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Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend 2019; 200:95-114. [PMID: 31121495 PMCID: PMC6639084 DOI: 10.1016/j.drugalcdep.2019.02.033] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. METHODS PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. RESULTS The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. CONCLUSIONS Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
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Affiliation(s)
- Victoria R. Votaw
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA,Corresponding author: Victoria R. Votaw, Clinical Psychology Ph.D. Student Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, Albuquerque, NM 87131,
| | - Rachel Geyer
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Maya M. Rieselbach
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
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Marel C, Sunderland M, Mills KL, Slade T, Teesson M, Chapman C. Conditional probabilities of substance use disorders and associated risk factors: Progression from first use to use disorder on alcohol, cannabis, stimulants, sedatives and opioids. Drug Alcohol Depend 2019; 194:136-142. [PMID: 30439610 DOI: 10.1016/j.drugalcdep.2018.10.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/09/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Relatively little is known about factors that may lead to the development of a substance use disorder (SUD), across a range of drug classes. This study aimed to identify factors that predict the likelihood of transition from use to SUD and the speed with which this may occur at the population level, with a focus on the impact of pre-existing mental disorders. METHODS Data were collected as part of the 2007 Australian National Survey of Mental Health and Wellbeing, a nationally representative survey of 8841 Australian adults. A series of discrete time survival analyses were undertaken on data pertaining to the age of onset of use and symptoms of use disorder, for alcohol, cannabis, sedatives, stimulants, and opioids, as well as the impact of pre-existing mood and anxiety disorders on the likelihood of developing a SUD. RESULTS Lifetime cumulative probability estimates indicated that 50.4% of stimulant, 46.6% of opioid, 39% of sedative, 37.5% of alcohol, and 34.1% of cannabis users would develop a SUD on those substances, within an estimated 14, 12, 8, 30, and 23 years after onset respectively. Pre-existing mental disorders were significantly associated with increased risk of developing a SUD for alcohol, cannabis and stimulant use disorder. CONCLUSION The relative speed associated with the transition from use to SUD emphasizes the narrow window of time available to intervene, underscoring the urgency of early identification of mental health conditions and the timely provision of appropriate evidence-based interventions, which could potentially prevent the development of secondary SUDs.
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Affiliation(s)
- Christina Marel
- National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, NSW 2052, Sydney, Australia.
| | - Matthew Sunderland
- National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, NSW 2052, Sydney, Australia
| | - Katherine L Mills
- National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, NSW 2052, Sydney, Australia
| | - Tim Slade
- National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, NSW 2052, Sydney, Australia
| | - Maree Teesson
- National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, NSW 2052, Sydney, Australia
| | - Cath Chapman
- National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, NSW 2052, Sydney, Australia
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Novel Synthetic Opioids: The Pathologist's Point of View. Brain Sci 2018; 8:brainsci8090170. [PMID: 30200549 PMCID: PMC6162684 DOI: 10.3390/brainsci8090170] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 02/03/2023] Open
Abstract
Background: New Psychoactive Substances (NPS) constitute a broad range of hundreds of natural and synthetic drugs, including synthetic opioids, synthetic cannabinoids, synthetic cathinones, and other NPS classes, which were not controlled from 1961 to 1971 by the United Nations drug control conventions. Among these, synthetic opioids represent a major threat to public health. Methods: A literature search was carried out using public databases (such as PubMed, Google Scholar, and Scopus) to survey fentanyl-, fentanyl analogs-, and other synthetic opioid-related deaths. Keywords including “fentanyl”, “fentanyl analogs”, “death”, “overdose”, “intoxication”, “synthetic opioids”, “Novel Psychoactive Substances”, “MT-45”, “AH-7921”, and “U-47700” were used for the inquiry. Results: From our literature examination, we inferred the frequent implication of fentanyls and synthetic opioids in side effects, which primarily affected the central nervous system and the cardiovascular and pulmonary systems. The data showed a great variety of substances and lethal concentrations. Multidrug-related deaths appeared very common, in most reported cases. Conclusions: The investigation of the contribution of novel synthetic opioid intoxication to death should be based on a multidisciplinary approach aimed at framing each case and directing the investigation towards targeted toxicological analyses.
