Attitudes towards a maintenance (-agonist) treatment approach in high-dose benzodiazepine-dependent patients: a qualitative study

Abstract

BackgroundHigh-dose benzodiazepine dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a benzodiazepine maintenance approach has been suggested as an alternative for patients’ failing discontinuation treatment. While there is some data supporting its effectiveness, patients’ perceptions of such an intervention have not been investigated.MethodsAn exploratory qualitative study was conducted among a sample of 41 high-dose benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings.ResultsParticipants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: “Only if I can try to discontinue…and please don’t call it that,” “More stability and less criminal activity…and that is why I would try it,” and “No cure, no brain and no flash…and thus, just for everybody else!”ConclusionsSome patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis

“…Recent emphasis on structural approaches to reduce the risk of initiation (78) has built on lessons gained from individual level approaches seeking to alter behavior, which may be constrained in their capacity to effectively reduce the potential for initiation (11). This review seeks to develop this emphasis further and we, therefore, explored the emergence of injecting within constraining and enabling contexts.…”

Activism and scientific research: 20 years of community action by the Vancouver area network of drug users

“…Based on our findings, it is not surprising that PWUDs and others have advocated for greater and more meaningful involvement for members of the DTES. This advocacy is based on legitimizing and valuing PWUDs contributions and expertise, and also to strengthen the inclusion of this community in decisions and actions that affect their lives [ 33 – 35 ].…”

Benzodiazepines Dependence: Addiction to Legally Prescribed Substances

“…The misuse and dependence of BZDs has become a serious health problem [6,59], clinically recognized [32], so it is a matter of general concern for health professionals, patients and regulators [3]. It is fundamental to understand, prevent and intervene in this problem [28], thus becoming the addictive behavior of modern times, alongside others.…”

“…Management and treatment of BZD dependence involves a gradual withdrawal of this substance, maintenance treatment by antagonist or agonist with equivalent long half-life dose, and/ or by psychological interventions [5,10,28,32]. However, until at least 2013, there was no validated treatment for BZD dependence [9].…”

“…However, although there are several therapeutic possibilities for its management and treatment [5,10,28,32], none have been particularly effective [9]. It should be added that many of the patients are not recognized or treated, which is disappointing [17].…”