Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review
Adam Bakker et al. J Psychopharmacol. 2017 Jan.
Abstract PubMed PMID
Full text linksCite
Background: Co-prescribing benzodiazepines to patients in opiate substitution treatment is controversial and often alleged to increase mortality. In an inner-London general practice, patients with problematic benzodiazepine co-dependence were allowed benzodiazepine maintenance treatment (BMT) since 1994, providing an opportunity for analysis.
Method: 1) Case-note review of all 278 opiate substitution treatment patients, accruing 1289 patient treatment years; 46% had concurrent BMT. 2) National Health Service database search for patients who died after leaving accrued a further 883 years of information; only patients who left the UK were unaccounted for (4%). Three groups were studied: 1) never obtained benzodiazepine prescription (NOB): n=80); 2) briefly/occasionally prescribed benzodiazepines (BOP): n=71; 3) BMT: n=127.
Outcomes measured: Treatment retention (months); deaths/100 patient treatment years; deaths after leaving the service/100 years of information.
Results: Treatment retention: NOB: 34 months; BOP: 51 months; BMT: 72 months. In-treatment mortality: NOB: 1.79/100 patient treatment years; BOP: 0.33/100 patient treatment years; BMT: 1.31/100 patient treatment years. Deaths after leaving service: NOB: 2.24/100 years of information, BOP: 0.63/100 years of information. However, mortality for previously BMT-patients increased by 450% to 5.90/100 years of information.
Discussion: BMT patients had longer treatment retention than NOB or BOP and lower mortality than NOB patients. It is unlikely that patients had access to prescribed benzodiazepines on leaving the service because of restrictions in the national guidelines but co-dependent patients are a high-risk group who may stand to gain most benefit from opiate substitution treatment if combined with benzodiazepine-maintenance.
Keywords: Benzodiazepine; addiction; maintenance; opiate; substitution.
Benzodiazepine use during buprenorphine treatment for opioid dependence: clinical and safety outcomes.
Schuman-Olivier Z, et al. Drug Alcohol Depend. 2013. PMID: 23688843 Free PMC article.
Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians.
DeFlavio JR, et al. Rural Remote Health. 2015. PMID: 25651434 Review.
Impact of pharmacist and clinician dual intervention on prescribed benzodiazepines in prisoner patients: a retrospective study.
Lerat MC, et al. Fundam Clin Pharmacol. 2011. PMID: 21166860
Using Client's Routine Urinalysis Records From Multiple Treatment Systems to Model Five-Year Opioid Substitution Treatment Outcomes.
Comiskey CM, et al. Subst Use Misuse. 2016. PMID: 26942315
Medication-assisted treatment with buprenorphine: assessing the evidence.
Thomas CP, et al. Psychiatr Serv. 2014. PMID: 24247147 Review.
See all similar articles
Cited by 8 articles
Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence: A Systematic Review and Meta-analysis.
Santo T Jr, et al. JAMA Psychiatry. 2021. PMID: 34076676
Harm reduction in the time of COVID-19: Case study of homelessness and drug use in Dublin, Ireland.
O'Carroll A, et al. Int J Drug Policy. 2021. PMID: 33166825 Free PMC article.
Same-day vs. delayed buprenorphine prescribing and patient retention in an office-based buprenorphine treatment program.
Jakubowski A, et al. J Subst Abuse Treat. 2020. PMID: 33138925
Potentially addictive drugs dispensing to patients receiving opioid agonist therapy: a register-based prospective cohort study in Norway and Sweden from 2015 to 2017.
Vold JH, et al. BMJ Open. 2020. PMID: 32771988 Free PMC article.
Dispensations of benzodiazepines, z-hypnotics, and gabapentinoids to patients receiving opioid agonist therapy; a prospective cohort study in Norway from 2013 to 2017.
Vold JH, et al. BMC Health Serv Res. 2020. PMID: 32334602 Free PMC article.
See all "Cited by" articles
Benzodiazepines / therapeutic use*
Opiate Substitution Treatment / methods
Opioid-Related Disorders / etiology*
Related informationCited in BooksPubChem Compound (MeSH Keyword)
LinkOut - more resourcesFull Text SourcesAtyponOvid Technologies, Inc.Other Literature Sourcesscite Smart CitationsMedicalClinicalTrials.govMedlinePlus Health InformationResearch MaterialsNCI CPTC Antibody Characterization Program