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Yamamoto T, Dargan PI, Dines A, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Sedefov R, Wood DM. Concurrent Use of Benzodiazepine by Heroin Users-What Are the Prevalence and the Risks Associated with This Pattern of Use? J Med Toxicol 2018; 15:4-11. [PMID: 30066312 DOI: 10.1007/s13181-018-0674-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Polydrug use involving heroin and benzodiazepines is common. The potential risk of additive pharmacological effects may be associated with poorer outcomes in patients who use benzodiazepines together with heroin. The aim of this study was to determine the clinical picture of patients presenting to the emergency department following acute drug toxicity involving heroin and benzodiazepines. METHODS Exposure information, clinical data and outcome of acute drug toxicity presentations were collected between 1 October 2013 and 30 September 2014 as part of the European Drug Emergencies Network (Euro-DEN) project. The database was interrogated to identify patients who had taken heroin with or without benzodiazepine(s). RESULTS A total of 1345 presentations involving acute heroin toxicity were identified: 492 had used one or more non-heroin/benzodiazepine drug and were not further considered in this study; 662 were lone heroin users and 191 had co-used heroin with one or more benzodiazepines. Co-users were more likely than lone heroin users to have reduced respiratory rate at presentation 12.7 ± 4.9 vs 13.6 ± 4.4 (p = 0.02) and require admission to hospital 18.3 vs 9.8% (p < 0.01). There were no differences in critical care admission rates 3.1 vs 3.9% (p = 0.83) or length of stay 4 h 59 min vs 5 h 32 min (p = 0.23). The 3 most common benzodiazepines were clonazepam, diazepam, and alprazolam. No differences were observed for clinical features between the three benzodiazepines. CONCLUSION This study shows that co-use of heroin and benzodiazepines is common, although the overall outcomes between co-users of heroin and benzodiazepines and heroin-only users were similar.
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Affiliation(s)
- T Yamamoto
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - P I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - C Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain
| | - F Heyerdahl
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - K E Hovda
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - I Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - R Sedefov
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - D M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. .,Faculty of Life Sciences and Medicine, King's College London, London, UK.
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Palamar JJ, Le A, Mateu-Gelabert P. Not just heroin: Extensive polysubstance use among US high school seniors who currently use heroin. Drug Alcohol Depend 2018; 188:377-384. [PMID: 29880271 PMCID: PMC6198323 DOI: 10.1016/j.drugalcdep.2018.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heroin-related deaths are on the rise in the US and a large portion of heroin overdoses involve co-use of other drugs such as benzodiazepines. A better understanding of heroin polysubstance use patterns could help discern better prevention measures. METHODS Data were examined from past-month ("current") heroin users from a nationally representative sample of high school seniors in the Monitoring the Future study (2010-2016, n = 327). We examined how past-month use and frequency of use of various drugs relate to frequency of current heroin use using chi-square and multivariable ordinal logistic regression. RESULTS Prevalence of any past-month use of various other drugs (and past-month use 10+ times) tends to increase as the frequency of heroin use increases; however, other drug use tends to decline among those reporting the use of heroin 40+ times in the past month. In multivariable models controlling for demographic characteristics, most levels of alcohol use were associated with decreased odds of higher-frequency heroin use (ps<.05). Nonmedical opioid (aOR = 5.84, p = .037) and tranquilizer (aOR = 14.63, p = .045) use 40+ times in the past month were associated with increased odds of higher-frequency heroin use. CONCLUSIONS High school seniors who use heroin also use multiple other drugs. Increases in the frequency of heroin use are associated with shifts in the nature and frequency of polysubstance use, with a higher frequency of heroin use associated with the highest percentage and frequency of use of depressants (nonmedical opioid and benzodiazepine use), compounding the risk of overdose. Prevention measures should consider polysubstance use patterns among heroin-using adolescents.
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Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University Langone Medical Center, 227 E. 30th Street, 7th Floor, New York, NY, 10016, USA; Center for Drug Use and HIV/HCV Research, New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA.
| | - Austin Le
- Department of Population Health, New York University Langone Medical Center, 227 E. 30th Street, 7th Floor, New York, NY, 10016, USA; New York University College of Dentistry, 345 E. 24th Street, New York, NY, 10010, USA
| | - Pedro Mateu-Gelabert
- Center for Drug Use and HIV/HCV Research, New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA; National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
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Hulme S, Bright D, Nielsen S. The source and diversion of pharmaceutical drugs for non-medical use: A systematic review and meta-analysis. Drug Alcohol Depend 2018; 186:242-256. [PMID: 29626777 DOI: 10.1016/j.drugalcdep.2018.02.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The non-medical use (NMU) of pharmaceutical drugs is an increasing public health concern. This systematic review consolidates current knowledge about how pharmaceutical drugs are obtained for NMU and the processes and people involved in diversion. METHODS Peer-reviewed and grey literature databases were searched for empirical studies published between 1996 and 2017 that examined the source or diversion of pharmaceutical opioids, sedatives or stimulants for NMU in countries with reported misuse problems. Pooled prevalence meta-analyses using random effects models were used to estimate the prevalence of medical and non-medical sourcing reported by end-users, and gifting, selling and trading by various populations. RESULTS This review synthesizes the findings of 54 cross-sectional studies via meta-analyses, with a remaining 95 studies examined through narrative review. Pharmaceutical drugs are primarily sourced for NMU from friends and family (57%, 95% CI 53%-62%, I2 = 98.5, n = 30) and despite perceptions of healthcare professionals to the contrary, illegitimate practices such as doctor shopping are uncommon (7%, 95% CI 6%-10%, I2 = 97.4, n = 29). Those at risk of diversion include patients displaying aberrant medication behaviors, people with substance use issues and students in fraternity/sorority environments. Sourcing via dealers is also common (32%, 95% CI 23%-41%, I2 = 99.8, n = 25) and particularly so among people who use illicit drugs (47%, 95% CI 35%-60%, I2 = 99.1, n = 15). There is little to no organized criminal involvement in the pharmaceutical black market. CONCLUSION Pharmaceutical drugs for NMU are primarily sourced by end-users through social networks. Future research should examine how dealers source pharmaceutical drugs.
