“It could potentially be dangerous... but nothing else has seemed to help me.”: Patient and clinician perspectives on benzodiazepine use in opioid agonist treatment

Park, Tae Woo; Sikov, Jennifer; dellaBitta, Vanessa; Saitz, Richard; Walley, Alexander Y.; Drainoni, Mari-Lynn

doi:10.1016/j.jsat.2021.108455

Cited by 7 publications

(9 citation statements)

References 26 publications

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“…In qualitative interviews, many participants reported taking benzodiazepines with and without a prescription to manage their anxiety as well as to enhance the euphoric effects of MOUD, particularly methadone. Research shows that people with OUD often have comorbid mental health symptoms [49,50], and benzodiazepine use is commonly prescribed to treat anxiety, panic disorders, and even sleep disturbances among people with OUD [32,51]. Further, in prior qualitative research with people with a lifetime history of non-medical opioid use [33], participants reported using benzodiazepines with and without a prescription to manage their untreated mental health symptoms [32,33] and enhance the effects of opioids and other drugs [33].…”

Section: Discussionmentioning

confidence: 99%

“…Research shows that people with OUD often have comorbid mental health symptoms [49,50], and benzodiazepine use is commonly prescribed to treat anxiety, panic disorders, and even sleep disturbances among people with OUD [32,51]. Further, in prior qualitative research with people with a lifetime history of non-medical opioid use [33], participants reported using benzodiazepines with and without a prescription to manage their untreated mental health symptoms [32,33] and enhance the effects of opioids and other drugs [33]. Although the use of benzodiazepines together with illegal opioids and/or methadone or buprenorphine is associated with elevated risk for overdose [18,[26][27][28]52], and people on MOUD are often aware of these risks [32], national OUD treatment guidelines acknowledge that untreated OUD carries a greater risk of morbidity and mortality than does the co-use of benzodiazepines and MOUD and calls for clinicians to carefully manage these prescriptions [52][53][54].…”

Section: Discussionmentioning

confidence: 99%

“…Conclusions Findings highlight variations in continued drug use by MOUD use history, reasons for concurrent use, and implications for MOUD treatment delivery and continuity. health symptoms [32]. In another qualitative study of 46 people in New York City with a lifetime history of using prescription opioids for non-medical reasons, participants reported using benzodiazepines to both enhance the high of opioids and to self-manage their mental health concerns such as anxiety [33].…”

Section: Introductionmentioning

confidence: 99%

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Drug use patterns and factors related to the use and discontinuation of medications for opioid use disorder in the age of fentanyl: findings from a mixed-methods study of people who use drugs

Hughto

Tapper

Rapisarda

et al. 2023

Subst Abuse Treat Prev Policy

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Background Medications for opioid use disorder (MOUD; methadone, buprenorphine, naltrexone) are the most effective treatments for OUD, and MOUD is protective against fatal overdoses. However, continued illegal drug use can increase the risk of treatment discontinuation. Given the widespread presence of fentanyl in the drug supply, research is needed to understand who is at greatest risk for concurrent MOUD and drug use and the contexts shaping use and treatment discontinuation. Methods From 2017 to 2020, Massachusetts residents with past-30-day illegal drug use completed surveys (N = 284) and interviews (N = 99) about MOUD and drug use. An age-adjusted multinomial logistic regression model tested associations between past-30-day drug use and MOUD use (current/past/never). Among those on methadone or buprenorphine (N = 108), multivariable logistic regression models examined the association between socio-demographics, MOUD type; and past-30-day use of heroin/fentanyl; crack; benzodiazepines; and pain medications. Qualitative interviews explored drivers of concurrent drug and MOUD use. Results Most (79.9%) participants had used MOUD (38.7% currently; 41.2% past), and past 30-day drug use was high: 74.4% heroin/fentanyl; 51.4% crack cocaine; 31.3% benzodiazepines, and 18% pain medications. In exploring drug use by MOUD history, multinomial regression analyses found that crack use was positively associated with past and current MOUD use (outcome referent: never used MOUD); whereas benzodiazepine use was not associated with past MOUD use but was positively associated with current use. Conversely, pain medication use was associated with reduced odds of past and current MOUD use. Among those on methadone or buprenorphine, separate multivariable logistic regression models found that benzodiazepine and methadone use were positively associated with heroin/fentanyl use; living in a medium-sized city and sex work were positively associated with crack use; heroin/fentanyl use was positively associated with benzodiazepine use; and witnessing an overdose was inversely associated with pain medication use. Many participants qualitatively reported reducing illegal opioid use while on MOUD, yet inadequate dosage, trauma, psychological cravings, and environmental triggers drove their continued drug use, which increased their risk of treatment discontinuation and overdose. Conclusions Findings highlight variations in continued drug use by MOUD use history, reasons for concurrent use, and implications for MOUD treatment delivery and continuity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drug use patterns and factors related to the use and discontinuation of medications for opioid use disorder in the age of fentanyl: findings from a mixed-methods study of people who use drugs

