Symptom-based management was initiated using diazepam to stabilise the patient during active withdrawal. Tapering of withdrawal medications and initiation of medical management for co-existing psychiatric conditions followed stabilisation. Current recommendations utilise equivalent benzodiazepine conversions and scheduled tapers. In the setting of unknown equivalents, physicians should prioritise symptomatic stabilisation to prevent poor outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2025-266077","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T18:05:22Z","timestamp":1754330722000},"page":"e266077","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Successful symptom-based management of active withdrawal from multiple illicit benzodiazepines"],"prefix":"10.1136","volume":"18","author":[{"given":"Madeline","family":"Butler","sequence":"first","affiliation":[{"name":"College of Medicine Rockford, University of Illinois Chicago, Rockford, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesseca","family":"Pirkle","sequence":"additional","affiliation":[{"name":"College of Medicine Rockford, University of Illinois Chicago, Rockford, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3361-4805","authenticated-orcid":false,"given":"Annette","family":"Carmichael","sequence":"additional","affiliation":[{"name":"College of Medicine Rockford, University of Illinois Chicago, Rockford, Illinois, USA"},{"name":"Retzky College of Pharmacy, University of Illinois Chicago, Rockford, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Carlson-Dexter","sequence":"additional","affiliation":[{"name":"College of Medicine Rockford, University of Illinois Chicago, Rockford, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2606-2392","authenticated-orcid":false,"given":"Tony","family":"Rosella","sequence":"additional","affiliation":[{"name":"College of Medicine Rockford, University of Illinois Chicago, Rockford, Illinois, USA"},{"name":"Retzky College of Pharmacy, University of Illinois Chicago, Rockford, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"2025082708364666000_18.8.e266077.1","unstructured":"Ortiz NR , Preuss CV . 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