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Koniuszewski F, Vogel FD, Dajić I, Seidel T, Kunze M, Willeit M, Ernst M. Navigating the complex landscape of benzodiazepine- and Z-drug diversity: insights from comprehensive FDA adverse event reporting system analysis and beyond. Front Psychiatry 2023; 14:1188101. [PMID: 37457785 PMCID: PMC10345211 DOI: 10.3389/fpsyt.2023.1188101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Medications which target benzodiazepine (BZD) binding sites of GABAA receptors (GABAARs) have been in widespread use since the nineteen-sixties. They carry labels as anxiolytics, hypnotics or antiepileptics. All benzodiazepines and several nonbenzodiazepine Z-drugs share high affinity binding sites on certain subtypes of GABAA receptors, from which they can be displaced by the clinically used antagonist flumazenil. Additional binding sites exist and overlap in part with sites used by some general anaesthetics and barbiturates. Despite substantial preclinical efforts, it remains unclear which receptor subtypes and ligand features mediate individual drug effects. There is a paucity of literature comparing clinically observed adverse effect liabilities across substances in methodologically coherent ways. Methods In order to examine heterogeneity in clinical outcome, we screened the publicly available U.S. FDA adverse event reporting system (FAERS) database for reports of individual compounds and analyzed them for each sex individually with the use of disproportionality analysis. The complementary use of physico-chemical descriptors provides a molecular basis for the analysis of clinical observations of wanted and unwanted drug effects. Results and Discussion We found a multifaceted FAERS picture, and suggest that more thorough clinical and pharmacoepidemiologic investigations of the heterogenous side effect profiles for benzodiazepines and Z-drugs are needed. This may lead to more differentiated safety profiles and prescription practice for particular compounds, which in turn could potentially ease side effect burden in everyday clinical practice considerably. From both preclinical literature and pharmacovigilance data, there is converging evidence that this very large class of psychoactive molecules displays a broad range of distinctive unwanted effect profiles - too broad to be explained by the four canonical, so-called "diazepam-sensitive high-affinity interaction sites". The substance-specific signatures of compound effects may partly be mediated by phenomena such as occupancy of additional binding sites, and/or synergistic interactions with endogenous substances like steroids and endocannabinoids. These in turn drive the wanted and unwanted effects and sex differences of individual compounds.
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Affiliation(s)
- Filip Koniuszewski
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Florian D. Vogel
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Irena Dajić
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Seidel
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Markus Kunze
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Matthäus Willeit
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Margot Ernst
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
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Edinoff AN, Nix CA, Hollier J, Sagrera CE, Delacroix BM, Abubakar T, Cornett EM, Kaye AM, Kaye AD. Benzodiazepines: Uses, Dangers, and Clinical Considerations. Neurol Int 2021; 13:594-607. [PMID: 34842811 PMCID: PMC8629021 DOI: 10.3390/neurolint13040059] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Benzodiazepines (BZDs) are among one of the most widely prescribed drug classes in the United States. BZDs are a class of psychoactive drugs known for their depressant effect on the central nervous system (CNS). They quickly diffuse through the blood-brain barrier to affect the inhibitory neurotransmitter GABA and exert sedative effects. Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy. One of the debilitating side effects of BZDs is their addictive potential. The dependence on BZDs generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed. Regular use of BZDs has been shown to cause severe, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal. Some of these withdrawal symptoms can be life threatening. The current treatment for withdrawal is through tapering with clonazepam. Many drugs have been tested as a treatment for withdrawal, with few proving efficacious in randomized control trials. Future research is warranted for further exploration into alternative methods of treating BZD withdrawal. This call to action proves especially relevant, as those seeking treatment for BZD dependence and withdrawal are on the rise in the United States.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.A.N.); (J.H.)
- Correspondence: ; Tel.: +1-(318)-675-8969
| | - Catherine A. Nix
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.A.N.); (J.H.)
| | - Janice Hollier
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.A.N.); (J.H.)
| | - Caroline E. Sagrera
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.E.S.); (B.M.D.); (T.A.)
| | - Blake M. Delacroix
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.E.S.); (B.M.D.); (T.A.)
| | - Tunde Abubakar
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.E.S.); (B.M.D.); (T.A.)
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
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Abstract
In this paper, I reflect on two of my intertwined research interests. The first is my professional engagement with researching drug use and abuse in Ireland, especially heroin addiction, in applied ethnographic projects, generally answering a specific set of questions on how services for 'drug addiction' work. My second interest is the historical construction of 'addiction' and the discursive intersections that produce various kinds of power, subjects, and techniques around this concept. I find the dialectical relationship between heroin and methadone in Ireland, especially the emergence of heroin 'injecting rooms', as a window into how drugs are social things. Drugs and the bodies who take them live in complex moral worlds, not as inert objects surrounded by abstract human creations. These worlds are an integral part of how 'addiction' works and how drugs treating addiction are actually used. Without a deeper understanding of such complexities we will continue to miss key issues in the lives of people we hope to help.
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Affiliation(s)
- A Jamie Saris
- Department of Anthropology, Maynooth University, Maynooth, Ireland
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Mori T, Iwase Y, Uzawa N, Takahashi Y, Mochizuki A, Fukase M, Shibasaki M, Suzuki T. Synergistic effects of MDMA and ethanol on behavior: Possible effects of ethanol on dopamine D 2 -receptor-related signaling. Addict Biol 2021; 26:e13000. [PMID: 33372347 DOI: 10.1111/adb.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
Polydrug abuse is common among drug abusers. In particular, psychostimulants are often taken with ethanol, and the combination of 3,4-methylenedioxymethamphetamine (MDMA) and alcohol is one of the most common forms of polydrug abuse. However, the mechanism by which these drugs influence behavior remains unclear. The present study was designed to delineate the mechanisms that underlie the effects of the interaction between MDMA and ethanol on behavior in rodents. The combination of MDMA with ethanol enhanced their locomotor-increasing, rewarding, and discriminative stimulus effects without enhancing their effects on the release of dopamine from the nucleus accumbens in rodents. In addition, ethanol potently enhanced locomotor activity produced by the dopamine receptor agonist apomorphine in mice. In antagonism tests, the dopamine D1 -receptor antagonist SCH23390, but not the D2 -receptor antagonist haloperidol, completely suppressed hyperlocomotion induced by MDMA. However, hyperlocomotion induced by the co-administration of MDMA and ethanol was potently suppressed by haloperidol. These results suggest that the synergistic effects of MDMA and ethanol are mediated through dopamine transmission, especially through postsynaptical regulation of D2 -receptor-mediated functions.
