Benzodiazepine Use and Misuse Among Patients in a Methadone Program

Center for Integrative Medicine University of Maryland School of Medicine 520 W, Lombard St, East Hall, Baltimore, MD 21201, USA.
BMC Psychiatry (Impact Factor: 2.21). 05/2011; 11(1):90. DOI: 10.1186/1471-244X-11-90
Source: PubMed


Benzodiazepines (BZD) misuse is a serious public health problem, especially among opiate-dependent patients with anxiety enrolled in methadone program because it puts patients at higher risk of life-threatening multiple drug overdoses. Both elevated anxiety and BZD misuse increase the risk for ex-addicts to relapse. However, there is no recent study to assess how serious the problem is and what factors are associated with BZD misuse. This study estimates the prevalence of BZD misuse in a methadone program, and provides information on the characteristics of BZD users compared to non-users.
An anonymous survey was carried out at a methadone program in Baltimore, MD, and all patients were invited to participate through group meetings and fliers around the clinic on a voluntary basis. Of the 205 returned questionnaires, 194 were complete and entered into final data analysis. Those who completed the questionnaire were offered a $5 gift card as an appreciation.
47% of the respondents had a history of BZD use, and 39.8% used BZD without a prescription. Half of the BZD users (54%) started using BZD after entering the methadone program, and 61% of previous BZD users reported increased or resumed use after entering methadone program. Compared to the non-users, BZD users were more likely to be White, have prescribed medication for mental problems, have preexistent anxiety problems before opiate use, and had anxiety problems before entering methadone program. They reported more mental health problems in the past month, and had higher scores in anxiety state, depression and perceived stress (p < .05).
Important information on epidemiology of BZD misuse among methadone-maintenance patients suggests that most methadone programs do not address co-occurring anxiety problems, and methadone treatment may trigger onset or worsening of BZD misuse. Further study is needed to explore how to curb misuse and abuse of BZD in the addiction population, and provide effective treatments targeting simultaneously addiction symptoms, anxiety disorders and BZD misuse.

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    • "In opiate-dependent patients, the misuse and abuse of BZD is a public health problem because methadone and BZD both have sedating effects on the central nervous system, which lead to difficulty in breathing as well as cognitive impairment [27] [28]. A recent survey revealed a 47% prevalence of lifetime use of BZD among methadonemaintained patients [29] and nonprescribed BZD use among MMT patients ranged from 44 to 66% [30] [31]. In addition , methadone-maintained patients who abuse BZD are associated with higher rates of depression and anxiety [32], increased risk of continuing opiate abuse, and discontinuing methadone treatment [33] [34]. "
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    • "In particular, studies conducted on a population of heroin addicts in methadone maintenance showed that the co-occurrence of BZD abuse worsened the QoL of these patients (Chen et al., 2011; Brands et al., 2008; Vorma et al., 2004; Brunette et al., 2003; Colpaert et al., 2012). However, in these settings BZD are usually prescribed for the management of withdrawal symptoms, of major psychiatric disorders or represent a co-dependence. "
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    • "These findings are congruent with previous research that links the misuse of prescription drugs to mental health problems (Seal et al., 2012; Herman-Stahl et al., 2007). Depression, in particular, appears to be an important and consistent risk factor for BZ misuse across a variety of populations (Chen et al., 2011; Rooney et al., 1999). Patients receiving BZs for anxiety or insomnia, for example, may be more prone to misuse when depressive symptoms are also present. "
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