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Affiliation(s)
- Shann Hulme
- National Drug and Alcohol Research Centre, 22-32 King St, Randwick, NSW, 2031, Australia.
| | - David Bright
- School of Social Sciences, UNSW Australia, High Street, Kensington, NSW, 2052, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, 22-32 King St, Randwick, NSW, 2031, Australia
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Roy É, Arruda N, Jutras-Aswad D, Berbiche D, Motta-Ochoa R, Bruneau J. Tranquilizer misuse among active cocaine users: Predictors of initiation. Drug Alcohol Rev 2018; 37:520-526. [PMID: 29405461 DOI: 10.1111/dar.12666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/21/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND AIMS Tranquilizer use is associated with negative health outcomes among people who use drugs. This paper aims to estimate the incidence rate (initiation) and identify predictors of tranquilizer misuse (TM) among cocaine users. DESIGN AND METHODS A prospective cohort study was conducted in Montreal, Canada. Interviewer-administered questionnaires were carried out at 3-month intervals. Initiation was defined as misusing a tranquilizer for the first time during follow-up. 'Lasting-initiation', defined as reporting TM at the next visit following first use, was also examined. Cox proportional hazard regression analyses were carried out to assess predictors of initiation to TM. RESULTS Among the 245 participants who were eligible for the initiation analyses, 123 started TM during follow-up for an incidence rate of 40.49 per 100 person-years (95% confidence interval, CI: 33.80-48.15). Of the 123 initiates, 35.7% were still using at the interview following initiation for an incidence rate of 14.70 per 100 person-years (95% CI: 10.82-19.56). Multivariate models showed that independent predictors of initiation and 'lasting initiation' were identical as having had a criminal activity as the main source of income, having been recently in treatment for a substance use disorder (SUD) and reporting non-medical use of prescription opioids. DISCUSSION AND CONCLUSIONS The incidence rate of TM initiation was high among a sample of cocaine users. Initiation was predicted by a problematic drug use pattern involving polydrug use, involvement in the street economy and having been in treatment for a SUD. These findings have implications for prevention and harm reduction strategies.
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Affiliation(s)
- Élise Roy
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada.,National Institute of Public Health of Quebec, Montreal, Canada
| | - Nelson Arruda
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada
| | | | - Djamal Berbiche
- Department of Psychiatry, University of Montreal, Montreal, Canada
| | - Rossio Motta-Ochoa
- Faculty of Medicine and Health Sciences, Charles-Le Moyne Hospital Research Centre, Longueuil, Canada
| | - Julie Bruneau
- Department of Family Medicine, University of Montreal, Montreal, Canada
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Walton G, Dong H, Milloy MJ, DeBeck K, Kerr T, Wood E, Hayashi K. Increasing availability of benzodiazepines among people who inject drugs in a Canadian setting. Subst Abus 2018; 39:69-76. [PMID: 28727956 DOI: 10.1080/08897077.2017.1356798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Benzodiazepine misuse is associated with mortality and is common among people who inject drugs (PWID). This study aimed to examine the temporal trends in the availability of benzodiazepines among PWID in a Canadian setting, and to identify factors associated with more immediate access to benzodiazepines. METHODS Data were derived from 3 prospective cohorts of PWID in Vancouver, Canada, between June 2012 and May 2015. The primary outcome was the perceived availability of benzodiazepines, measured in 3 levels: not available, delayed availability (available in ≥10 minutes), and immediate availability (available in <10 minutes). The authors used multivariable generalized estimating equations to identify factors associated with availability of benzodiazepines. RESULTS In total, 1641 individuals were included in these analyses. In multivariable analyses, factors associated with immediate benzodiazepine availability included incarceration (adjusted odds ratio [AOR]: 1.42, 95% confidence interval [CI]: 1.06, 1.89) and participation in methadone maintenance therapy (MMT) (AOR: 1.35, 95% CI: 1.14, 1.60). Factors associated with delayed benzodiazepine availability included incarceration (AOR: 1.45, 95% CI: 1.02, 2.07) and participation in MMT (AOR: 1.77, 95% CI: 1.48, 2.12). Benzodiazepine availability increased throughout the study period for both immediate (AOR: 1.14, 95% CI: 1.10, 1.18 per 6-month follow-up period) and delayed (AOR: 1.17, 95% CI: 1.12, 1.22 per 6-month follow-up period) availability. CONCLUSIONS Among our sample of PWID, benzodiazepine availability is increasing and was associated with health and criminal justice system characteristics. Our findings indicate a need to examine prescribing practices and educate both PWID and health care providers about the risks associated with benzodiazepine use.
