Benzodiazepines/Non-benzodiazepines (Z-drugs) are drugs used in the treatment of anxiety and sleep disorders, while Opioids are primarily used in the management of pain; both drug classes are CNS depressants. They have significant therapeutic benefits when used individually. Still, when co-administered, whether prescribed or illicitly procured, they potentiate each other’s CNS depressing functions, causing severe adverse effects like the increased risk of overdose, severe respiratory depression, and even death.
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Even though Benzodiazepines (e.g., diazepam, Alprazolam) and Z-drugs (e.g., Zoplicone, zolpidem) mediate their actions through GABA-A receptors, they are chemically distinct pharmacological substances. Opioids act through opioid receptors in the brain and spinal cord, preventing the propagation of pain.
With an increase in the rates of Drug-related deaths (DRD) associated with the co-use of benzodiazepines/Z-drugs and opioids such as heroin/methadone, this study aims to understand the patterns of co-use and how it can inform risk mitigation strategies for DRD.
Patterns of co-use
Table of Contents
This study identified six patterns of co-use after interviewing 48 participants:
- Co-use to facilitate sleep or sober up.
- Curated dual use/ Opioids assisted therapy (OAT) only.
- Benzodiazepine use in the morning and night combined with all-day opioid use.
- Co-use sprees
- Dual usage all through the day
- All-day benzodiazepines/Z-drugs use with OAT
The first three patterns suggest a more controlled co-use at separate times to achieve specific functions; it is, however, classified as simultaneous use because of the overlapping duration of the action in the body. The last three, depicting a lesser degree of control, are associated with higher doses and more multidrug use to achieve euphoria (chasing a high).
Co-use patterns and risk of overdose
It was found that at least one participant, in all patterns, reported an almost fatal incident following an overdose, with a more significant proportion of them indicating a prescription of methadone (an opioid) compared to those prescribed with buprenorphine(also an opioid).
Factors affecting Co-use
Motivation
Participants did not tell of any clear preference for the order in which the drugs were taken, but dual-use patterns development was found to be driven by co-use. For example, participants who fell into the curated co-use pattern did so deliberately in a well-planned manner to achieve specific needs like improving mood or calming racing thoughts in contrast to those who co-use throughout the day to achieve a “buzz.”
Finances, drug affordability, and availability
The ease of access, low cost of acquisition, and how available the drugs are were found by the study to facilitate the Binge pattern of co-use. One of the participants reported that with the drug being easily accessible on the streets, he binges after being paid.
Location
Due to the high rate of DRDs in Glasgow, it was not unexpected to find that participants in Glasgow exhibited less controlled patterns of co-use.
Clinical implications
Benzodiazepines/Z-drugs dual-use has been linked to a rise in abuse of the drugs, whether they have been prescribed or illegally acquired. Therefore, every potential risk of abuse and information about proper handling of the drugs should be explicitly provided to the patient by the healthcare provider.
Policy-making bodies should also consider how patterns of co-use development before they formulate guidelines for prescribing benzodiazepines/Z-drugs and opioids.
Conclusion
Benzodiazepine/Z-drugs co-use patterns have been found to inform findings that will help guide the making of policies and health management to tackle the issue of drug-related deaths effectively and also support people who co-use these substances.
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References
Family E.H., Vojt G., Poulter H., Bailey C.P., Sheikh A.P.A., Cavallo D., Karimi S., Booth N., Silva P., Aitken L., Stewart S., Hickman M., Henderson G., Scott J., Kesten J.M. https://doi.org/10.1101/2024.07.26.24311053
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