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Affiliation(s)
- Tomohisa Mori
- Department of Pharmacology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
- Department of Toxicology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
| | - Yoshiyuki Iwase
- Department of Pharmacology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
- Department of Toxicology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
| | - Naoki Uzawa
- Department of Pharmacology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
- Department of Toxicology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
| | - Yui Takahashi
- Department of Pharmacology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
- Department of Toxicology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
| | - Ayano Mochizuki
- Department of Toxicology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
| | - Mika Fukase
- Department of Toxicology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
| | - Masahiro Shibasaki
- Department of Pharmacology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
- Department of Toxicology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
| | - Tsutomu Suzuki
- Department of Toxicology Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
- Institute of Drug Addiction Research Hoshi University School of Pharmacy and Pharmaceutical Sciences Tokyo Japan
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Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend 2019; 200:95-114. [PMID: 31121495 PMCID: PMC6639084 DOI: 10.1016/j.drugalcdep.2019.02.033] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. METHODS PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. RESULTS The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. CONCLUSIONS Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
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Affiliation(s)
- Victoria R. Votaw
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA,Corresponding author: Victoria R. Votaw, Clinical Psychology Ph.D. Student Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, Albuquerque, NM 87131,
| | - Rachel Geyer
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Maya M. Rieselbach
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
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Yamamoto T, Dargan PI, Dines A, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Sedefov R, Wood DM. Concurrent Use of Benzodiazepine by Heroin Users-What Are the Prevalence and the Risks Associated with This Pattern of Use? J Med Toxicol 2018; 15:4-11. [PMID: 30066312 DOI: 10.1007/s13181-018-0674-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Polydrug use involving heroin and benzodiazepines is common. The potential risk of additive pharmacological effects may be associated with poorer outcomes in patients who use benzodiazepines together with heroin. The aim of this study was to determine the clinical picture of patients presenting to the emergency department following acute drug toxicity involving heroin and benzodiazepines. METHODS Exposure information, clinical data and outcome of acute drug toxicity presentations were collected between 1 October 2013 and 30 September 2014 as part of the European Drug Emergencies Network (Euro-DEN) project. The database was interrogated to identify patients who had taken heroin with or without benzodiazepine(s). RESULTS A total of 1345 presentations involving acute heroin toxicity were identified: 492 had used one or more non-heroin/benzodiazepine drug and were not further considered in this study; 662 were lone heroin users and 191 had co-used heroin with one or more benzodiazepines. Co-users were more likely than lone heroin users to have reduced respiratory rate at presentation 12.7 ± 4.9 vs 13.6 ± 4.4 (p = 0.02) and require admission to hospital 18.3 vs 9.8% (p < 0.01). There were no differences in critical care admission rates 3.1 vs 3.9% (p = 0.83) or length of stay 4 h 59 min vs 5 h 32 min (p = 0.23). The 3 most common benzodiazepines were clonazepam, diazepam, and alprazolam. No differences were observed for clinical features between the three benzodiazepines. CONCLUSION This study shows that co-use of heroin and benzodiazepines is common, although the overall outcomes between co-users of heroin and benzodiazepines and heroin-only users were similar.
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Affiliation(s)
- T Yamamoto
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - P I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - C Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain
| | - F Heyerdahl
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - K E Hovda
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - I Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - R Sedefov
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - D M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. .,Faculty of Life Sciences and Medicine, King's College London, London, UK.
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Calcaterra SL, Severtson SG, Bau GE, Margolin ZR, Bucher-Bartelson B, Green JL, Dart RC. Trends in intentional abuse or misuse of benzodiazepines and opioid analgesics and the associated mortality reported to poison centers across the United States from 2000 to 2014. Clin Toxicol (Phila) 2018; 56:1107-1114. [DOI: 10.1080/15563650.2018.1457792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- S. L. Calcaterra
- Department of Medicine, Division of Hospital Medicine, Denver Health Medical Center, Denver, CO, USA
- Department of Medicine, Division of General Internal Medicine, University of Colorado Denver, CO, USA
| | - S. G. Severtson
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - G. E. Bau
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Z. R. Margolin
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - B. Bucher-Bartelson
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - J. L. Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - R. C. Dart
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
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High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:17-27. [PMID: 28577506 DOI: 10.1016/j.drugpo.2017.05.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/08/2017] [Accepted: 05/03/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular-a combination that can increase the risk for fatal and non-fatal overdose. This mixed-methods study examines nonmedical use of benzodiazepines among young adults in New York City and its relationship with opioid use. METHODS For qualitative analysis, 46 90-minute semi-structured interviews were conducted with young adult opioid users (ages 18-32). Interviews were transcribed and coded for key themes. For quantitative analysis, 464 young adult opioid users (ages 18-29) were recruited using Respondent-Driven Sampling and completed structured interviews. Benzodiazepine use was assessed via a self-report questionnaire that included measures related to nonmedical benzodiazepine and opioid use. RESULTS Participants reported using benzodiazepines nonmedically for a wide variety of reasons, including: to increase the high of other drugs; to lessen withdrawal symptoms; and to come down from other drugs. Benzodiazepines were described as readily available and cheap. There was a high prevalence (93%) of nonmedical benzodiazepine use among nonmedical opioid users, with 57% reporting regular nonmedical use. In bivariate analyses, drug-related risk behaviours such as polysubstance use, drug binging, heroin injection and overdose were strongly associated with regular nonmedical benzodiazepine use. In multivariate analysis, growing up in a middle-income household (earning between $51,000 and $100,000 annually), lifetime overdose experience, having ever used cocaine regularly, having ever been prescribed benzodiazepines, recent drug binging, and encouraging fellow drug users to use benzodiazepines to cope with opioid withdrawal were consistently strong predictors of regular nonmedical benzodiazepine use. CONCLUSION Nonmedical benzodiazepine use may be common among nonmedical opioid users due to its drug-related multi-functionality. Harm reduction messages should account for the multiple functions benzodiazepines serve in a drug-using context, and encourage drug users to tailor their endorsement of benzodiazepines to peers to include safer alternatives.
