Treatment or “high”: Benzodiazepine use in patients on injectable heroin or oral opioids

• Published in: Addictive behaviors 2013-10, Vol.38 (10), p.2477-2484
• Main Authors: Vogel, Marc, Knöpfli, Bina, Schmid, Otto, Prica, Mari, Strasser, Johannes, Prieto, Luis, Wiesbeck, Gerhard A, Dürsteler-MacFarland, Kenneth M
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anxiety; Anxiety Disorders - drug therapy; Anxiety Disorders - epidemiology; Benzodiazepines - administration & dosage; Benzodiazepines - adverse effects; Benzodiazepines - therapeutic use; Depressive Disorder - drug therapy; Depressive Disorder - epidemiology; Diacetylmorphine; Drug abuse; Epidemiologic Methods; Female; Heroin - administration & dosage; Heroin - therapeutic use; Humans; Male; Medical treatment; Mental depression; Middle Aged; Motivation; Motive; Narcotics; Opiate Substitution Treatment - methods; Opiate Substitution Treatment - psychology; Opioid dependence; Prescription Drug Misuse; Psychiatric comorbidity; Psychiatry; Sedative; Self Medication - psychology; Self Medication - statistics & numerical data; Sleep disorders; Sleep Initiation and Maintenance Disorders - drug therapy; Sleep Initiation and Maintenance Disorders - epidemiology; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Substance-Related Disorders - rehabilitation; Young Adult
• ISSN: 0306-4603; 1873-6327
• DOI: 10.1016/j.addbeh.2013.05.008

Abstract Benzodiazepine (BZD) use is widespread among opioid-maintained patients worldwide. We conducted a cross-sectional survey to investigate motives and patterns of BZD use and psychiatric comorbidity in a convenience sample of patients (n = 193) maintained on oral opioid agonists or diacetylmorphine (DAM). Prolonged BZD use and high-risk behaviors like parenteral use were common. After principal component analysis, motives were divided into those related to negative affect regulation, positive affect regulation (i.e. reward-seeking) and somato-medical problems. Negative affect regulation and somato-medical motives were associated with prolonged use. Psychiatric comorbidity was associated with several self-therapeutic motives, most importantly to lose anxiety. Patients maintained on DAM were more likely to be ex-users of BZD and report high positive affect regulation. Therefore, patients maintained on different agonists may have deviating motives for BZD use, which could be of importance when addressing this issue. Treatment of psychiatric comorbidity, in particular anxiety, depressive and sleeping disorders, may be helpful in reducing BZD use, particularly in patients maintained on oral opioids.