Benzodiazepine Use among Patients Receiving Methadone Maintenance
Benzodiazepine (BZD) misuse among opioid-dependent patients receiving methadone maintenance treatment (MMT) may increase the risk of ongoing illicit opioid use and overdose. There are few recent data on BZD use among MMT patients in the US. Chen et al. surveyed 194 patients at a Baltimore, MD, methadone clinic to estimate the prevalence and correlates of BZD use in this population.*
- Forty-three percent of respondents were women, and 76% were African American.
- Forty-seven percent reported ever using BZD, and one-quarter had used a BZD within the last 30 days.
- Of those who had ever used a BZD, most (84%) had done so without a prescription at least once (the most common reasons being curiosity and to relieve tension/anxiety). Half did not use BZDs until after entering MMT; among the remainder, 61% reported increasing or restarting use after entering MMT.
- In a multivariable model, white race (OR, 2.7), having an anxiety problem before entering MMT (OR, 2.4), past initiation of opioids for pleasure or to get high (instead of reasons such as curiosity or to relax; OR, 2.6), and incremental increases in a depression score (OR, 1.05) were significantly associated with ever having used BZDs, prescribed or not.
*Of note, in this clinic, BZD use, prescribed or not, led to penalties (e.g., removal of take-home privileges.
Comments:Many patients initiate or increase BZD use after entering MMT, even when BZD use is penalized. Limitations to this study include possible underreporting of use, given that some respondents filled out the survey at group counseling sessions, and lack of information on what proportion of current BZD users exhibited misuse. Further, single-site findings may not be generalizable to all settings; both use and misuse may be more common in clinics where BZD prescriptions are allowed. Despite these limitations, the study suggests a need for MMT programs to address co-occurring addiction and anxiety and to ensure appropriate monitoring for BZD misuse regardless of clinic policy about BZD prescriptions. Christine Pace, MD† & Richard Saitz, MD, MPH
†Contributing Editorial Intern, Resident in Addiction Medicine, and Fellow in General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston, MA.