Diazepam use among methadone maintenance patients: Patterns and dosages

doi:10.1016/0376-8716(81)90061-2

Drug and Alcohol Dependence

Volume 8, Issue 3, November 1981, Pages 189-199

https://doi.org/10.1016/0376-8716(81)90061-2 Get rights and content

Abstract

Methadone maintenance patients who use benzodiazepine drugs were interviewed about the dosage levels, patterns, frequency and motives for their use of these drugs. The sample was drawn from two treatment clinics, one in Baltimore (N = 12) and one in Philadelphia (N = 17). Benzodiazepine use was prevalent at both of these clinics — 65–70% of maintenance patients had positive urinalysis tests during a single month. Ninety-three per cent of survey participants identified diazepam as the drug which they used most often. The median value of the usual daily dose was 40–45 mg, 31% reported usual daily doses between 70 and 300 mg and 62% had experience with doses of 100 mg and higher. The majority of the sample reported taking diazepam in a single daily dose within one hour of the time that they ingested their daily methadone; 72% of the sample indicated that diazepam boosts the effects obtained from the daily methadone dose. Another sample of addicts who reported extensive experience with both benzodiazepines and barbiturates indicated that diazepam increases the effects of methadone while barbiturates produce no change in the effects of methadone. Results of this study suggest that patterns and dosages of diazepam use among methadone maintenance patients are primarily abusive rather than therapeutic.

References (17)

D.A. Downs
Interactions of acetylmethadol or methadone with other drugs in rhesus monkeys
Pharmacol. Biochem. Behav.
(1979)
T. Duka et al.
Benzodiazepines modulate striatal enkephaline levels via a gabaergic mechanism
Life Sciences
(1980)
J. Marks
The Benzodiazepines: Use, Overuse, Misuse, Abuse
(1978)
T. Yanagita et al.
Dependence liability of several sedative-hypnotic agents evaluated in monkeys
J. Pharmacol. Exp. Ther.
(1973)
R.R. Griffiths et al.
Benzodiazepine self-administration in animals and humans: A comprehensive literature review
R.R. Griffiths et al.
Human drug self-administration: Double-blind comparison of pentobarbital, diazepam, chlorpromazine and placebo
J. Pharmacol. Exp. Ther.
(1979)
R.R. Griffiths et al.
Drug preference in humans: Double-blind choice comparison of pentobarbital, diazepam, and placebo
J. Pharmacol. Exp. Ther.
(1980)
G.E. Bigelow
Narcotic addiction treatment: Behavioral methods concurrent with methadone maintenance
Int. J. Addict.
(1980)

There are more references available in the full text version of this article.

Cited by (137)

