Correlates of benzodiazepine abuse in methadone maintenance treatment. A 1 year prospective study in an Israeli clinic

Dr Miriam & Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel-Aviv Elias Sourasky Medical Center, Israel.
Addiction (Impact Factor: 4.74). 11/1999; 94(10):1533-40.
Source: PubMed

ABSTRACT This study addressed the following questions for patients after 1 year of methadone maintenance treatment (MMT); (1) What are the demographic features and past history of drug use of benzodiazepine (BZD) abusers? (2) Do BZD abusers abuse more heroin, cocaine and/or cannabis and do they receive a higher methadone dosage level? (3) Do BZD abusers suffer more from hepatitis C (HCV) and do they have more HIV/HCV risk-taking behaviors than non-abusers? (4) Do BZD abusers have more psychopathology and more emotional distress than non-abusers?
All 148 patients who completed 1 year of MMT underwent random and twice-weekly observed urine analysis for various drugs of abuse, responded to self-report questionnaires (SCL-90-R; POMS; HIV/HCV risk-taking behaviors), interviews (ASI) and underwent testing for hepatitis C. Abuse in this study is defined as any use during the 12th month of treatment.
After 1 year of MMT, more BZD abusers (n = 63) were single, had spent time in prison, were unemployed and had at least one parent with an addiction problem or mental illness in comparison to non-abusers (n = 85). They had started using heroin and cocaine earlier and currently abused more cocaine, heroin and cannabis. They had significantly more psychopathology and negative mood. They had significantly more HCV and reported more HIV/HCV risk-taking behavior.
We suggest that this group of patients is in need of more intensive pharmacological and psychological treatment.

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    • "psychosocial functioning, ongoing substance use, psychiatric and somatic comorbidity and death related to overdose (Bleich et al., 1999; Ghitza et al., 2008; Marzo et al., 2009; McCowan, Kidd, & Fahey, 2009; Peles et al., 2009; Schreiber, Peles, & Adelson, 2008). There is some evidence that heroin-assisted treatment (HAT) may be associated with a greater reduction in BZD use than methadone maintenance (Eiroa-Orosa et al., 2010; Perneger, Giner, del Rio, & Mino, 1998). "
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    ABSTRACT: 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.
    Addictive behaviors 05/2013; 38(10):2477-2484. DOI:10.1016/j.addbeh.2013.05.008 · 2.76 Impact Factor
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    • "BZD use is frequently part of a polysubstance consumption pattern in untreated opiate addicts (Verthein et al., 2001), and BZD dependence is associated with increased rates of additional substance-related disorders (Chutuape et al., 1997; Ross and Darke, 2000). In MMT, BZD-using patients showed increased rates for heroin, cocaine, cannabis and daily alcohol use (Fairbank et al., 1993; Bleich et al., 1999; Backmund et al., 2003). "
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    ABSTRACT: OBJECTIVE: Cross-sectional studies show that considerable proportions of opiate dependents in methadone maintenance treatment (MMT) consume benzodiazepines (BZD). The longitudinal patterns of BZD use over time were described here. METHODS: After admission to MMT, patients from two outpatient MMT clinics (n = 345) were observed for up to 2 years whilst in treatment. The use of BZD, cannabis, opiates and cocaine was assessed by urine sampling carried out twice a month. RESULTS: For the whole sample, the mean BZD-positive urine specimen rate was 0.36 during the first 3 months. Rates slightly decreased during the first year and remained stable afterwards (last observation carried forward). For study completers (n = 152), the rate decreased over time, from 0.31 (first 3-month period) to 0.19 (last period; p < 0.001). According to a longitudinal cluster analysis, 26% of all patients showed a pattern of constantly high BZD-positivity rates, mostly in combination with other substances. Inpatient detoxifications from BZD (carried out in 18% of cases) did not have a sustained effect on levels of BZD use. CONCLUSIONS: BZD consumption in MMT is often part of a polydrug consumption pattern and is associated with poorer treatment retention. It is necessary to further investigate the reasons for BZD use in MMT patients and to develop effective interventions to reduce levels of BZD consumption. Copyright © 2011 John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 08/2011; 26(6). DOI:10.1002/hup.1222 · 2.19 Impact Factor
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    • "In opioid-maintained samples, BZD use has been associated with poor treatment outcomes, such as worse psychosocial functioning, continuing substance misuse, psychiatric and somatic comorbidities and drug-related death (Bleich et al., 1999; Ghitza et al., 2008; Marzo et al., 2009; McCowan et al., 2009; Peles et al., 2009; Schreiber et al., 2008; Wedekind et al., 2010). One study reported methadone-maintained patients with BZD abuse had an eightfold increase of risk of death (Caplehorn, 1996). "
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    ABSTRACT: Benzodiazepine (BZD) misuse in opioid-maintained patients is widespread and has been related to poorer treatment success. Associated factors, in particular, traumatic childhood experiences, have not been investigated extensively. Cross-sectional survey including the childhood trauma questionnaire (CTQ) and clinical data among 193 patients prescribed oral opioids or injectable diacetylmorphine for opioid dependence. BZD use was prevalent (61%) and the burden of childhood traumatic experiences was high with 67% reporting at least one trauma subscore of moderate-to-severe level. In univariate analysis, CTQ-subcategories "emotional abuse" (p<0.05), "emotional neglect" (p<0.01) and "physical neglect" (p<0.001) were significantly associated with prolonged BZD use. In multivariate analysis, prolonged BZD use was associated with categorized overall CTQ-scores (OR 1.5), HCV-seropositivity (OR 4.0), psychiatric family history (OR 2.3), and opioid dose (mg methadone equivalents, OR 1.010). Childhood traumatic experiences may be associated with prolonged BZD use in opioid-maintained patients and could pose an important starting-point for prevention.
    Drug and alcohol dependence 06/2011; 119(1-2):93-8. DOI:10.1016/j.drugalcdep.2011.05.037 · 3.42 Impact Factor
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