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Affiliation(s)
- Geoffrey Walton
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,b Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Huiru Dong
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - M J Milloy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,b Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Kora DeBeck
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,c School of Public Policy , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Thomas Kerr
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Evan Wood
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,b Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Kanna Hayashi
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,d Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
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High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:17-27. [PMID: 28577506 DOI: 10.1016/j.drugpo.2017.05.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/08/2017] [Accepted: 05/03/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular-a combination that can increase the risk for fatal and non-fatal overdose. This mixed-methods study examines nonmedical use of benzodiazepines among young adults in New York City and its relationship with opioid use. METHODS For qualitative analysis, 46 90-minute semi-structured interviews were conducted with young adult opioid users (ages 18-32). Interviews were transcribed and coded for key themes. For quantitative analysis, 464 young adult opioid users (ages 18-29) were recruited using Respondent-Driven Sampling and completed structured interviews. Benzodiazepine use was assessed via a self-report questionnaire that included measures related to nonmedical benzodiazepine and opioid use. RESULTS Participants reported using benzodiazepines nonmedically for a wide variety of reasons, including: to increase the high of other drugs; to lessen withdrawal symptoms; and to come down from other drugs. Benzodiazepines were described as readily available and cheap. There was a high prevalence (93%) of nonmedical benzodiazepine use among nonmedical opioid users, with 57% reporting regular nonmedical use. In bivariate analyses, drug-related risk behaviours such as polysubstance use, drug binging, heroin injection and overdose were strongly associated with regular nonmedical benzodiazepine use. In multivariate analysis, growing up in a middle-income household (earning between $51,000 and $100,000 annually), lifetime overdose experience, having ever used cocaine regularly, having ever been prescribed benzodiazepines, recent drug binging, and encouraging fellow drug users to use benzodiazepines to cope with opioid withdrawal were consistently strong predictors of regular nonmedical benzodiazepine use. CONCLUSION Nonmedical benzodiazepine use may be common among nonmedical opioid users due to its drug-related multi-functionality. Harm reduction messages should account for the multiple functions benzodiazepines serve in a drug-using context, and encourage drug users to tailor their endorsement of benzodiazepines to peers to include safer alternatives.
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Bakker A, Streel E. Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review. J Psychopharmacol 2017; 31:62-66. [PMID: 28072037 DOI: 10.1177/0269881116675508] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Co-prescribing benzodiazepines to patients in opiate substitution treatment is controversial and often alleged to increase mortality. In an inner-London general practice, patients with problematic benzodiazepine co-dependence were allowed benzodiazepine maintenance treatment (BMT) since 1994, providing an opportunity for analysis. METHOD 1) Case-note review of all 278 opiate substitution treatment patients, accruing 1289 patient treatment years; 46% had concurrent BMT. 2) National Health Service database search for patients who died after leaving accrued a further 883 years of information; only patients who left the UK were unaccounted for (4%). Three groups were studied: 1) never obtained benzodiazepine prescription (NOB): n=80); 2) briefly/occasionally prescribed benzodiazepines (BOP): n=71; 3) BMT: n=127. OUTCOMES MEASURED Treatment retention (months); deaths/100 patient treatment years; deaths after leaving the service/100 years of information. RESULTS Treatment retention: NOB: 34 months; BOP: 51 months; BMT: 72 months. In-treatment mortality: NOB: 1.79/100 patient treatment years; BOP: 0.33/100 patient treatment years; BMT: 1.31/100 patient treatment years. Deaths after leaving service: NOB: 2.24/100 years of information, BOP: 0.63/100 years of information. However, mortality for previously BMT-patients increased by 450% to 5.90/100 years of information. DISCUSSION BMT patients had longer treatment retention than NOB or BOP and lower mortality than NOB patients. It is unlikely that patients had access to prescribed benzodiazepines on leaving the service because of restrictions in the national guidelines but co-dependent patients are a high-risk group who may stand to gain most benefit from opiate substitution treatment if combined with benzodiazepine-maintenance.