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Stein MD, Anderson BJ, Kenney SR, Bailey GL. Beliefs about the consequences of using benzodiazepines among persons with opioid use disorder. J Subst Abuse Treat 2017; 77:67-71. [PMID: 28476275 DOI: 10.1016/j.jsat.2017.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients admitted to addiction treatment programs report high rates of concurrent opioid and benzodiazepine (BZD) use. This combination places individuals at high risk for accidental overdose and other serious consequences. However, little is known about the beliefs opioid users have about the consequences of BZD use. METHODS We surveyed consecutive persons initiating inpatient opioid detoxification (N=476; 95.0% enrollment) and identified 245 who reported BZD use in the past 30days and/or had a positive toxicology. We compared those who did and did not report BZD use on demographic and substance use variables, and specific beliefs about the potential effects of BZDs. RESULTS Participants averaged 32.2years of age, 71.2% were male, 86.6% used heroin, and 68.7% reported injection drug use in the past 30days. Over half (51.5%) used a BZD in the month prior to admission; of these, 26.2% (n=64) reported being prescribed a BZD. Alprazolam (Xanax) was the most commonly used BZD (54%). Benzodiazepine users (versus non-users) were significantly more likely to be female and non-Hispanic White, use concurrent substances, and report past year overdose. Overall, nearly all BZD users endorsed accurate beliefs that BZDs can increase the risk of overdose and can be addictive. However, BZD users, relative to non-users, were significantly less likely to endorse some known adverse consequences of BZDs, such as risk of worsening depression and poor medication-assisted opioid treatment retention. CONCLUSIONS Delineating the full array of risks from combining BZDs and opioids should be a high priority in detoxification settings, given the increased risks associated with BZD misuse in this population.
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Affiliation(s)
- Michael D Stein
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States; Boston University School of Public Health, Boston, MA 02118, United States.
| | - Bradley J Anderson
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States
| | - Shannon R Kenney
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States; Warren Alpert Medical School of Brown University, Providence, RI 02912, United States
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, RI 02912, United States; Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, United States
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Peacock A, Bruno R, Larance B, Lintzeris N, Nielsen S, Ali R, Dobbins T, Degenhardt L. Same-day use of opioids and other central nervous system depressants amongst people who tamper with pharmaceutical opioids: A retrospective 7-day diary study. Drug Alcohol Depend 2016; 166:125-33. [PMID: 27430400 DOI: 10.1016/j.drugalcdep.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/27/2016] [Accepted: 07/03/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims were to determine: (i) quantity and frequency of same-day use of opioids with benzodiazepines and/or alcohol amongst people who regularly tamper with pharmaceutical opioids; and (ii) socio-demographic, mental health, harms and treatment profile associated with same-day use of high doses. METHOD The cohort (n=437) completed a retrospective 7-day diary detailing opioid, benzodiazepine, and alcohol intake. Oral morphine equivalent (OME) units and diazepam equivalent units (DEU) were calculated, with >200mg OME, >40mg DEU and >4 standard alcoholic drinks (each 10g alcohol) considered a "high dose". RESULTS One-half (47%) exclusively consumed opioids without benzodiazepines/alcohol; 26% had days of opioid use with and without benzodiazepines/alcohol; and 26% always used opioids and benzodiazepines/alcohol. Same-day use of opioids with benzodiazepines/alcohol typically occurred on 1-3days in the past week. Six in ten (61%) participants reported high dose opioid use on at least one day; one in five (20%) reported high dose opioid and high dose benzodiazepine/alcohol use on at least one day. The latter group were more likely to use prescribed opioid substitution therapy, often alongside diverted pharmaceutical opioids. Socio-demographic and clinical profiles did not vary according to high dose opioid, alcohol and benzodiazepine use, and there was no association with harms. CONCLUSIONS Same-day use of opioids with benzodiazepines/alcohol, and high dose combinations, are common amongst people who tamper with pharmaceutical opioids. Assessment of concomitant benzodiazepine/alcohol use during opioid therapy, implementation of real-time prescription monitoring systems, and research to clarify upper safe limits for polydrug depressant use, are potential implications.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; School of Medicine, University of Tasmania, Tasmania, Australia.
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; School of Medicine, University of Tasmania, Tasmania, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Nick Lintzeris
- Sydney Medical School, Sydney University, New South Wales, Australia; Drug and Alcohol Services, South East Sydney Local Health District, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; Drug and Alcohol Services, South East Sydney Local Health District, New South Wales, Australia
| | - Robert Ali
- University of Adelaide, South Australia, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Rafnsson SB, Oliver JJ, Elton RA, Bateman DN. Poisons admissions in Edinburgh 1981-2001: agent trends and predictors of hospital readmissions. Hum Exp Toxicol 2016; 26:49-57. [PMID: 17334179 DOI: 10.1177/0960327107071855] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Self-poisoning is a major public health problem. This study describes patterns of admissions and readmissions from self-poisoning to the Royal Infirmary of Edinburgh from 1981 to 2001. A database on hospital discharges with a diagnosis (ICD-9/10) of poisoning between 1981 and 2001 was used. Annual admissions were described for seven main drug categories, and proportions of patients readmitted within 1-5 years from first admission, were computed for each category. Cox proportional hazards regression was used to evaluate prognostic factors for readmission risk over 1981-2001. For both sexes, admissions increased from the early to mid 1990s, and declined thereafter. The proportion readmitted varied with the drug taken at first admission, from 11.9% (95% CI: 10.8-13%) for non-opiate analgesics, to 17.6% (16.5-18.7%) for benzodiazepines. Deprivation was positively related to readmission risk after first admissions with paracetamol (P<0.001) and benzodiazepines (P<0.001). Timing of first admissions involving paracetamol (P<0.01), benzodiazepines (P<0.001), antidepressants (P<0.001), non-opiate analgesics (P<0.001), and opiates (P<0.05), was inversely associated with readmission risk. In patients admitted for drug overdose, readmission risk is influenced by type of drug taken at first admission. Information on drug type used in self-poisoning may assist in identifying patients at risk for future events, and in reducing hospital read-missions.
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Affiliation(s)
- S B Rafnsson
- Department of Public Health Sciences, University of Edinburgh Medical School, Teviot Place, EH8 9AG, Edinburgh, UK.