The impact of benzodiazepine exposure on treatment retention in an open-access methadone program: A retrospective cohort study
2022, Drug and Alcohol Dependence
Open-access opioid treatment programs (OTP) offer same-day access to methadone without an appointment and aim to minimize treatment barriers that often reduce admission and/or retention. We explored whether patients with benzodiazepine exposure at treatment entry would have similar 12-month retention compared to those without benzodiazepine exposure.
We conducted a retrospective cohort study of 2968 patients consecutively initiated on methadone between January 2015 and February 2017 at an open-access OTP. The sample was stratified into benzodiazepine-exposed and nonexposed groups based on intake urine toxicology. Group comparison of 12-month retention was conducted. Kaplan Meier analysis compared time to methadone treatment discontinuation between groups with a log-rank test. Multivariable Cox regression was performed to compare retention by baseline benzodiazepine exposure with adjustment for confounders.
Overall, 31% of patients with benzodiazepine exposure (n = 171) and 31% without exposure (n = 2423) were retained at 12 months (p = 0.95). Median treatment duration was 182 days (95% CI, 152–239) and 175 days (95% CI, 156–196) for patients with and without benzodiazepine exposure, respectively. Kaplan-Meier analysis showed no significant difference in treatment duration between groups (log-rank test p = 0.73). Cox regression found no difference in treatment retention between groups (adjusted Hazard Ratio= 1.03, 95% CI, 0.91–1.16).
In this cohort of patients receiving methadone at an open-access OTP, benzodiazepine exposure at intake was not observed to impact 12-month treatment retention or duration. These findings support U.S. Food and Drug Administration (FDA) recommendations to not withhold medications for opioid use disorder from patients taking benzodiazepines.
Specificity of personality relationships to particular forms of concurrent substance use among methadone maintenance therapy clients
2019, Addictive Behaviors
Citation Excerpt :
Individuals high in AS are theoretically and empirically more sensitive to the anxiolytic effects of drugs like benzodiazepines (Conrod et al., 2000; Hearon et al., 2011; Stewart & Kushner, 2001). It has long been suggested that opioids and benzodiazepines have interacting pharmacokinetic effects, which may explain the historically high co-use of these drugs in opioid treatment programs (Jones et al., 2012; Stitzer, Griffiths, McLellan, Grabowski, & Hawthorne, 1981). Moreover, this combination is particularly dangerous, as co-use of benzodiazepines and opioids (including methadone) confers greater overdose risk (Gudin, Mogali, Jones, & Comer, 2013; White & Irvine, 1999).
A mainstay treatment for opioid addiction in North America is methadone maintenance therapy (MMT) – a form of opiate agonist therapy (OAT). While efficacious for treating opioid addiction, MMT fails to address the concurrent polysubstance use that is common among opioid dependent clients. Moreover, psychosocial approaches for addressing polysubstance use during MMT are lacking. Our study's goals were to validate the use of the four-factor personality model of substance use vulnerability in MMT clients, and to demonstrate theoretically-relevant relationships of personality to concurrent substance use while receiving MMT.
Respondents included 138 daily-witnessed MMT clients (65.9% male, 79.7% Caucasian), mean age (SD) 40.18 (11.56), recruited across four Canadian MMT clinics. Bayesian confirmatory factor analysis was used to establish the structural validity of the four-factor personality model of substance use vulnerability (operationalized with the Substance Use Risk Profile Scale [SURPS]) in MMT clients. SURPS personality scores were then used as predictors for specific forms of recent (past 30-day) substance use.
Using a latent hierarchal model, hopelessness was associated with recent opioid use; anxiety sensitivity with recent tranquilizer use; and sensation seeking with recent alcohol, cannabis, and stimulant use.
Personality is associated with substance use patterns and may be an appropriate target for intervention for those undergoing MMT to reduce opioid use, and potentially dangerous concurrent use of other drugs, while receiving methadone.
The epidemiology of benzodiazepine misuse: A systematic review
2019, Drug and Alcohol Dependence
Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research.
PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse.
The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment.
Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
Anxiety sensitivity and nonmedical benzodiazepine use among adults with opioid use disorder
2017, Addictive Behaviors
Citation Excerpt :
Nonetheless, the nonmedical use of benzodiazepines for its rewarding properties (i.e., to get high) is also common (Fatseas et al., 2009; Vogel et al., 2013), and might reflect an alternative pathway to nonmedical use, particularly among those with opioid use disorder. Both animal and human laboratory studies have found that benzodiazepines enhance the reinforcing effects of opioids (Lintzeris, Mitchell, Bond, Nestor, & Strang, 2007; Walker & Ettenberg, 2001, 2003), consistent with self-report by patients that they often use benzodiazepines to enhance the “high” of opioids (Stitzer, Griffiths, McLellan, Grabowski, & Hawthorne, 1981). It is likely that each of these pathways, in part, contribute to the elevated prevalence of nonmedical benzodiazepine use among those with opioid use disorder.
Nonmedical benzodiazepine use is common among adults with opioid use disorder; however, little is known about this co-occurrence. Anxiety sensitivity–the fear of anxiety symptoms and sensations–motivates behaviors to escape and avoid distressing states, and accordingly is associated with coping motives for substance use. This might be particularly relevant among women, who report using substances to cope with negative emotions more often than men. The aim of the current study was to examine whether nonmedical benzodiazepine use was associated with higher anxiety sensitivity among treatment-seeking adults diagnosed with opioid use disorder, and to investigate whether gender moderated this association. A sample of adults (ranging in age from 18 to 81 years) receiving inpatient treatment for opioid use disorder (N = 257) completed measures of anxiety, anxiety sensitivity, and benzodiazepine use frequency. Results of an analysis of variance indicated that frequency of past-month nonmedical benzodiazepine use was associated with significantly higher anxiety sensitivity. This effect remained when controlling for the effect of anxiety symptoms (F[1, 251] = 3.91, p = 0.049, η_p² = 0.02). Gender moderated this association, and post-hoc analyses found a strong association between nonmedical benzodiazepine use and anxiety sensitivity in women, and not men. Anxiety sensitivity, which can be reduced with treatment, might be a candidate therapeutic target in this population, particularly in women.
Risk factors associated with benzodiazepine use among people who inject drugs in an urban Canadian setting
2016, Addictive Behaviors
Though known to have abuse potential, benzodiazepine medications remain widely prescribed. Furthermore, issues related to benzodiazepine use by people who inject drugs (PWID) remain to be fully characterized. We therefore sought to examine the prevalence of and risk factors associated with benzodiazepine use in a street-involved urban population.
Between May 1996 and November 2013, data were derived from two open prospective cohort studies in Vancouver, Canada, restricted to PWID. Multivariable logistic regression with generalized estimating equations (GEE) was used to determine factors independently associated with benzodiazepine use.
Over the study period, 2806 individuals were recruited, including 949 (34%) women. Of these, 1080 (38.5%) participants reported benzodiazepine use at least once during the study period. In the multivariable analysis, Caucasian ethnicity, ≥ daily heroin injection, ≥ daily cocaine injection, non-fatal overdose, incarceration, syringe sharing, and unsafe sex were all independently associated with benzodiazepine use. Conversely, older age, homelessness, and ≥ daily crack smoking were negatively associated with benzodiazepine use.
Use of benzodiazepines was common in this urban setting and was associated with several markers of addiction severity and significant health and social vulnerabilities including syringe sharing and unsafe sex. These findings underscore the need to promote treatment for benzodiazepine use, safer benzodiazepine prescribing, including greater recognition of the limited indications for evidence-based use of this medication class.
Treatment or "high": Benzodiazepine use in patients on injectable heroin or oral opioids
2013, Addictive Behaviors
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.

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Diazepam use among methadone maintenance patients: Patterns and dosages

Abstract

Pharmacol. Biochem. Behav.

Life Sciences

The Benzodiazepines: Use, Overuse, Misuse, Abuse

Dependence liability of several sedative-hypnotic agents evaluated in monkeys

J. Pharmacol. Exp. Ther.

Benzodiazepine self-administration in animals and humans: A comprehensive literature review

Human drug self-administration: Double-blind comparison of pentobarbital, diazepam, chlorpromazine and placebo

J. Pharmacol. Exp. Ther.

Drug preference in humans: Double-blind choice comparison of pentobarbital, diazepam, and placebo

J. Pharmacol. Exp. Ther.

Narcotic addiction treatment: Behavioral methods concurrent with methadone maintenance

Int. J. Addict.