Hughto

Tapper

Rapisarda

et al. 2023

Subst Abuse Treat Prev Policy

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“…These contradictory findings might be explained by the observation that patients sometimes learn how to use BZD as prescribed over the course of treatment. Whereas BZD use is more likely to start as BZD misuse in the initial OAT phase (e.g., to get a high), they are often used as intended in later treatment stages (e.g., to treat anxiety) leading to patients experiencing positive outcomes [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine use, quality of life and psychiatric symptom burden in oral and injectable opioid agonist treatment: a cross-sectional study

Meyer,

Gygli,

Westenberg

et al. 2023

Addict Sci Clin Pract

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Background Use of benzodiazepines (BZD) in patients receiving opioid agonist treatment (OAT) is common and associated with a variety of negative health and social outcomes. This cross-sectional study investigates the impact of BZD use in OAT patients on their quality of life (QoL). Methods A convenience sample of patients receiving oral OAT or heroin-assisted treatment in two outpatient centres in Basel, Switzerland was investigated. Participants (n = 141) completed self-report questionnaires on psychiatric symptoms and psychological distress (The Symptom Checklist 27, SCL-27), depressive state (German version of the Center for Epidemiological Studies Depression Scale), quality of life (Lancashire Quality of Life Profile, LQOLP) and use of BZD and other drugs (self-report questionnaire). Substance use was assessed by urine toxicology testing. Results In bivariate analysis, total QoL scores were significantly lower for lifetime, current, and prolonged BZD users compared to participants without the respective use patterns. There was no significant relationship between BZD dose and QoL. In multivariable linear regression models controlling for psychiatric symptom load and depressive state, only lifetime use predicted lower QoL, whereas other BZD use patterns were not significantly associated. Conclusions The association of lower QoL and BZD use in OAT patients is strongly confounded by co-occurring depressive state and psychiatric symptoms. Careful diagnosis and treatment of co-occurring mental disorders in OAT is paramount to improve QoL in this patient population and may also help reduce BZD use.

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“…There is, in many instances, also a discrepant view of benzodiazepine benefits and risks between some clinicians and patients. This view seems to exist to a certain level even in prescribing benzodiazepines with opioid agonist treatment, where patients and clinicians weigh the risks and benefits of benzodiazepines differently, and clinicians and patients may have different treatment goals [3].…”

mentioning

confidence: 99%

Who’s Afraid of Benzodiazepines?

Balon

2022

Psychother Psychosom

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“It could potentially be dangerous... but nothing else has seemed to help me.”: Patient and clinician perspectives on benzodiazepine use in opioid agonist treatment

Cited by 7 publications

References 26 publications

Drug use patterns and factors related to the use and discontinuation of medications for opioid use disorder in the age of fentanyl: findings from a mixed-methods study of people who use drugs

Drug use patterns and factors related to the use and discontinuation of medications for opioid use disorder in the age of fentanyl: findings from a mixed-methods study of people who use drugs

Benzodiazepine use, quality of life and psychiatric symptom burden in oral and injectable opioid agonist treatment: a cross-sectional study

Who’s Afraid of Benzodiazepines?

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