University:
Boston University
Course:
SAR HP 151 | Introduction to Health Professions
Academic year:

2024
Views:

433

Pages:

14
Author:

Hanusia3lug

Benzodiazepine prescribing in opioid agonist therapy: the risks and the benefits Benzodiazepine prescribing attitudes Geppert, 2007 Benzodiazepine-related mortality NIDA Benzodiazepines and opioids Benzodiazepines are commonly involved in opioid analgesic overdose cases Benzodiazepines can increase respiratory depression caused by opioids Jones, 2013 White, 1999 Benzodiazepines and risk of opioid overdose Hazard ratio 95% CI 1.00 (ref) - 3.72 3.36-4.12 >0-10 1.00 (ref) - >10-20 1.59 1.34-1.90 >20-30 2.27 1.86-2.79 >30-40 2.47 1.96-3.11 >40 2.93 2.29-3.76 Benzodiazepine exposure None Currently prescribed Benzodiazepine dose Park, 2015 Benzodiazepines and overdose in opioid agonist therapy Benzodiazepine use in methadone maintenance treatment is associated with increased risk of overdose death ◦ Cohort study in Scotland ◦ Case-control study in UK McCowan, 2009 Oliver, 2007 Benzodiazepine prescribing in opioid agonist therapy Benzodiazepine prescribing in opioid agonist therapy varies by region ◦ Buprenorphine: 11-39% ◦ Methadone: 7-24% Variation in practice may reflect prescriber uncertainty Park, 2014 Efficacy of benzodiazepines Meta-analysis for GAD, panic disorder, and SAD Bandelow et al, 2015 Anxiety and relapse Anxiety associated with relapse and poorer treatment outcomes in substance use disorders ◦ Five times increased risk of re-admission for alcohol treatment ◦ Associated with worse addiction treatment outcomes Tomasson, 1998 Compton, 2003 Benzodiazepines and treatment retention Benzodiazepine prescription associated with increased methadone treatment retention in one clinic Benzodiazepine prescription predicted one year treatment retention in buprenorphine treatment in BMC’s Department of Psychiatry Bakker, 2017 Montalvo, in preparation Benzodiazepine use in opioid agonist therapy POTENTIAL RISKS: Overdose death Addiction to benzodiazepine POTENTIAL BENEFITS: Treats anxiety Improves treatment retention Qualitative study: Benzodiazepine use in opioid agonist therapy Research questions Among patients who receive opioid agonist therapy and have used benzodiazepines, what are the: ◦ Motivations for benzodiazepine use? ◦ Patient understanding of the risks and benefits of benzodiazepine use? ◦ Barriers and facilitators for discontinuing benzodiazepine use? Methods 18 participants Inclusion criteria: Adults receiving opioid agonist therapy, have regularly used benzodiazepines, and speak English Purposive sampling from an office-based buprenorphine clinic and a methadone clinic Interviews were conducted and transcribed by the PI and 2 research assistants Interview guide was a semi-structured interview based on a priori topic areas