Opioid Users Understand Risks of Benzodiazepines, But Need Strategies to Stop Dual Use.

Benzodiazepine (BZD) use among people with opioid use disorder is common and is a major contributor to the overdose epidemic. But while most users understand the risks, many lack the motivation and strategies to quit BZDs, according to a new study led by a School of Public Health researcher.

In a study in the Journal of Substance Abuse Treatment, a team of researchers from SPH, Butler Hospital in Providence, the Warren Alpert Medical School of Brown University, and a Fall River, Massachusetts, treatment center surveyed more than 470 patients who initiated inpatient opioid detoxification, and identified nearly half who reported also using benzodiazepines. BZD users were significantly more likely to be female, use concurrent substances, and report past year overdoses.

Overall, nearly all BZD users endorsed “accurate beliefs” that benzodiazepines increase the risk of overdose and can be addictive. Study participants “were nearly universally aware that BZDs can be addictive, muddle one’s thinking, cause fatigue and driving accidents, contribute to overdose risk, and, if halted, produce withdrawal symptoms,” the study says. “That is, BZD users overall held accurate perceptions about BZDs’ major adverse effects.”

However, the authors said, BZD users were less likely to believe that BZD use was associated with worsening depression, and that use interfered with methadone or buprenorphine treatment—despite evidence that BZD use negatively affects those outcomes. BZD use is a marker for psychiatric symptoms and mental health and addiction severity, and users entering treatment with unaddressed mental health problems are especially vulnerable to poor retention and treatment failure.

“Our findings suggest that detoxification programs may be well positioned to implement screening to identify and intervene with patients reporting BZD use,” the study says. “Patients appear to understand the risks associated with concurrent opioid-BZD use—the vast majority of concurrent users in this sample recognized risk for overdose (92.7 percent) and dependence (97.6 percent) . . . but may lack the motivation and strategies needed to quit BZD or prevent future consequences.”

In fact, said lead author Michael Stein, chair and professor of health law, policy, and management, “It’s been very difficult to develop effective interventions to reduce the use of BZDs by persons with opioid use disorders, but it’s a critical piece of the epidemic of overdose deaths. The risks are well-described, and opioid users know them, yet it’s hard to change BZD use because BZDs are serving some purpose—often symptom relief—for many patients.” He said novel therapies for BZD misuse “should be one of the targets of research in our efforts to curtail the overdose epidemic.”

The study was funded by the National Institute on Drug Abuse.