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Stein MD, Kanabar M, Anderson BJ, Lembke A, Bailey GL. Reasons for Benzodiazepine Use Among Persons Seeking Opioid Detoxification. J Subst Abuse Treat 2016; 68:57-61. [PMID: 27431047 DOI: 10.1016/j.jsat.2016.06.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/06/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Over the past decade, patients admitted to addiction treatment programs have reported increasing rates of concurrent opioid and benzodiazepine (BZD) use. This drug combination places individuals at high risk for accidental overdose. Little is known about reasons for BZD use among individuals seeking treatment for opioid use disorders. METHODS We surveyed consecutive persons initiating inpatient opioid detoxification and identified 176 out of 438 who reported BZD use in the past 30 days and/or had a positive toxicology. RESULTS Forty percent of persons surveyed used a BZD in the month prior to admission, and 25% of these met criteria for BZD dependence (DSM IV). BZD users averaged 32.0 years of age, 63.6% were male, 85.2% used heroin, and reported, on average, 13.3 (±11.2) days of BZD use during the past month. Alprazolam (Xanax) was the most commonly used BZD (52%), and buying it on the street the most common source (48%). The most commonly reported reason for BZD use was 'to manage anxiety' (42.6%), followed by 'to get or enhance a high' (27.7%), 'to help with sleep' (11.4%), and 'to decrease opioid withdrawal' (10.2%). The most common reason for BZD use was significantly associated (p<.001) with most likely source of BZDs, with persons who got their BZDs from a prescriber (23%) more likely to report BZD anxiety as their primary reason for use, while persons who bought BZDs on "the street" (48%) had the highest likelihood of reporting using BZD to get or enhance a high. Participants using BZDs most commonly for anxiety did not endorse lower anxiety than those using BZDs for other reasons. CONCLUSIONS Two in five persons seeking detoxification for an opioid use disorder used a BZD in the prior month. Anxiety was the most common reason patients reported using a benzodiazepine, but they also reported using BZDs to enhance a 'high' and manage opioid withdrawal. Evidence-based discussions about the risks of combining BZDs and opioids, and alternatives to BZDs should be a high priority in detoxification settings.
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Affiliation(s)
- Michael D Stein
- Behavioral Medicine Division, Butler Hospital, Providence, RI, 02906, USA; Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA.
| | - Mitika Kanabar
- Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Bradley J Anderson
- Behavioral Medicine Division, Butler Hospital, Providence, RI, 02906, USA
| | - Anna Lembke
- Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA; Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, USA
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Bach P, Walton G, Hayashi K, Milloy MJ, Dong H, Kerr T, Montaner J, Wood E. Benzodiazepine Use and Hepatitis C Seroconversion in a Cohort of Persons Who Inject Drugs. Am J Public Health 2016; 106:1067-72. [PMID: 26985601 DOI: 10.2105/ajph.2016.303090] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To examine the relationship between benzodiazepine (BZD) use and HCV seroconversion in 2 linked prospective cohorts of persons who inject drugs (PWID). METHODS We examined prospective cohorts of 440 PWID (baseline BZD users: n = 102; 23.2%) from the AIDS Care Cohort to Evaluate Access to Survival Services (ACCESS) and the Vancouver Injection Drug Users Study (VIDUS) cohorts, followed-up from 1996 to 2013 in Vancouver, Canada. RESULTS At baseline, the prevalence of HCV was higher among those who used BZD (80.5% vs 61.5%; P < .001). After adjustment, BZD use remained independently associated with increased rates of HCV seroconversion (adjusted rate ratio = 1.67; 95% confidence interval = 1.05, 2.66). CONCLUSIONS BZD use is independently associated with HCV seroconversion in a population of PWID.
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Affiliation(s)
- Paxton Bach
- Paxton Bach, Geoffrey Walton, M-J Milloy, Thomas Kerr, Julio Montaner, and Evan Wood are with the Department of Medicine, University of British Columbia, Vancouver, Canada. Kanna Hayashi, Huiru Dong, Thomas Kerr, Julio Montaner, and Evan Wood are with the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Geoffrey Walton
- Paxton Bach, Geoffrey Walton, M-J Milloy, Thomas Kerr, Julio Montaner, and Evan Wood are with the Department of Medicine, University of British Columbia, Vancouver, Canada. Kanna Hayashi, Huiru Dong, Thomas Kerr, Julio Montaner, and Evan Wood are with the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Kanna Hayashi
- Paxton Bach, Geoffrey Walton, M-J Milloy, Thomas Kerr, Julio Montaner, and Evan Wood are with the Department of Medicine, University of British Columbia, Vancouver, Canada. Kanna Hayashi, Huiru Dong, Thomas Kerr, Julio Montaner, and Evan Wood are with the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - M-J Milloy
- Paxton Bach, Geoffrey Walton, M-J Milloy, Thomas Kerr, Julio Montaner, and Evan Wood are with the Department of Medicine, University of British Columbia, Vancouver, Canada. Kanna Hayashi, Huiru Dong, Thomas Kerr, Julio Montaner, and Evan Wood are with the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Huiru Dong
- Paxton Bach, Geoffrey Walton, M-J Milloy, Thomas Kerr, Julio Montaner, and Evan Wood are with the Department of Medicine, University of British Columbia, Vancouver, Canada. Kanna Hayashi, Huiru Dong, Thomas Kerr, Julio Montaner, and Evan Wood are with the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Thomas Kerr
- Paxton Bach, Geoffrey Walton, M-J Milloy, Thomas Kerr, Julio Montaner, and Evan Wood are with the Department of Medicine, University of British Columbia, Vancouver, Canada. Kanna Hayashi, Huiru Dong, Thomas Kerr, Julio Montaner, and Evan Wood are with the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Julio Montaner
- Paxton Bach, Geoffrey Walton, M-J Milloy, Thomas Kerr, Julio Montaner, and Evan Wood are with the Department of Medicine, University of British Columbia, Vancouver, Canada. Kanna Hayashi, Huiru Dong, Thomas Kerr, Julio Montaner, and Evan Wood are with the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Evan Wood
- Paxton Bach, Geoffrey Walton, M-J Milloy, Thomas Kerr, Julio Montaner, and Evan Wood are with the Department of Medicine, University of British Columbia, Vancouver, Canada. Kanna Hayashi, Huiru Dong, Thomas Kerr, Julio Montaner, and Evan Wood are with the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Abstract
OBJECTIVES The aim of this study was to assess the prevalence of alcohol dependence and anxiety and depressive disorder symptomatology among heroin users in drug treatment. METHOD Fifty-five clients on methadone maintenance treatment programmes in Dublin were interviewed. RESULTS Prevalence rates were found to be 56% [n = 31] for alcohol dependence, 56% [n = 31] for anxiety disorder symptomatology, and 42% [n = 23] for depressive disorder symptomatology. This finding of comorbid alcohol dependence and psychopathology among methadone maintenance treatment clients suggests that both clients' health and methadone maintenance treatment participation and completion rates may be compromised. CONCLUSIONS Alcohol dependence and psychopathology among methadone maintenance treatment clients should be considered when providing effectively targeted services to the drug using population.
