Interactions of benzodiazepines with heroin: Respiratory depression, temperature effects, and behavior

Afzal, Anum; Kiyatkin, Eugene A.

doi:10.1016/j.neuropharm.2019.107677

Cited by 22 publications

(10 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both benzodiazepines and opioids inhibit respiration so that the effects of the combination may be additive. Although mechanisms underlying this interaction have not been elucidated, in animal models pretreatment of a benzodiazepine potentiated opioid-induced brain hypothermia, but not hypoxia, whereas co-administration of the two potentiated the opioid-induced decrease in oxygen levels in brain [ 82 ].…”

Section: Neuroscience Studiesmentioning

confidence: 99%

Polysubstance use in the U.S. opioid crisis

2020

View full text Add to dashboard Cite

Interventions to address the U.S. opioid crisis primarily target opioid use, misuse, and addiction, but because the opioid crisis includes multiple substances, the opioid specificity of interventions may limit their ability to address the broader problem of polysubstance use. Overlap of opioids with other substances ranges from shifts among the substances used across the lifespan to simultaneous co-use of substances that span similar and disparate pharmacological categories. Evidence suggests that nonmedical opioid users quite commonly use other drugs, and this polysubstance use contributes to increasing morbidity and mortality. Reasons for adding other substances to opioids include enhancement of the high (additive or synergistic reward), compensation for undesired effects of one drug by taking another, compensation for negative internal states, or a common predisposition that is related to all substance consumption. But consumption of multiple substances may itself have unique effects. To achieve the maximum benefit, addressing the overlap of opioids with multiple other substances is needed across the spectrum of prevention and treatment interventions, overdose reversal, public health surveillance, and research. By addressing the multiple patterns of consumption and the reasons that people mix opioids with other substances, interventions and research may be enhanced.

show abstract

Section: Neuroscience Studiesmentioning

confidence: 99%

Polysubstance use in the U.S. opioid crisis

2020

View full text Add to dashboard Cite

show abstract

“…Concomitant use of prescribed medication was also common, including opioid substitutes, anxiolytics and antidepressants. Medication with sedating profiles were often prescribed and used with alcohol and other substances which may also cause drowsiness and respiratory depression [ 33 , 34 ]. Evaluation of the technology employed in drug checking and detailed analysis of supplied drug samples will be discussed in a subsequent paper (in preparation).…”

Section: Resultsmentioning

confidence: 99%

Piloting the UK’s First Home-Office-Licensed Pharmacist-Led Drug Checking Service at a Community Substance Misuse Service

Guirguis

Gittins²,

Schifano

2020

Behavioral Sciences

View full text Add to dashboard Cite

(1) Introduction: Drug-related deaths in the UK are at concerning high levels. The unknown content and purity of illicit substances can cause unpredictable adverse effects and thus a public health risk with no sign of abating. On-site drug checking is a public health strategy that has previously been implemented, predominantly in festival settings, but without Home Office licensing. (2) Aims: The aim of this study was to pilot the UK’s first pharmacist-led, Home Office-licensed community drug checking service. (3) Methods: A bespoke protocol incorporating legally, professionally and ethically binding documents was implemented. This free, confidential service ran between February and March 2019, was available to anyone over 18 who were purposefully recruited, gave informed consent and agreed to relinquish their drug sample. Samples were checked on-site within an established Substance Misuse Service (SMS) using a handheld Raman spectrometer to determine likely drug content and adulterants. In parallel, participants completed a questionnaire about their substance use and the drug sample(s) being tested. A pharmacist-led multidisciplinary approach was adopted to discuss the analytical findings. Informed by the results of the analysis and the questionnaire, people who used the service received tailored harm reduction advice. (4) Results and Discussion: The pilot operated for a total of four days over four weeks. Eleven people visited and relinquished a total of thirteen samples. Half of the participants had previously overdosed and were known to the SMS. Seventy per cent were male, all were White British individuals, 30% were employed and two people disclosed visiting from another nearby town. Samples included what was thought to be heroin, synthetic cannabinoids, stimulants, benzodiazepines and LSD and none required activation of the “alerts cascade” process. Most participants drank alcohol regularly and the concomitant use of traditional illicit drugs and prescribed medication (including opioids, anxiolytics and antidepressants) with sedating profiles was common. Given some of the ethical decisions and interpretation of the results, specialist pharmacist involvement was deemed essential. (5) Conclusions: This pilot demonstrated the proof-of-concept that a pharmacist-led Home Office-licensed drug checking service can be successfully implemented in community SMSs.

show abstract

“…Additionally, these findings should not be interpreted as advocacy for the indiscriminate prescription of benzodiazepines during MAT. Interactions between opioids and benzodiazepines may increase the likelihood of death due to respiratory depression [ 38 ]. Furthermore, while studies found no effect of prescription benzodiazepine on MAT treatment, they also demonstrated a concomitant increase in the likelihood of accidental injuries, ED visits, as well as issues with physical dependence [ 20 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with opioid overdose during medication-assisted treatment: How can we identify individuals at risk?

Rosic

Sanger

et al. 2021

Harm Reduct J

View full text Add to dashboard Cite

Background Due to the loss of tolerance to opioids during medication-assisted treatment (MAT), this period may represent a time of heightened risk for overdose. Identifying factors associated with increased risk of overdose during treatment is therefore paramount to improving outcomes. We aimed to determine the prevalence of opioid overdoses in patients receiving MAT. Additionally, we explored factors associated with opioid overdose during MAT and the association between length of time enrolled in MAT and overdose. Methods Data were collected prospectively from 2360 participants receiving outpatient MAT in Ontario, Canada. Participants were divided into three groups by overdose status: no history of overdose, any lifetime history of overdose, and emergency department visit for opioid overdose in the last year. We used a multivariate multinomial regression model to assess demographic and clinical factors associated with overdose status. Results Twenty-four percent of participants reported a lifetime history of overdose (n = 562), and 8% reported an emergency department (ED) visit for opioid overdose in the last year (n = 179). Individuals with a recent ED visit for opioid overdose were in treatment for shorter duration (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.87, 0.97, p = 0.001). Individuals with a lifetime or recent history of overdose were more likely to be younger in age (OR 0.93, 95% CI 0.89, 0.98, p = 0.007 and OR 0.84, 95% CI 0.77, 0.92, p < 0.001, respectively), report more physical symptoms (OR 1.02, 95% CI 1.01, 1.03, p = 0.005 and OR 1.03, 95% CI 1.01, 1.05, p = 0.005, respectively), and had higher rates of non-prescription benzodiazepine use (OR 1.87, 95% CI 1.32, 2.66, p < 0.001 and OR 2.34, 95% CI 1.43, 3.81, p = 0.001, respectively) compared to individuals with no history of overdose. Conclusions A considerable number of patients enrolled in MAT have experienced overdose. Our study highlights that there are identifiable factors associated with a patient’s overdose status that may represent areas for intervention. In particular, longer duration in MAT is associated with a decreased risk of overdose.

show abstract

Interactions of benzodiazepines with heroin: Respiratory depression, temperature effects, and behavior

Cited by 22 publications

References 34 publications

Polysubstance use in the U.S. opioid crisis

Polysubstance use in the U.S. opioid crisis

Piloting the UK’s First Home-Office-Licensed Pharmacist-Led Drug Checking Service at a Community Substance Misuse Service

Factors associated with opioid overdose during medication-assisted treatment: How can we identify individuals at risk?

Contact Info

Product

Resources

About