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Lefrançois E, Esseiva P, Gervasoni JP, Lucia S, Zobel F, Augsburger M. Analysis of residual content of used syringes collected from low threshold facilities in Lausanne, Switzerland. Forensic Sci Int 2016; 266:534-540. [PMID: 27514014 DOI: 10.1016/j.forsciint.2016.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND For the first time in Switzerland, an analysis of residual contents from used syringes collected from low threshold facilities was performed. This preliminary study is part of a wider project aiming to understand patterns of injecting drug use over time. METHODS Among the 100,000 syringes exchanged annually by the ABS foundation (Accueil Bas Seuil), 113 were collected following a purposive sampling method and analysed by gas chromatography coupled with mass spectrometry (GC-MS). RESULTS Four syringes (4% of the sample population) contained no substances take into consideration the limit of the method. Cocaine was the most commonly observed compound and was detected in 77 syringes (68%), whilst users reported syringes with cocaine among those analysed in this study. Heroin was detected in 49 syringes (43%) and reported by 53 users returning syringes; midazolam was detected in 31 syringes (27%) and reported as the medicine Dormicum(®) in 22 occurrences. No new or unusual illicit drug was detected in the sample. CONCLUSION The results show the presence of cocaine in more than half of the sample, an absence of new or unusual illicit drugs, as well as very few traces of methadone, which suggests that this substitution drug is rarely injected. This preliminary study also demonstrates the potential of this developed methodology for monitoring purposes. An ongoing and more systematic approach could allow to detect modifications in drug use patterns among the target population as well as the appearance of new and hazardous substances. Such systematic and timely results could allow an adaptation of harm reduction interventions.
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Affiliation(s)
- Elodie Lefrançois
- Ecole des Sciences Criminelles, University of Lausanne, Switzerland.
| | - Pierre Esseiva
- Ecole des Sciences Criminelles, University of Lausanne, Switzerland
| | | | - Sonia Lucia
- Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland
| | | | - Marc Augsburger
- Centre Universitaire de Médecine Légale, Lausanne, Switzerland
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Impact of the Combined Use of Benzodiazepines and Opioids on Workers' Compensation Claim Cost. J Occup Environ Med 2014; 56:973-8. [DOI: 10.1097/jom.0000000000000203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
OBJECTIVES The aim of this study was to assess the prevalence of alcohol dependence and anxiety and depressive disorder symptomatology among heroin users in drug treatment. METHOD Fifty-five clients on methadone maintenance treatment programmes in Dublin were interviewed. RESULTS Prevalence rates were found to be 56% [n = 31] for alcohol dependence, 56% [n = 31] for anxiety disorder symptomatology, and 42% [n = 23] for depressive disorder symptomatology. This finding of comorbid alcohol dependence and psychopathology among methadone maintenance treatment clients suggests that both clients' health and methadone maintenance treatment participation and completion rates may be compromised. CONCLUSIONS Alcohol dependence and psychopathology among methadone maintenance treatment clients should be considered when providing effectively targeted services to the drug using population.
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Abstract
AbstractObjectives: The study reports on benzodiazepine use among opiate dependent patients attending National Health Service community prescribing services and examines current practice in the clinical management of benzodiazepine dependence.Method: A postal questionnaire survey of 174 NHS substance misuse services in England and Wales.Results: A 71% response rate was achieved. Services estimated the prevalence of benzodiazepine use to be 40% and the prevalence of benzodiazepine dependence to be less than 25% among opiate dependent patients in treatment. Illicit supplies (street) and general practitioners were regarded as the most common source of benzodiazepines. The most commonly reported reasons for benzodiazepine use were for the direct intoxicating effects and for the treatment of anxiety/insomnia. The majority of services (93,75%) reported prescribing benzodiazepines to patients for benzodiazepine detoxification while 43 (35%) reported prescribing for benzodiazepine maintenance treatment. The variations in benzodiazepine prescribing practices across services are described.Conclusions: Benzodiazepine use remains common among opiate addicts in contact with treatment services. The majority of services surveyed reported prescribing benzodiazepines but there was much variation in clinical practice nationally. There is need for further research to identify effective treatment approaches for comorbid benzodiazepine dependence in opiate misusers.
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Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend 2012; 125:8-18. [PMID: 22857878 PMCID: PMC3454351 DOI: 10.1016/j.drugalcdep.2012.07.004] [Citation(s) in RCA: 461] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 07/08/2012] [Accepted: 07/09/2012] [Indexed: 12/26/2022]
Abstract
This paper reviews studies examining the pharmacological interactions and epidemiology of the combined use of opioids and benzodiazepines (BZDs). A search of English language publications from 1970 to 2012 was conducted using PubMed and PsycINFO(®). Our search found approximately 200 articles appropriate for inclusion in this paper. While numerous reports indicate that the co-abuse of opioids and BZDs is ubiquitous around the world, the reasons for the co-abuse of these medications are not entirely clear. Though the possibility remains that opioid abusers are using BZDs therapeutically to self-medicate anxiety, mania or insomnia, the data reviewed in this paper suggest that BZD use is primarily recreational. For example, co-users report seeking BZD prescriptions for the purpose of enhancing opioid intoxication or "high," and use doses that exceed the therapeutic range. Since there are few clinical studies investigating the pharmacological interaction and abuse liability of their combined use, this hypothesis has not been extensively evaluated in clinical settings. As such, our analysis encourages further systematic investigation of BZD abuse among opioid abusers. The co-abuse of BZDs and opioids is substantial and has negative consequences for general health, overdose lethality, and treatment outcome. Physicians should address this important and underappreciated problem with more cautious prescribing practices, and increased vigilance for abusive patterns of use.