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Rigg KK, Ford JA. The misuse of benzodiazepines among adolescents: psychosocial risk factors in a national sample. Drug Alcohol Depend 2014; 137:137-42. [PMID: 24582910 DOI: 10.1016/j.drugalcdep.2014.01.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 12/01/2022]
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.
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Affiliation(s)
- Khary K Rigg
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, USA.
| | - Jason A Ford
- Department of Sociology, University of Central Florida, USA
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Gudin JA, Mogali S, Jones JD, Comer SD. Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgrad Med 2013; 125:115-30. [PMID: 23933900 DOI: 10.3810/pgm.2013.07.2684] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The concurrent use of opioids, benzodiazepines (BZDs), and/or alcohol poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs and/or alcohol are at higher risk for fatal/nonfatal overdose and have more aberrant behaviors. Few practice guidelines for BZD treatment are readily available, especially when they are combined clinically with opioid analgesics and other central nervous system-depressant agents. However, coadministration of these agents produces a defined increase in rates of adverse events, overdose, and death, warranting close monitoring and consideration when treating patients with pain. To improve patient outcomes, ongoing screening for aberrant behavior, monitoring of treatment compliance, documentation of medical necessity, and the adjustment of treatment to clinical changes are essential. In this article, we review the prevalence and pharmacologic consequences of BZDs and/or alcohol use among patients with pain on chronic opioid therapy, as well as the importance of urine drug testing, an indispensable tool for therapeutic drug monitoring, which helps to ensure the continued safety of patients. Regardless of risk or known aberrant drug-related behaviors, patients on chronic opioid therapy should periodically undergo urine drug testing to confirm adherence to the treatment plan.
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Affiliation(s)
- Jeffrey A Gudin
- Pain Management and Wellness Center, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA.
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Shibasaki M, Masukawa D, Ishii K, Yamagishi Y, Mori T, Suzuki T. Involvement of the K+-Cl- co-transporter KCC2 in the sensitization to morphine-induced hyperlocomotion under chronic treatment with zolpidem in the mesolimbic system. J Neurochem 2013; 125:747-55. [PMID: 23565710 DOI: 10.1111/jnc.12258] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/14/2013] [Accepted: 03/25/2013] [Indexed: 11/30/2022]
Abstract
Benzodiazepines are commonly used as sedatives, sleeping aids, and anti-anxiety drugs. However, chronic treatment with benzodiazepines is known to induce dependence, which is considered related to neuroplastic changes in the mesolimbic system. This study investigated the involvement of K(+) -Cl(-) co-transporter 2 (KCC2) in the sensitization to morphine-induced hyperlocomotion after chronic treatment with zolpidem [a selective agonist of γ-aminobutyric acid A-type receptor (GABAA R) α1 subunit]. In this study, chronic treatment with zolpidem enhanced morphine-induced hyperlocomotion, which is accompanied by the up-regulation of KCC2 in the limbic forebrain. We also found that chronic treatment with zolpidem induced the down-regulation of protein phosphatase-1 (PP-1) as well as the up-regulation of phosphorylated protein kinase C γ (pPKCγ). Furthermore, PP-1 directly associated with KCC2 and pPKCγ, whereas pPKCγ did not associate with KCC2. On the other hand, pre-treatment with furosemide (a KCC2 inhibitor) suppressed the enhancing effects of zolpidem on morphine-induced hyperlocomotion. These results suggest that the mesolimbic dopaminergic system could be amenable to neuroplastic change through a pPKCγ-PP-1-KCC2 pathway by chronic treatment with zolpidem.
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Affiliation(s)
- Masahiro Shibasaki
- Department of Toxicology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Tokyo 142-8501, Japan
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18
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Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend 2012; 125:8-18. [PMID: 22857878 PMCID: PMC3454351 DOI: 10.1016/j.drugalcdep.2012.07.004] [Citation(s) in RCA: 468] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 07/08/2012] [Accepted: 07/09/2012] [Indexed: 12/26/2022]
Abstract
This paper reviews studies examining the pharmacological interactions and epidemiology of the combined use of opioids and benzodiazepines (BZDs). A search of English language publications from 1970 to 2012 was conducted using PubMed and PsycINFO(®). Our search found approximately 200 articles appropriate for inclusion in this paper. While numerous reports indicate that the co-abuse of opioids and BZDs is ubiquitous around the world, the reasons for the co-abuse of these medications are not entirely clear. Though the possibility remains that opioid abusers are using BZDs therapeutically to self-medicate anxiety, mania or insomnia, the data reviewed in this paper suggest that BZD use is primarily recreational. For example, co-users report seeking BZD prescriptions for the purpose of enhancing opioid intoxication or "high," and use doses that exceed the therapeutic range. Since there are few clinical studies investigating the pharmacological interaction and abuse liability of their combined use, this hypothesis has not been extensively evaluated in clinical settings. As such, our analysis encourages further systematic investigation of BZD abuse among opioid abusers. The co-abuse of BZDs and opioids is substantial and has negative consequences for general health, overdose lethality, and treatment outcome. Physicians should address this important and underappreciated problem with more cautious prescribing practices, and increased vigilance for abusive patterns of use.
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Affiliation(s)
- Jermaine D. Jones
- Division on Substance Abuse, New York Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Shanthi Mogali
- Division on Substance Abuse, New York Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Sandra D. Comer
- Division on Substance Abuse, New York Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
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19
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Which indicators can public health authorities use to monitor prescription drug abuse and evaluate the impact of regulatory measures? Controlling High Dosage Buprenorphine abuse. Drug Alcohol Depend 2011; 113:29-36. [PMID: 20692778 DOI: 10.1016/j.drugalcdep.2010.06.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Two methods have been recently developed from a drug reimbursement database to provide useful indicators for public health authorities concerning the abuse potential of psychotropic drugs. The doctor-shopping indicator (DSI) measures the proportion of the drug obtained by doctor shopping among the overall quantity of the drug reimbursed and the clustering method reveals subgroups of deviant patients. OBJECTIVE The objective of the study was to analyze and compare indicators resulting from these two methods, applied to High Dosage Buprenorphine (HDB) (a product well-known to be diverted in France), in order to determine which public health authorities needs they answer. DATA ANALYSIS The patients with reimbursed HDB were grouped using the clustering method in terms of drug dispensations characteristics over a nine month period. The characteristics of the resulting subgroups, including their DSI, were then compared. RESULTS 4787 Patients (73.4%) had no measurable doctor-shopping behaviour. But the comparison of the two methods demonstrated that the more a patient's profile was characterized by deviant behavior, the higher was the DSI: from 0.4% in a subgroup with a median profile to 72% in a subgroup with a deviant profile. CONCLUSION These two methods are useful surveillance tools for public health authorities: the clustering method may help devise pertinent intervention strategies to reduce prescription drug abuse while the DSI method provides quantitative information demonstrating whether these strategies are useful. We discuss the advantages and disadvantages of using these two methods as useful indicators for public health authorities.
