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.

Download full-text


Available from: Kevin W Chen, Oct 08, 2015
29 Reads
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Methadone maintenance therapy is an effective treatment for opiate dependence, but more than three-quarters of persons receiving the treatment report sleep quality disturbances. In this double-blind, randomized, controlled trial, we recruited 90 individuals receiving methadone for at least one month who reported sleep disturbances and had Pittsburgh Sleep Quality Index (PSQI) scores > 5. The purpose of this study was to determine whether Suan Zao Ren Tang, one of the most commonly prescribed traditional Chinese medications for treatment of insomnia, improves subjective sleep among methadone-maintained persons with disturbed sleep quality. Ninety patients were randomly assigned to intervention group (n = 45) and placebo group (n = 45), and all participants were analyzed. Compared with placebo treatment, Suan Zao Ren Tang treatment for four weeks produced a statistically significant improvement in the mean total PSQI scores (P = 0.007) and average sleep efficiency (P = 0.017). All adverse events (e.g., lethargy, diarrhea, and dizziness) were mild in severity. Suan Zao Ren Tang is effective for improving sleep quality and sleep efficiency among methadone-maintained patients with sleep complaints.
    Evidence-based Complementary and Alternative Medicine 09/2015; 2015(15):710895. DOI:10.1155/2015/710895 · 1.88 Impact Factor
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The misuse of benzodiazepines (BZs) among adolescents is an important issue within the fields of mental health, medicine, and public health. Though there is an increasing amount of research on prescription medication misuse, a relatively small number of studies focus on adolescent BZ misuse. The goal of this study, therefore, is to identify demographic and psychosocial factors that place adolescents at risk for misusing BZs. Additionally, the authors applied concepts from social bonding theory, social learning theory, and strain theory to determine the extent to which these concepts explain BZ misuse. Methods Using data from the 2011 National Survey of Drug Use & Health, multivariate logistic regression models were estimated to determine which factors were associated with an increased risk of BZ misuse. Results These findings help to describe the psychosocial profile of adolescent BZ misusers which should increase the ability of clinicians to identify patients who may be at greater risk for misuse. Conclusion This study is particularly important within the context of psychiatry, where a clearer understanding of adolescent BZ misuse is critical for informing prevention efforts and developing best practices for prescribing BZs.
    Drug and alcohol dependence 04/2014; 137(1). DOI:10.1016/j.drugalcdep.2014.01.026 · 3.42 Impact Factor
  • Source
    • "This characteristic has also been confi rmed by an objective polysomnography study (Peles et al. 2009). The factors that were closely related to poor sleep among MMT patients were benzodiazepine (BDZ) abuse which is highly prevalent ( ˜ 45%) among MMT patients worldwide (Peles et al. 2008; Chen et al. 2011), and chronic pain, which is also reported to be highly prevalent among MMT patients, ranging between 37 and 46.5% depending on pain severity (Rosenblum et al. 2003; Peles et al. 2005). The cause-and-effect association between poor sleep-quality and poor cognitive-state is well established (Taras et al. 2005; Mansukhani et al. 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. Methadone maintenance treatment (MMT) patients may achieve up to a 2-week privilege of methadone take-home doses (THD), which is associated with considerable responsibility. MMT patients are characterized as having poor sleep quality and low cognitive states. We studied sleep indices and cognitive status with respect to THD privileges. Methods. A sample of 123 MMT patients stratified by THD groups was studied. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the cognitive Clock Drawing Test (CDT) were performed. Results. Thirty-one of 123 patients never had any THD and 92 did (25 had the maximum of 2 weeks). The never THD had history of longer duration of opiate usage and a shorter period in MMT. They had the highest rates of poor sleep (80.6%, PSQI > 5), daily sleepiness ("fall asleep while talking") (41.9%), and impaired cognitive status (58.1%, CDT < 3), while those who had 2-week privileges had the lowest (56, 8, and 28%, respectively). Logistic regression characterized THD patients as no-benzodiazepine and no-cocaine, short opiate usage duration, low ADHD scores, and no cognitive impairment (CDT = 3) and its interaction with treatment duration. Conclusion. Privileges that reflect patients' abstinence and rehabilitation were also expanded to be associated with better cognitive states. These finding confirm the THD dispensing performance. Including CDT as part of the decision for dispensing THD may be considered.
    The World Journal of Biological Psychiatry 03/2014; 15(8). DOI:10.3109/15622975.2014.897003 · 4.18 Impact Factor
Show more