Benzodiazepine use among patients in heroin-assisted vs. methadone maintenance treatment: Findings of the German randomized controlled trial

Eiroá-Orosa, Francisco José; Haasen, Christian; Verthein, Uwe; Dilg, Christoph; Schäfer, Ingo; Reimer, Jens

doi:10.1016/j.drugalcdep.2010.06.013

Cited by 51 publications

(50 citation statements)

References 29 publications

(34 reference statements)

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“…MMT patients with BZD use disorders have an 8-fold likelihood of death compared to other MMT patients (11) and BZDs are also likely to contribute to deaths from methadone toxicity in patients receiving MMT (12, 13). In summary, BZD use disorders in MMT programs is widespread and is associated with a negative impact on treatment outcomes (14, 15). Despite the risk of BZD use problems on MMT patients, no clearly effective strategy for managing this clinical problem has been developed.…”

Section: Introductionmentioning

confidence: 99%

Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Mariani

Malcolm

Mamczur

et al. 2016

The American Journal of Drug and Alcohol Abuse

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Background Benzodiazepine (BZD) use disorders are a common clinical problem among methadone maintenance treatment patients and have adverse effects on clinical outcomes. Objectives To evaluate gabapentin for the outpatient treatment of BZD abuse or dependence in methadone maintenance patients. Methods Participants (n=19) using BZDs at least 4 days per week were enrolled into an eight-week randomized double-blind placebo-controlled outpatient pilot trial. All participants received a manual-guided supportive psychotherapy aimed to promote abstinence. Study medication was titrated over a two-week period to a maximum dose of gabapentin 1200 mg or placebo three times a day. BZD use was assessed using urine toxicology confirmed self-report. BZDs were not provided as part of study participation; participants were provided guidance to gradually reduce BZD intake. Results Sixteen participants had post-randomization data for analysis. Retention at week eight was 50%. The mean dose of gabapentin achieved by titration was 2666 mg/day (SD=±1446). There were no significant between group differences on BZD use outcomes (amount BZD per day (Mann-Whitney U = 27, p = .745), abstinent days per week (U = 28, p = .811)) and CIWA-BZD scale (U = 29.0, p = .913). One participant in the gabapentin group discontinued study medication because of peripheral edema. Two participants in the placebo group requested admission for inpatient detoxification treatment. Conclusion Gabapentin was not found to differ from placebo, although the small sample recruited for this trial may have limited the ability to detect a difference.

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Section: Introductionmentioning

confidence: 99%

Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Mariani

Malcolm

Mamczur

et al. 2016

The American Journal of Drug and Alcohol Abuse

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“…52 Compared with opioid abusers, concurrent users of BZDs and opioids take higher doses of the drugs for longer periods of time, are more likely to abuse additional substances (eg, alcohol), and are more likely to have a psychiatric comorbidity. 57–60 …”

Section: Clinical Managementmentioning

confidence: 99%

Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use

Gudin

Mogali

Jones

et al. 2013

Postgraduate Medicine

199

122

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The concurrent use of opioids, benzodiazepines (BZDs), and/or alcohol poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs and/or alcohol are at higher risk for fatal/nonfatal overdose and have more aberrant behaviors. Few practice guidelines for BZD treatment are readily available, especially when they are combined clinically with opioid analgesics and other central nervous system–depressant agents. However, coadministration of these agents produces a defined increase in rates of adverse events, overdose, and death, warranting close monitoring and consideration when treating patients with pain. To improve patient outcomes, ongoing screening for aberrant behavior, monitoring of treatment compliance, documentation of medical necessity, and the adjustment of treatment to clinical changes are essential. In this article, we review the prevalence and pharmacologic consequences of BZDs and/or alcohol use among patients with pain on chronic opioid therapy, as well as the importance of urine drug testing, an indispensable tool for therapeutic drug monitoring, which helps to ensure the continued safety of patients. Regardless of risk or known aberrant drug-related behaviors, patients on chronic opioid therapy should periodically undergo urine drug testing to confirm adherence to the treatment plan.

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“…In highly marginal patients, this represents an important opportunity for them to benefit from psychoeducation and to progressively lose contact with illicit drug using friends. In other studies, HAT is accompanied by significant decreases in both benzodiazepine and alcohol use [33,34]. This is probably due to the fact that patients must be alcohol-free and benzodiazepine-free on screening prior to heroin injection.…”

Section: Heroin-assisted Maintenance Treatment (Hat)mentioning

confidence: 96%

Pharmacological Treatments of Opiate Dependence

Benyamina¹,

Reynaud²,

Blecha³

et al. 2011

CPD

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Opiate substitution therapies have largely contributed to improving outcomes in opiate dependent patients. Their impact has significantly diminished HIV transmission rates, decreased incidence of overdose and reduced delinquency due to heroin trafficking. Since then, some advances have been made in the formulations and dosing regimen of these treatments. They have also largely facilitated opiate withdrawal. However, concerning the maintenance of opiate abstinence, very few new treatments have been proposed. Despite considerable advances in our knowledge of the neurobiological mechanisms of opiate dependence, few clinical trials have been proposed to test new molecules both in accompanying opiate substitution and in maintaining abstinence from illicit opiate use. The objective of this article is to examine the evidence concerning the treatment of opiate dependent patients, especially new treatments and to examine the eventual gaps between currently knowledge, available treatment and demands.

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Benzodiazepine use among patients in heroin-assisted vs. methadone maintenance treatment: Findings of the German randomized controlled trial

Abstract: Benzodiazepine (BZD) use has been found to be associated with poorer psychosocial adjustment, higher levels of polydrug use and more risk-taking behaviors among opioid

Cited by 51 publications

References 29 publications

Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use

Pharmacological Treatments of Opiate Dependence

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