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Affiliation(s)
- Jermaine D. Jones
- Division on Substance Abuse, New York Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Shanthi Mogali
- Division on Substance Abuse, New York Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Sandra D. Comer
- Division on Substance Abuse, New York Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
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Darke S, Ross J, Mills K, Teesson M, Williamson A, Havard A. Benzodiazepine use among heroin users: baseline use, current use and clinical outcome. Drug Alcohol Rev 2010; 29:250-5. [PMID: 20565516 DOI: 10.1111/j.1465-3362.2009.00101.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Benzodiazepine use is associated with elevated levels of harm. The current study aimed to ascertain the long-term nature of the relationship between benzodiazepine use and clinical profile among heroin users. DESIGN AND METHODS Longitudinal cohort, with follow-up at 3, 12, 24 and 36 months. Participants were 615 heroin users recruited for the Australian Treatment Outcome Study. RESULTS At baseline, current benzodiazepine users were more likely to be committing crime, had poorer psychological health and poorer physical health. Baseline benzodiazepine use was not associated with the likelihood across follow-up of heroin use (P = 0.44), committing crime (P = 0.17), poorer psychological health (P = 0.31) or poorer physical health (P = 0.48). Current benzodiazepine use was, however, associated with a greater likelihood of concurrent heroin use (OR 2.77), crime (OR 2.04), poorer psychological health (beta = -4.47) and poorer physical health (beta = -2.33). DISCUSSION AND CONCLUSIONS Clinicians should be aware that reductions in benzodiazepine use are associated with reductions in harm, and that baseline benzodiazepine status does not equate to poor long-term outcome.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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17
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Best D, Noble A, Man LH, Gossop M, Finch E, Strang J. Factors surrounding long-term benzodiazepine prescribing in methadone maintenance clients. JOURNAL OF SUBSTANCE USE 2010. [DOI: 10.1080/14659890209169348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Abstract
General hospital clinicians frequently deal with injecting drug users because substance use has diverse medical and psychiatric complications. Non-specialist clinicians often initiate management when specialist consultation is not available or accepted by the patient. Here, we summarise evidence for the management of hospitalised injecting drug users. The first challenge is to engage a drug user into medical care. A non-judgmental approach towards patients and acceptance of their lifestyle choices facilitates engagement. Pragmatic clinical goals can be negotiated and achieved. We also describe common conditions of injecting drug users. Accurate diagnosis and appropriate management focus on common issues such as intoxication, withdrawal, pain management, drug seeking, psychological comorbidity, behavioural difficulties, and pregnancy. Effective management can reduce the medical and social effect of these conditions and is not difficult.
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Affiliation(s)
- Paul S Haber
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, and University of Sydney, Discipline of Addiction Medicine, Sydney, NSW, Australia.
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19
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DEGENHARDT LOUISA, ROXBURGH AMANDA, VAN BEEK INGRID, HALL WAYNED, ROBINSON MAXINEKF, ROSS JOANNE, MANT ANDREA. The effects of the market withdrawal of temazepam gel capsules on benzodiazepine injecting in Sydney, Australia. Drug Alcohol Rev 2009; 27:145-51. [DOI: 10.1080/09595230701829413] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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DISSABANDARA LAKALO, DIAS SHAVINDRAR, DODD PETERR, STADLIN ALFREDA. Patterns of substance use in male incarcerated drug users in Sri Lanka. Drug Alcohol Rev 2009; 28:600-7. [DOI: 10.1111/j.1465-3362.2009.00062.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Burns JM, Martyres RF, Clode D, Boldero JM. Overdose in young people using heroin: associations with mental health, prescription drug use and personal circumstances. Med J Aust 2004; 181:S25-8. [PMID: 15462639 DOI: 10.5694/j.1326-5377.2004.tb06351.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Accepted: 05/06/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify patterns of mental health, prescription drug use and personal circumstances associated with heroin overdose in young people. DESIGN Linkage of data on use of Pharmaceutical Benefits Scheme (PBS) prescription drugs with data from a self-report questionnaire. SETTING Inner metropolitan Melbourne, Australia. SUBJECTS 163 young people, 15-30 years, using heroin. MAIN OUTCOME MEASURES Personal circumstances, mental health (as measured by various scales), and PBS-listed prescription drug use. RESULTS Young people using heroin reported high rates of feelings of hopelessness, depression, antisocial behaviour, self-harm and diagnosed mental illness. A prior history of overdose was associated with previous mental illness, which in turn was associated with being female, having poor social support, being dissatisfied with relationships, and living alone or in temporary accommodation. While feelings of hopelessness and antisocial behaviour were strongly associated with overdose history, the number of PBS prescription drugs used had a very strong relationship with overdose, particularly benzodiazepines, other opioids, tricyclic antidepressants and tranquillisers. CONCLUSIONS Further research to explore causal relationships between prescription drugs and heroin overdose is warranted. Improved data linkage to PBS records for general practitioners may facilitate safer prescribing practices.
