A qualitative study of benzodiazepine/z-drug and opioid co-use patterns and overdose risk.

The co-use of benzodiazepines and/or 'z-drugs' with opioids has been linked to an increase in drug-related deaths (DRDs) in the UK. To better understand this issue, a study was conducted to explore the patterns of co-use among individuals who take both illicit and/or prescribed opioids and benzodiazepines/z-drugs. The study involved 48 semi-structured interviews with participants from Glasgow, Bristol, and Teesside, with 18 of these interviews co-facilitated by local peer researchers. The interviews were analyzed using the Framework method, which revealed six distinct co-use patterns. These patterns ranged from more controlled co-use, where individuals used benzodiazepines and opioids to self-medicate and manage anxiety, to less controlled co-use, where individuals sought euphoria or oblivion through poly-drug use. The six co-use patterns identified in the study were: (1) co-use to aid sleep or come down, (2) curated co-use with opioid agonist therapy (OAT) only, (3) morning and evening benzodiazepine doses with opioids throughout the day, (4) co-use binges, (5) co-use throughout the day, and (6) benzodiazepine use throughout the day plus OAT. Patterns one to three were characterized by more controlled co-use, with a focus on self-medicating to manage anxiety, promote sleep, and come down from other substances. Patterns four to six, on the other hand, involved less controlled co-use and a focus on seeking euphoria or oblivion, often as a way to escape untreated mental health conditions and trauma. Notably, near-fatal overdoses were reported by participants across all co-use patterns, with patterns four to six presenting a greater overdose risk due to the less controlled co-use and poly-drug use. The study's findings suggest that tailored harm reduction strategies, updated prescribing guidance, and improved access to mental health care could help reduce DRDs among individuals who co-use benzodiazepines and opioids. By understanding the different co-use patterns, healthcare professionals and policymakers can develop more effective interventions to address this complex issue.

Link: https://pubmed.ncbi.nlm.nih.gov/40016748/