Nonmedical use of benzodiazepines and Z‐drugs in the UK

Abstract

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.

Misuse of prescription and over-the-counter drugs to obtain illicit highs: how pharmacists can prevent abuse

“…Problematic use of hypnotic drugs has been described in male and young recreational users of high-dose drugs. They are often abused with other licit/illicit drugs via intranasal/intravenous administration [74]. A second abusing population was studied and comprised long-term users, including patients with comorbidities of mood/neurotic disorders and SUDs, and older people using Z-drug hypnotics to treat insomnia and were then unable to cut down the dosages needed to manage withdrawal symptoms [75][76].…”

Measuring prescription opioid misuse and its consequences

“…Finally, data from drug diversion investigators also indicate that IR formulations are the most common products sold on the street. 20 One surprise is that, in many countries, the manufacturers of misused generic prescription medications are often not required to perform effective postmarketing surveillance. This may seem illogical, but the generic product manufacturers are generally required to collect minimal data such as spontaneously reported adverse events.…”

“…This makes sense until one considers that Percocet has <5% of the market and research shows that it is primarily generic products that are misused. 20 The assumption that generic and branded pharmaceuticals is untenable in this instance because populations are likely to differ in meaningful ways (e.g. race, income, comorbidities) between those prescribed branded vs. generic products.…”

“…Data from poison centres indicates that the vast majority of cases involve IR formulations (Figure 5). Finally, data from drug diversion investigators also indicate that IR formulations are the most common products sold on the street 20 …”

Nonmedical use of prescription drugs

“…Hockenhull report data gathered from the UK survey of NMU of prescription drugs programme (NMURx), which is part of the Research Abuse, Diversion and Addiction Related Surveillance (RADARS®) System. 10 The authors report interesting findings with respect to the misuse of these drugs, both alone and in combination with other drugs of abuse such as opioids and how the average user actually acquires these drugs. Finally, these authors also report data on the abuse of benzodiazepines and GABA analogues in various European countries using the NMURx survey from France, Germany, Italy, Spain, and the United Kingdom.…”