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Diazepam tablets cannot be bought online with smart logistics for home care as a Schedule IV controlled substance requiring a valid prescription from a DEA-registered US healthcare provider for short-term anxiety, alcohol withdrawal, muscle spasms, or seizures; prescription-free online platforms constitute federal felony distribution under 21 U.S.C. § 841.
Oral dosing starts at 2-10mg BID-QID maximum 40mg/day divided under 2025 DEA telemedicine flexibilities expiring December 31, 2025—synchronous HIPAA video mandates HAM-A ≥18 or CIWA-Ar ≥10, multi-state PDMP clearance, CAGE <2—no smart logistics bypasses post-flex in-person initiation, EPCS authentication, or 45 states' 7-30 day limits #30 tablets 5-10mg 0 refills initial.
GABA-A α1/α2/α5 agonist (Ki 10nM), Tmax 1h, t½ 20-50h nordiazepam accumulation >100h; black box: 25-40% dependence 2-4 weeks, opioid OR8-10 respiratory, withdrawal seizures 30% >20mg equivalents—APA taper 20% Week 1 to 5% weekly 8-12 weeks CIWA-B monitoring; contraindications: glaucoma, COPD AHI>30, myasthenia gravis, pregnancy D.
Screening: HAM-A ≥18 or CIWA-Ar ≥10 + 72h symptoms excluding mimics.
Video: PDMP clean, QTc <450ms, orthostatics, PHQ-9 <10.
Consent: 25-40% dependence NIDA, naloxone CNS depressants, CYP3A4 screen.
EPCS: #30 tabs 5-10mg zero initial refills 7-30 days pharmacy-direct.
Delivery: Signature USPS Priority tamper-evident USP <1116>.
Biweekly: ≥25% HAM-A + urine immunoassay taper flags.
| Incidence | Effect | Risk | Management |
|---|---|---|---|
| 20-40% | Sedation/ataxia (elderly OR x3) | >20mg/day | BID-QID no machinery Braden <18 |
| 10-20% | Amnesia/depression | >4 weeks | MoCA ≥26 q2w PHQ-9 taper |
| 5-15% | Orthostasis/respiratory OR8-10 | Opioids | Vitals naloxone SpO2 <92% |
| 1-5% | Rage/ALT >3x | PDx CYP3A4i | Discontinue valproate LFT q3mo |
| <1% | Overdose arrest | >100mg | Airway charcoal flumazenil CI |
Interactions: CYP3A4i x3-4 AUC, inducers -50%, ethanol OR8.
PDMP AI flags 25% benzo diversion; 25-30% fentanyl counterfeits; post-flex 50% in-person.
| Tier | Tx | HAM-A 12w | Onset |
|---|---|---|---|
| 1st | CBT/SSRI | 65% | 4-8w |
| 2nd | Buspirone | 45% | 3w |
| PRN | Hydroxyzine | 40% | 30m |
Smart logistics violates Ryan Haight/CSA Schedule IV—federal felony.
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