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20
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Pinto H, Maskrey V, Swift L, Rumball D, Wagle A, Holland R. The SUMMIT Trial:. J Subst Abuse Treat 2010; 39:340-52. [DOI: 10.1016/j.jsat.2010.07.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 07/19/2010] [Accepted: 07/22/2010] [Indexed: 11/27/2022]
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Lintzeris N, Nielsen S. Benzodiazepines, Methadone and Buprenorphine: Interactions and Clinical Management. Am J Addict 2010; 19:59-72. [DOI: 10.1111/j.1521-0391.2009.00007.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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O'Brien BP, Murphy D, Conrick-Martin I, Marsh B. The Functional Outcome and Recovery of Patients Admitted to an Intensive Care Unit following Drug Overdose: A Follow-Up Study. Anaesth Intensive Care 2009; 37:802-6. [DOI: 10.1177/0310057x0903700508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients who have overdosed on drugs commonly present to emergency departments, with only the most severe cases requiring intensive care unit (ICU) admission. Such patients typically survive hospitalisation. We studied their longer term functional outcomes and recovery patterns which have not been well described. All patients admitted to the 18-bed ICU of a university-affiliated teaching hospital following drug overdoses between 1 January 2004 and 31 December 2006 were identified. With ethical approval, we evaluated the functional outcome and recovery patterns of the surviving patients 31 months after presentation, by telephone or personal interview. These were recorded as Glasgow outcome score, Karnofsky performance index and present work status. During the three years studied, 43 patients were identified as being admitted to our ICU because of an overdose. The average age was 34 years, 72% were male and the mean APACHE II score was 16.7. Of these, 32 were discharged from hospital alive. Follow-up data was attained on all of them. At a median of 31 months follow-up, a further eight had died. Of the 24 surviving there were 13 unemployed, seven employed and four in custody. The median Glasgow outcome score of survivors was 4.5, their Karnofsky score 80. Admission to ICU for treatment of overdose is associated with a very high risk of death in both the short- and long-term. While excellent functional recovery is achievable, 16% of survivors were held in custody and 54% unemployed.
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Affiliation(s)
- B. P. O'Brien
- Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D. Murphy
- Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Dublin, Ireland
| | - I. Conrick-Martin
- Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Dublin, Ireland
| | - B. Marsh
- Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Dublin, Ireland
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Smyth BP, McMahon J, O'Connor JJ, Ryan J. The use of primary care services by opiate-dependant injecting drug users in the era of ‘shared care’. Eur J Gen Pract 2009. [DOI: 10.3109/13814789909094287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Laqueille X, Launay C, Dervaux A, Kanit M. Abus d’alcool et de benzodiazépines lors des traitements de substitution chez l’héroïnomane : une revue de la littérature. Encephale 2009; 35:220-5. [PMID: 19540407 DOI: 10.1016/j.encep.2008.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 05/19/2008] [Indexed: 11/30/2022]
Affiliation(s)
- X Laqueille
- Service d'addictologie, centre hospitalier Sainte-Anne, université René-Descartes Paris-V, 1, rue Cabanis, 75674 Paris cedex 14 France.
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Elliott L, Glenday J, Freeman L, Ajeda D, Johnston B, Christie M, Ogston S. Reducing diazepam prescribing for illicit drug users: A randomised control study. Drug Alcohol Rev 2009; 24:25-31. [PMID: 16191718 DOI: 10.1080/09595230500125138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Illicit drug users undergoing mandatory reductions in prescribed diazepam were randomly allocated to one of two methods of delivering psychological support to help reduce their prescription: a) an enhanced intervention consisting of skills training and reinforcement, and b) a limited intervention where patients initially received skills training and thereafter only advice. Outcome measures at baseline and six-months consisted of daily diazepam dose; reported illicit drug use; Severity of Dependence Scale; Hospital Anxiety and Depression Scale (HADS); Pittsburgh Sleep Quality Index. Fifty-three of 119 eligible patients agreed to be randomly allocated to the interventions. Those in the enhanced intervention reduced their daily dose of prescribed diazepam from a mean of 27.8 mgs to 19.9 mgs at six months (5.3% per month) compared with 29.8 mgs to 17.6 mgs at six months (7.5%) among those in the limited intervention group. However, there was no statistically significant difference in the reduction rate between the intervention groups. Approximately 75% of patients in each group suspended their reduction programme. The enhanced intervention group reported a statistically and clinically greater reduction in the mean HADS depression score (10.6 at baseline and 7.7 at follow-up), compared with a rise from 8.9 to 11.2 in the limited intervention group. In conclusion, it is possible to reduce prescribed diazepam among illicit drug users but not at the rate of 10% per month set by the study. The difficulties of working with this population necessitate a flexible and possibly long-term approach to reducing prescribed benzodiazepines.
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Affiliation(s)
- Lawrie Elliott
- School of Nursing and Midwifery, University of Dundee, UK.
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DISSABANDARA LAKALO, DIAS SHAVINDRAR, DODD PETERR, STADLIN ALFREDA. Patterns of substance use in male incarcerated drug users in Sri Lanka. Drug Alcohol Rev 2009; 28:600-7. [DOI: 10.1111/j.1465-3362.2009.00062.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Semple SJ, Strathdee SA, Zians J, Patterson TL. Sexual risk behavior associated with co-administration of methamphetamine and other drugs in a sample of HIV-positive men who have sex with men. Am J Addict 2009; 18:65-72. [PMID: 19219667 PMCID: PMC3044646 DOI: 10.1080/10550490802544466] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study examined the association between sexual risk behavior and co-administration of methamphetamine with other drugs in a sample of 341 HIV-positive MSM. Those who reported methamphetamine co-administration in the past two months (65%) reported significantly more unprotected anal and oral sex and a greater number of casual, anonymous, and paid sex partners in this timeframe compared to men who used methamphetamine alone. Two primary patterns of co-administration were identified: 1) drug combinations motivated by sexual performance and enhancement (eg, methamphetamine, poppers, sildenafil); and 2) "party drug" combinations (eg, methamphetamine, GHB, ketamine). Implications for further research and possible applications to risk-reduction interventions are discussed.