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Affiliation(s)
- Jane M Burns
- beyondblue: the national depression initiative, Hawthorn West, VIC, Australia
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22
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Breen CL, Degenhardt LJ, Bruno RB, Roxburgh AD, Jenkinson R. The effects of restricting publicly subsidised temazepam capsules on benzodiazepine use among injecting drug users in Australia. Med J Aust 2004; 181:300-4. [PMID: 15377238 DOI: 10.5694/j.1326-5377.2004.tb06293.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2003] [Accepted: 07/22/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the effect of a restriction on publicly subsidised temazepam 10 mg capsules upon the injection of benzodiazepines by injecting drug users (IDUs). DESIGN AND PARTICIPANTS Cross-sectional study of regular IDUs targeting periods before and after the policy change. Analysis of prescription data, including time-series analysis. SETTING Drug services in the capital cities of New South Wales, Victoria, Tasmania, Queensland and the Northern Territory. MAIN OUTCOME MEASURES Changes in prescriptions and patterns of benzodiazepine use; harms associated with benzodiazepine use. RESULTS There was a decrease in temazepam 10 mg capsule prescriptions and a corresponding increase in temazepam 10 mg tablet prescriptions after the policy change. IDU survey data suggested that IDUs continued to inject benzodiazepines and temazepam capsules. The frequency of the injection of capsules after the restriction appeared similar to that before the policy change. There was no change in the frequency of injection of tablets. Most IDUs reported obtaining their benzodiazepines from doctors, with substantial proportions obtaining capsules even after the restriction. About half the IDUs reported purchasing benzodiazepines on the street. Most IDUs who injected benzodiazepines reported injection-related problems. CONCLUSION Limiting the prescribing of temazepam capsules may have reduced their injection by some IDUs, but additional strategies are needed to reduce the misuse among this group. These may include further restriction of capsule preparations, continued education of doctors and IDUs, and the examination of prescribing practices of individual doctors.
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Affiliation(s)
- Courtney L Breen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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23
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Darke S, Ross J, Teesson M, Lynskey M. Health service utilization and benzodiazepine use among heroin users: findings from the Australian Treatment Outcome Study (ATOS). Addiction 2003; 98:1129-35. [PMID: 12873247 DOI: 10.1046/j.1360-0443.2003.00430.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To determine levels of health service utilization among heroin users, the types of prescription drugs obtained by heroin users and the contribution of benzodiazepine use in health service utilization and prescribed drug use. DESIGN Cross-sectional survey. SETTING Sydney, Australia. PARTICIPANTS A total of 615 current heroin users recruited for the Australian Treatment Outcome Study (ATOS). FINDINGS Sixty per cent of subjects had consulted a general practitioner (GP) and 7% a specialist in the preceding month. An ambulance had attended 11% of subjects in the preceding month. Forty-eight per cent of subjects had prescriptions dispensed for medication in the preceding month. Thirty-nine per cent of participants had prescriptions dispensed for psychotropic medications, representing 80% of all prescriptions. Twenty per cent of subjects had prescriptions dispensed for non-psychotropic medications (20% of prescriptions). The most commonly prescribed drugs were benzodiazepines (59% of prescriptions), which had been obtained by 30% of subjects. Benzodiazepine users had more GP and psychiatrist visits, were more likely to have had an ambulance attendance and had significantly more dispensed prescriptions. CONCLUSIONS There were high levels of health utilization among heroin users. Prescription drug use was common, and dominated by psychotropic drugs. Benzodiazepine use was a dominant factor in the use of services and in prescriptions dispensed. Despite increased awareness of the harms associated with benzodiazepines, they continue to be prescribed widely to heroin users.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Australia.
