Concurrent Use of Benzodiazepine by Heroin Users—What Are the Prevalence and the Risks Associated with This Pattern of Use?

Yamamoto, Takahiro; Dargan, Paul I.; Dines, Alison; Yates, Chris; Heyerdahl, Fridtjof; Hovda, Knut Erik; Giraudon, Isabelle; Sedefov, Roumen

doi:10.1007/s13181-018-0674-4

Cited by 12 publications

(16 citation statements)

References 25 publications

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“…35,36 Data from the Euro-DEN dataset is collected from sentinel centres rather than all emergency departments across the countries, although they are primarily located in large cities that are associated with high-levels of recreational drug use. 37 There was variability in number of tramadol related acute toxicity related presentations across the Euro-DEN Plus centres with clustering of cases in certain countries. These presentations potentially pose a significant burden on EDs with a large proportion requiring admission to hospital for ongoing care.…”

Section: Discussionmentioning

confidence: 99%

Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus

Layne

Dargan

Dines

et al. 2020

Brit J Clinical Pharma

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Following the development of the tramadol crisis currently affecting countries in the Middle East, and Africa, there has been increasing international interest in the regulation of tramadol. This study investigates the misuse of tramadol in patients presenting to emergency departments across Europe. Data from 32 emergency departments in 21 countries were extracted from the Euro-DEN Plus database for the 4-year period from 1 January 2014 to 31 December 2017. Of the reported 24,957 emergency department presentations, tramadol misuse was reported in 105 (0.4% presentations). Tramadol misuse was most common in Bratislava (Slovakia; n = 11, 7.5% of all presentations to this centre), Riga (Latvia; n = 4, 4.9%) and Munich (Germany; n = 17, 2.9%). On arrival, 14 (13.3%) of presentations were in coma/Glasgow coma score ≤ 8 and 9 of these had a respiratory rate <12 breaths/min. These presentations potentially pose a significant burden on emergency departments with a large proportion requiring admission to hospital for ongoing care.

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Section: Discussionmentioning

confidence: 99%

Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus

Layne

Dargan

Dines

et al. 2020

Brit J Clinical Pharma

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“…[32][33][34] Combining opioids and sedatives increases the risk of respiratory depression, overdose and death. 7,8,35 While data regarding co-use of Z-drugs and prescription opioids are limited, it has been suggested that the main attractions of zopiclone for drug users is that, unlike benzodiazepines, they do not cause amnesia and may not be detected during standard illicit drug screening. 36,37 Acquisition of benzodiazepines/Z-drugs for NMU was more common without a prescription than with a prescription and obtaining the drugs from family/friends was the most common source of acquisition for both drug groups.…”

Section: Discussionmentioning

confidence: 99%

“…6 Also, a cause for concern is concurrent use of benzodiazepines by heroin users and increased risk of emergency department visits, overdose and death. 7,8 The available data suggest that benzodiazepines encountered on the illicit drug market are primarily diverted from legitimate sources rather than being counterfeit medicines and that diversion can occur at all points along the pharmaceutical supply pathway from manufacturing sites and distributors to patients themselves. 4 A 2016 report by the UK Advisory Council on the Misuse of Drugs on Diversion and Illicit Supply of Medicines found that within the UK the most prevalent diverted drugs are opioids and benzodiazepines, with benzodiazepines and Z-drugs being the most common medicines illegally diverted from the regulated supply chain.…”

Section: Introductionmentioning

confidence: 99%

Nonmedical use of benzodiazepines and Z‐drugs in the UK

Hockenhull

Black

Haynes

et al. 2020

Brit J Clinical Pharma

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To estimate prevalence of last 12-month nonmedical use (NMU) of benzodiazepines and Z-drugs (the nonbenzodiazepine hypnotics zaleplon, zolpidem and zopiclone) in the UK. Methods: Data were collected using the Non-Medical Use of Prescription Drugs survey with poststratification weighting applied to be representative of the UK population (≥16 years). Participants were questioned about whether they had nonmedically used benzodiazepines and/or Z-drugs in the last 12-months and from where they had obtained the drug (including via a prescription, or illicitly from a friend/family member, a dealer or via the internet). Additional questions were asked about last 12-month use of illicit drugs (cannabis, cocaine, 3,4-methylenedioxymethylamphetamine [MDMA], non-pharmaceutical amphetamine, crack cocaine and/or heroin). Results: The study included 10 006 eligible participants representing approximately 52 927 000 UK adults. The estimated prevalence of past 12-month NMU of any benzodiazepine and/or Z-drug was 1.2% (95% confidence interval: 1.0-1.5) corresponding to approximately 635 000 adults; amongst this group only an estimated 4.6% (1.2-8.0) had NMU of both a benzodiazepine and a Z-drug. The highest prevalence of NMU for only Z-drugs was among those who had used heroin in the last 12-months (5.4%, 2.7-10.5), whilst the highest prevalence of NMU for only benzodiazepines was among those who had used illicit stimulants in the last 12-months: cocaine (5.9%, 3.8-8.9), amphetamine (5.6%, 3.1-10.0) and MDMA (5.2%, 3.1-8.8). The drug non-medically used was more commonly acquired without than with a prescription for both only benzodiazepines (70.2%, 59.4-81.1 compared to 51.3%, 41.5-64.6) and only Z-drugs (75.6%, 61.6-89.7 compared to 33.9%, 16.9-51.0). Conclusion: There is little overlap between benzodiazepine and Z-drug NMU suggesting distinct nonmedical use of the drugs; future studies need to explore whether this relates to personal preference, drug availability or other factors. A significant proportion are acquiring these drugs for NMU without a prescription, so without guidance and monitoring from a medical practitioner. While the dangers of mixing benzodiazepines and heroin/other opioids are well documented, there is a The authors confirm that the PI for this paper is Paul I. Dargan and that he had direct clinical responsibility for patients.

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“…There is an increasing problem with high dose BZD dependence both internationally and in Dublin ( Darker, Sweeney, Barry & Farrell, 2015 ; Yamamoto et al., 2019 ). Up to 66% of patients on OST misuse BZDs ( Nielsen, Dietze, Lee, Dunlop & Taylor, 2007 ).…”

Section: Bzd Maintenancementioning

confidence: 99%

Harm reduction in the time of COVID-19: Case study of homelessness and drug use in Dublin, Ireland

O'Carroll¹,

Duffin²,

Collins

2021

International Journal of Drug Policy

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Dublin appears to have performed very well as compared to various scenarios for COVID-19 mortality amongst homeless and drug using populations. The experience, if borne out by further research, provides important lessons for policy discussions on the pandemic, as well as broader lessons about pragmatic responses to these key client groups irrespective of COVID-19. The overarching lesson seems that when government policy is well coordinated and underpinned by a science-driven and fundamentally pragmatic approach, morbidity and mortality can be reduced. Within this, the importance of strategic clarity and delivery, housing, lowered thresholds to methadone provision, Benzodiazepine (BZD) provision and Naloxone availability were key determinants of policy success. Further, this paper argues that the rapid collapse in policy barriers to these interventions that COVID-19 produced should be secured and protected while further research is conducted.

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Concurrent Use of Benzodiazepine by Heroin Users—What Are the Prevalence and the Risks Associated with This Pattern of Use?

Abstract: This study shows that co-use of heroin and benzodiazepines is common, although the overall outcomes between co-users of heroin and benzodiazepines and heroin-only users were similar.

Cited by 12 publications

References 25 publications

Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus

Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus

Nonmedical use of benzodiazepines and Z‐drugs in the UK

Harm reduction in the time of COVID-19: Case study of homelessness and drug use in Dublin, Ireland

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