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Affiliation(s)
| | | | - Jim Zians
- Department of Psychiatry, University of California, San Diego
| | - Thomas L. Patterson
- Department of Psychiatry, University of California, San Diego
- Department of Veterans Affairs Medical Center, San Diego
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Abstract
This paper investigates some productive ambiguities around the medical administration of methadone in the Republic of Ireland. The tensions surrounding methadone maintenance therapy (MMT) are outlined, as well as the sociohistorical context in which a serious heroin addiction problem in Ireland developed. Irish psychiatry intervened in this situation, during a time of institutional change, debates concerning the nature of addiction, moral panics concerning heroin addiction in Irish society and the recent boom in the Irish economy, known popularly as the Celtic Tiger. A particular history of this sort illuminates how technologies like MMT become cosmopolitan, settling into, while changing, local contexts.
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Affiliation(s)
- A Jamie Saris
- Department of Anthropology, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland.
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Kristensen Ø, Lølandsmo T, Isaksen Å, Vederhus JK, Clausen T. Treatment of polydrug-using opiate dependents during withdrawal: towards a standardisation of treatment. BMC Psychiatry 2006; 6:54. [PMID: 17107609 PMCID: PMC1660570 DOI: 10.1186/1471-244x-6-54] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 11/15/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The growing tendency among opioid addicts to misuse multiple other drugs should lead clinicians and researchers to search for new pharmacological strategies in order to prevent life-threatening complications and minimize withdrawal symptoms during polydrug detoxification. METHODS A non-randomised, open-label in-patient detoxification study was used to compare the short-time efficacy of a standardised regimen comprising 6 days Buprenorphine and 10 days Valproate (BPN/VPA) (n = 12) to a control group (n = 50) who took a 10-day traditional Clonidine/Carbamazepine (CLN/CBZ) regimen. Sixty-two dependent subjects admitted to a detoxification unit were included, all dependent on at least opioids and benzodiazepines. Other dependencies were not excluded. RESULTS In the BPN/VPA group, 8 out of 12 patients (67%) completed treatment compared with 25 of 50 patients (50%) in the CLN/CBZ group; this difference between the groups was non-significant (p = 0.15). Withdrawal symptoms were reduced in both groups, but only the BPN/VPA group achieved a reduction in withdrawal symptoms from day one. The difference between the two groups was significantly in favour of the BPN/VPA group for days 2 (p < 0.001), 3 (p < 0.05), 4 (p < 0.001), 5 (p < 0.01), 7 (p < 0.01) and 8 (p < 0.05). The BPN/VPA combination did not affect blood pressure, pulse or liver function, and the total burden of side-effects was experienced as modest. There appeared to be no pharmacological interactions of clinical concern, based on measurement of Buprenorphine and Valproate serum levels. Both the patients and the staff were satisfied with the standardised treatment combination. CONCLUSION Overall, the combination of Buprenorphine and Valproate seems to be a safe and promising method for treating multiple drug withdrawal symptoms. The results of this study suggest that the BPN/VPA combination is potentially a better detoxification treatment for polydrug withdrawal than the traditional treatment with Clonidine and Carbamazepine. However, a randomised, double-blind study with a larger sample size to confirm our results is recommended.
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Affiliation(s)
| | | | - Åse Isaksen
- Addiction Unit, Sørlandet Hospital, Kristiansand, Norway
| | | | - Thomas Clausen
- Unit for Addiction Medicine, Institute of Psychiatry, University of Oslo, Norway
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Modestin J, Matutat B, Würmle O. Two types of classification for male opioid dependence: identification of an opioid addict with depressive features. Eur Arch Psychiatry Clin Neurosci 2005; 255:419-27. [PMID: 15868066 DOI: 10.1007/s00406-005-0592-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 03/01/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There are similarities between alcoholics and opioid addicts and an overlap between both diagnostic groups. We tested the hypothesis that the type I and II classification, well established in male alcoholism, could also be relevant in a population of male opioid addicts. METHODS A sample of 100 hospitalized adult opioid dependent men were studied with the help of an extended semi-structured clinical interview, considering four classification criteria sets devised by Cloninger et al. (1981, 1982), von Knorring et al. (1985, 1987), Buydens-Branchey et al. (1989) and Babor et al. (1992). RESULTS The two types of classification could be confirmed with all four criteria sets. In at least three of four analyses, 52 patients were allocated to the same larger cluster C1, and 25 patients to a smaller cluster C2. These two groups were compared with each other with the help of the stepwise discriminant analysis. Seven variables were identified which excellently discriminate between the groups: The C2 patient is younger, has a history of therapy because of depression and a history of severe suicide attempts, also abuses benzodiazepines and becomes violent while intoxicated. His father suffers from alcoholism and received treatment because of depression. The C1 patient lacks these characteristics. CONCLUSIONS The hypothesis was confirmed, showing that the two types of classification for male opioid addicts is feasible. A depressive type of male opioid dependent patient was identified. Early identification of patients of this type is clinically important.
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Affiliation(s)
- J Modestin
- University of Zurich, Department of Psychiatry, Burghölzli Hospital, Lenggstrasse 31, 8029, Zurich, Switzerland.
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Vivian J, Saleheen H, Singer M, Navarro J, Mirhej G. Under the counter: the diffusion of narcotic analgesics to the inner city street. J Ethn Subst Abuse 2005; 4:97-114. [PMID: 16275636 DOI: 10.1300/j233v04n02_05] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
During the past decade, there has been a well-documented rise in the non-medical use of prescription painkillers, often referred to as narcotics analgesics (NA). Relatively little is known, however, about who these users are, the range of health and social consequences associated with their use and the presence of illicit NA use on the inner city street. Results of a survey conducted with a sample of 242 street drug users indicated that NA use is now widespread in the inner city, and that it is associated with a number of serious health and psychiatric conditions. Other characteristics of this emerging drug user group are explored and the need for future research is highlighted.
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Affiliation(s)
- James Vivian
- Hispanic Health Council, Hartford, CT 06106, USA.
