Benzodiazepine Use in Opioid Maintenance Treatment Programme: Risks and Clinical Outcomes

Abstract

Introduction: The co-association of benzodiazepines and opioids is associated with an increased risk of overdose, death, and poorer psychosocial prognosis. The aim of this study is to characterize the prevalence, pattern of use, and primary clinical outcomes in benzodiazepines users in a public opioid maintenance treatment unit.Material and Methods: We conducted a cross-sectional study involving 236 patients treated with opioid substitutes (methadone and buprenorphine). We conducted a descriptive, bivariable, and multivariable analysis to determine clinical differences between benzodiazepines users and non-users.Results: The prevalence of consumption of benzodiazepines was 25.4% (60). The benzodiazepines were obtained with a medical prescription (49.8%) or on the black market (42.6%). The most prescribed benzodiazepine was diazepam (29.1%), and the main reasons were to relieve insomnia (27.7%) or anxiety (26.9%) and to enhance the psychoactive effects of other drugs (19.7%). Regarding the clinical outcomes, we highlight: a very high prevalence of hepatitis C (51.7%); severe ongoing consumption of psychoactive drugs (73.7%); and a high rate of depression and anxiety (> 60%), significantly higher in the benzodiazepines-user group. In the multivariable analysis of benzodiazepine use, we found alcohol consumption (OR 0.482; IC 95% 0.247, 0.238) had a negative association and having hepatitis C (OR 2.544, IC 95% 1.273, 5.084) or anxiety symptoms (OR 5.591; IC 95% 2.345, 13.326) had positive associations.Discussion: Our results suggest the BZD users had a complex drug addiction problem and underline the importance of adequately addressing BZD use, contemplating psychological and psychiatric approach in this particular population.Conclusion: Past or current use of benzodiazepines is associated with poor clinical and psychiatric outcomes. A multidisciplinary approach with a focus on infectious diseases and mental health is critical in order to enhance the treatment effectiveness and overall prognosis.

Potentially Inappropriate Medication Prescribing in Older Adults According to EU(7)-Potentially Inappropriate Medication List: A Nationwide Study in Portugal

“…13 However, because this pharmacological group is dependent on the duration of treatment, it was excluded from this analysis. The same methodology has been applied to some widely prescribed benzodiazepines 65 that are dose-dependent PIM, suggesting that the results presented here may have been underestimated and there is a chance that the number of PIMs prescribed to older adults could be larger than reported in this study. Another limitation is related to the fact that the data available in this database do not allow for the correlation of the possibility of the use of PIMs being associated with a certain pathology or with the occurrence of a certain adverse drug reactions.…”

Characterising incident opioid use among incident users of prescription sedative hypnotics: A national cohort study

“…4 This risk is greatly heightened when taken with other medications that cause respiratory depression such as opioids. [5][6][7][8][9] Benzodiazepines have been the focus of research related to the harm of coprescribing sedatives and opioids, but it is important to note that all three classes of sedative hypnotics…”

Anhedonia modulates benzodiazepine and opioid demand among persons in treatment for opioid use disorder

“…For example, BZD use and misuse is more common among women than men (26,35), whites than other racial/ethnic groups (36), and among injection opioid users (26,37); notably, the latter two factors are correlated, as some prior research has found opioid injectors are more likely to be white than black (38)(39)(40). Finally, several types of comorbidities can potentially modulate BZD/opioid use including anxiety-related symptoms/diagnoses (41)(42)(43), and sleep problems (9,44,45). A common assumption is that exaggerated negative affect plays a pivotal role in motivating BZD use to "self-medicate" anxious or depressive symptoms [i.e., negative reinforcement; (46)], however, this may not be the only functional relationship between psychiatric conditions and the reinforcing effects of BZDs.…”