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McGregor C, Machin A, White JM. In-patient benzodiazepine withdrawal: comparison of fixed and symptom-triggered taper methods. Drug Alcohol Rev 2003; 22:175-80. [PMID: 12850904 DOI: 10.1080/09595230100100615] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Fixed and symptom-triggered taper methods during in-patient benzodiazepine withdrawal treatment were compared using a randomized controlled design. Forty-four benzodiazepine users seeking in-patient withdrawal treatment at two substance use treatment clinics in Adelaide, Australia were recruited. Measurements included the Severity of Dependence Scale and the SF-36. A scale comprising six items from the Clinical Institute Withdrawal Assessment Scale--Benzodiazepines (CIWA-B) was used to measure withdrawal symptoms. Participants were randomized to receive a fixed diazepam tapering regime or diazepam only in response to withdrawal symptoms (symptom-triggered group). Results showed that there were no significant differences between treatment groups in terms of withdrawal severity, duration of in-patient treatment, amount of diazepam administered, treatment attrition and benzodiazepine use at follow-up. Both groups showed a reduction in benzodiazepine dosage of 86% over the first 8 days which was maintained at 1 month post-discharge. Although there were improvements in some subscales of the SF-36 between baseline and follow-up, values were significantly below age-matched norms at both time-points. This study showed that benzodiazepine users entering treatment have relatively poor health and that symptom-triggered taper methods incorporating flexible dosing and flexible treatment duration are as effective as fixed dose taper methods for in-patient benzodiazepine withdrawal treatment.
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Dobbin M, Martyres RF, Clode D, Champion De Crespigny FE. Association of benzodiazepine injection with the prescription of temazepam capsules. Drug Alcohol Rev 2003; 22:153-7. [PMID: 12850901 DOI: 10.1080/09595230100100589] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Temazepam capsules have become a popular choice for benzodiazepine injection by injecting drug users, and serious vascular and tissue damage leading to ulcers and gangrene can result. We compared the self-reported benzodiazepine injecting behaviour of 91 heroin users with their Pharmaceutical Benefits Schedule (PBS) records for the preceding 5 years. We found that individuals prescribed PBS temazepam capsules were more likely to report injecting benzodiazepines than individuals who had either not been prescribed PBS temazepam capsules or had been prescribed PBS temazepam tablets. These results provide empirical support for the argument to limit the prescription and supply of temazepam capsules in Australia.
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Affiliation(s)
- Malcolm Dobbin
- Melbourne Division of General Practice, Parkville, Victoria, Australia
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26
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Fry CL, Bruno RB. Recent trends in benzodiazepine use by injecting drug users in Victoria and Tasmania. Drug Alcohol Rev 2002; 21:363-7. [PMID: 12537706 DOI: 10.1080/0959523021000023225] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To address the lack of data on patterns of benzodiazepine use among injecting drug users (IDU) in Victoria and Tasmania, convenience samples of 152 Melbourne and 100 Hobart IDU were recruited from needle and syringe programme outlets and administered a structured survey on patterns of benzodiazepine use, injection-related health problems and drug use history. Most respondents had used benzodiazepines during the preceding 6 months, and more than one-third (Melbourne 36%, 95% CI, 28-44; Hobart 37%, 95% CI, 27-47) had injected benzodiazepines during this period. Diazepam was the preferred benzodiazepine for those using orally, while intravenous benzodiazepine users preferred to inject temazepam. Benzodiazepine injection for Melbourne IDU was related to greater levels of injection-related health problems. Patterns of benzodiazepine use amongst Melbourne and Hobart IDU are different to that in other Australian jurisdictions, with available data suggesting that prevalence of injection may be increasing. Ongoing monitoring of benzodiazepine injection, together with in-depth studies of supply characteristics and health impacts in jurisdictions where significant trends are detected is needed. Consideration of regulatory, supply, education and training options for the prevention of benzodiazepine injection is also indicated.
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Affiliation(s)
- Craig L Fry
- Turning Point Alcohol and Drug Centre Inc., Fitzroy, Victoria, Australia
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Darke S, Topp L, Ross J. The injection of methadone and benzodiazepines among Sydney injecting drug users 1996-2000: 5-year monitoring of trends from the Illicit Drug Reporting System. Drug Alcohol Rev 2002; 21:27-32. [PMID: 12189001 DOI: 10.1080/09595230220119318] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Trends in the injection of methadone and benzodiazepines by injecting drug users (IDU) recruited in Sydney for the Illicit Drug Reporting System over the period 1996-2000 were examined. A total of 788 IDU were interviewed over the 5-year period. The proportion of IDU reporting recent methadone injecting declined significantly over the study period, from a peak of 31% in 1997 to 13% in 2000. Unlike the injection of methadone, there was no significant difference between the proportions of IDU reporting recent benzodiazepine injecting over the study period, which ranged between 10% and 16%. A consistent minority (range 5-7%) of IDU reported having injected both methadone and benzodiazepines in all years of the study. There were no differences in the proportions of males and females reporting recent methadone or benzodiazepine injecting in any individual year. Both methadone and benzodiazepine injecting were independently associated with higher levels of injection-related health problems. Given the substantial harms associated with these practices, continued monitoring of their prevalence is warranted.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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