More Attention Needed to Dual Use of Opioids, Benzodiazepines
The majority of patients misusing both opioids and benzodiazepines (BZDs) recognize the risks of overdose and substance dependence, but need more education and motivation to stop concurrent use, says new research led by a School of Public Health addiction expert.
In a study in the Journal of Substance Abuse Treatment, Michael Stein, chair and professor of health law, policy & management, and colleagues say the risks of combining opioids and BZDs should be a “high priority” in detoxification programs and other places where opioid users touch the healthcare system.
“BZD use among patients undergoing inpatient opioid detoxification is common and places those returning to the community at high risk for overdose and death, as well as higher risk of poor treatment outcomes,” the study says. “Our findings suggest that detoxification programs may be well-positioned to implement screening to identify and intervene with patients reporting BZD misuse.”
Nationally, overdose deaths from prescribed opioid pain medications and heroin quadrupled in the past 15 years, studies show, with nearly one-third of those deaths associated with concurrent BZD use. People with opioid-use disorders tend to underestimate their risk of opioid-related overdose, researchers have found.
In the recent study of 476 opioid users in Fall River, Massachusetts, just over half had used BZDs in the last month. Women in the sample were more likely to be BZD users than men. The authors noted that white women represent a growing subpopulation at risk for concurrent opioid-BZD use.
The study found that most opioid users accurately understood that BZDs could be addictive, muddle one’s thinking, cause fatigue and driving accidents, contribute to overdose risk, and if halted, produce withdrawal symptoms, the study found.
“Benzodiazepines are used with eyes wide open,” Stein said, “which tells you that patients must experience some benefit from taking them—most likely a reduction in anxiety symptoms. It will be tough to decrease their use, even among those who are entering detox trying to stop using heroin or prescription opioids.”
Stein said more research is needed to better understand how risk perceptions may be leveraged for treatment purposes.
“If patients understood that BZDs can actually worsen depression and are associated with worse drug treatment outcomes, perhaps they would use less, and coincidentally reduce their overdose risk,” he said.
Study co-authors are from Brown University, Butler Hospital, and Stanley Street Treatment and Resources, Inc.