Risk factors associated with benzodiazepine use among people who inject drugs in an urban Canadian setting

Abstract

Background Though known to have abuse potential, benzodiazepine medications remain widely prescribed. Furthermore, issues related to benzodiazepine use by people who inject drugs (PWID) remain to be fully characterized. We therefore sought to examine the prevalence of and risk factors associated with benzodiazepine use in a street-involved urban population. Methods Between May 1996 and November 2013, data were derived from two open prospective cohort studies in Vancouver, Canada, restricted to PWID. Multivariable logistic regression with generalized estimating equations (GEE) was used to determine factors independently associated with benzodiazepine use. Results Over the study period, 2806 individuals were recruited, including 949 (34%) women. Of these, 1080 (38.5%) participants reported benzodiazepine use at least once during the study period. In the multivariable analysis, Caucasian ethnicity, ≥ daily heroin injection, ≥ daily cocaine injection, non-fatal overdose, incarceration, syringe sharing, and unsafe sex were all independently associated with benzodiazepine use. Conversely, older age, homelessness, and ≥ daily crack smoking were negatively associated with benzodiazepine use. Conclusions Use of benzodiazepines was common in this urban setting and was associated with several markers of addiction severity and significant health and social vulnerabilities including syringe sharing and unsafe sex. These findings underscore the need to promote treatment for benzodiazepine use, safer benzodiazepine prescribing, including greater recognition of the limited indications for evidence-based use of this medication class.

High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City

“…Other studies also indicate a benzodiazepine-using population that engages in polysubstance use (Kurtz et al, 2011; Tucker et al, 2016) and is largely non-Hispanic White (Chen et al, 2011; McCabe, 2005; McCabe & West, 2014). …”

Prevalence and correlates of benzodiazepine use and misuse among young adults who use prescription opioids non-medically

“…For those who misuse opioids, benzodiazepine use has been associated with being white (Cropsey et al, 2015; Tucker et al, 2016); being female (Cropsey et al, 2015; Stein et al, 2017b); older age (Stein et al, 2017b); and incarceration history (Tucker et al, 2016). Non-medical benzodiazepine use has been associated with screening positive for anxiety, depression, and other mental health concerns in this population (Chen et al, 2011; Lavie et al, 2009).…”

Tranquilizer misuse among active cocaine users: Predictors of initiation

“…The variables considered as potential predictors of TM initiation were selected based on the literature [11,13,18,19,[21][22][23][24][25][26][27][28].Potential factors explored were age (older individuals defined as >25-years-old vs. younger ones) [32], sex, country of origin (born in Canada vs. outside) and education (high school completed vs.non-completed). Main residential status (homelessness vs. stable residence), having a criminal activity as the main source of income (i.e.…”

“…Among persons who use drugs (PWUD), research on the use of tranquilizers has mainly concentrated on benzodiazepines. Studies have shown that benzodiazepine use (including misuse) is widespread among opiate users, including methadone-maintained individuals and active heroin users [6][7][8][9][10][11][12], persons who inject drugs (PWID) [13][14][15][16][17][18] and amphetamine users [19]. In Canada, data from the I-Track surveillance system reveals that between 2005 and 2008, 35.2% of PWID had used benzodiazepines by non-injection route of administration in the 6 months prior to the interview [20].…”

“…Studies have also identified risk behaviours and negative health outcomes associated with benzodiazepine use among PWUD and PWID, but most did not indicate whether they examined misuse specifically. Those behaviours and outcomes included drug dependence, addiction severity, polydrug use, fatal and non-fatal overdose, risky sexual behaviours, poorer psychosocial functioning and mental health problems such as anti-social personality disorder, anxiety, depression and psychological distress [13,18,19,[21][22][23][24][25][26]. PWID who used benzodiazepines were more likely to report HIV and hepatitis C virus risk-taking behaviours, share injecting equipment more frequently and with more people, as well as inject more frequently [9,13,14,18,27,28].…”