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de Wet C, Reed L, Glasper A, Moran P, Bearn J, Gossop M. Benzodiazepine co-dependence exacerbates the opiate withdrawal syndrome. Drug Alcohol Depend 2004; 76:31-5. [PMID: 15380286 DOI: 10.1016/j.drugalcdep.2004.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Revised: 03/23/2004] [Accepted: 04/05/2004] [Indexed: 10/26/2022]
Abstract
Patients seeking treatment for opiate withdrawal are commonly also dependent on benzodiazepines, although the interactions between benzodiazepine and opiate dependence and withdrawal syndromes have been subject to little systematic investigation. This is the first study comparing type, severity and course of opiate withdrawal symptoms between opiate dependent patients with, and without, concurrent benzodiazepine dependence. Patients dependent only on opiates (n = 39), and patients dependent on both opiates and benzodiazepines (n = 22), were recruited from consecutive admissions to an in-patient drug treatment unit. Quantity and duration of prior opiate use was similar for both groups. Patients completed daily self-ratings of opiate withdrawal (SOWS) for the duration of a standard in-patient detoxification treatment. Co-dependent patients were detoxified from benzodiazepines and opiates concurrently. Co-dependent patients reported a more severe withdrawal symptoms than patients withdrawing from opiates alone. Co-dependent patients had significantly more severe opiate withdrawal symptoms. Concurrent benzodiazepine withdrawal exacerbates opiate specific withdrawal symptoms. Possible psychological and neurophysiological mechanisms for the observed sensitisation are discussed.
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Affiliation(s)
- Cornelis de Wet
- Wickham Park House, South London & Maudsley NHS Trust Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
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Umbricht A, Huestis MA, Cone EJ, Preston KL. Effects of high-dose intravenous buprenorphine in experienced opioid abusers. J Clin Psychopharmacol 2004; 24:479-87. [PMID: 15349002 DOI: 10.1097/01.jcp.0000138766.15858.c6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sublingual buprenorphine, a long-acting, partial mu-opioid agonist, is as effective as methadone in the treatment of heroin dependence, with a better safety profile due to its antagonist activity. However, the safety of therapeutic doses (8 to 16 mg) that might be diverted for intravenous (i.v.) use has not been demonstrated. To evaluate the safety and possible ceiling effects of buprenorphine administered i.v. to experienced opioid users, buprenorphine was administered to 6 nondependent opioid abusers residing on a research unit; the doses tested, in separate sessions, were 12 mg buprenorphine sublingual, i.v./sublingual placebo, and escalating i.v. buprenorphine (2, 4, 8, 12, and 16 mg). Physiologic and subjective measures were collected for 72 hours post-drug administration. Buprenorphine minimally but significantly increased systolic blood pressure. Changes in heart rate or oxygen saturation among the 7 drug conditions were not statistically significant. The mean maximum decrease in oxygen saturation from baseline was greatest for the 8-mg i.v. dose. Buprenorphine produced positive mood effects, although with substantial variability among participants. Onset and peak effects occurred earlier following i.v. administration: peak i.v. effects occurred between 0.25 and 3 hours; peak sublingual effects occurred at 3 to 7 hours. Duration of effects varied among the outcome measures. The dose-response curves were flat for most parameters, particularly subjective measures. Side effects were mild except in one participant who experienced severe nausea and vomiting after the 12-mg i.v. dose. Buprenorphine appears to have a ceiling for cardiorespiratory and subjective effects and a high safety margin even when taken by the i.v. route.
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Affiliation(s)
- Annie Umbricht
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD 21224, USA
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Abstract
The use of cocaine by heroin-dependent individuals, or by patients in methadone or buprenorphine maintenance treatment, is substantial and has negative consequences on health, social adjustment and outcome of opioid-addiction treatment. The pharmacological reasons for cocaine use in opioid-dependent individuals, however, are poorly understood and little is known about the patterns of heroin and cocaine co-use. We reviewed anecdotal evidence suggesting that cocaine is co-used with opioid drugs in a variety of different patterns, to achieve different goals. Clinical and preclinical experimental evidence indicates that the simultaneous administration of cocaine and heroin (i.e. 'speedball') does not induce a novel set of subjective effects, nor is it more reinforcing than either drug alone, especially when the doses of heroin and cocaine are high. There is mixed evidence that the subjective effects of cocaine are enhanced in individuals dependent on opioids, although it is clear that cocaine can alleviate the severity of symptoms of withdrawal from opioids. We also reviewed preclinical studies investigating possible neurobiological interactions between opioids and cocaine, but the results of these studies have been difficult to interpret mainly because the neurochemical mechanisms mediating the motivational effects of cocaine are modified by dependence on, and withdrawal from, opioid drugs. Our analysis encourages further systematic investigation of cocaine use patterns among opioid-dependent individuals and in laboratory animals. Once clearly identified, pharmacological and neuroanatomical methods can be employed in self-administering laboratory animals to uncover the neurobiological correlates of specific patterns of co-use.
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Affiliation(s)
- Francesco Leri
- Center for Studies in Behavioural Neurobiology, Concordia University, Montréal, Montréal, Canada.
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Thirion X, Lapierre V, Micallef J, Ronflé E, Masut A, Pradel V, Coudert C, Mabriez JC, Sanmarco JL. Buprenorphine prescription by general practitioners in a French region. Drug Alcohol Depend 2002; 65:197-204. [PMID: 11772481 DOI: 10.1016/s0376-8716(01)00161-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Since 1996 French general practitioners (GPs) may prescribe sublingual buprenorphine tablets as maintenance treatment for opiate dependence. The computerised data management of the main French health reimbursement system now allows surveillance of the use of this drug, and how it is prescribed. The purpose of this study is to determine the profile of maintained patients, prescribed doses, associated psychotropic treatments and how practitioners prescribe these treatments. This study analyses the 11186 buprenorphine prescriptions electronically transmitted for reimbursement between September and December 1999 in a specific French region. It was found that the 2078 treated patients consumed a mean of 11.5 mg of buprenorphine per day and 12% of them procured prescriptions from more than two prescribers. 43% of maintained patients had an associated benzodiazepine prescription, mainly flunitrazepam, often on the same prescription form. 61% of patients had regular follow-up, others had occasional consultations (21%) and another 18% had deviant maintenance treatment (more than two prescribers or more than 20 mg per day of daily buprenorphine dose). Benzodiazepine consumption was much higher in the 'deviant group' (71.4%). 85% of buprenorphine prescriptions were made by GPs. 21% of GPs prescribed buprenorphine and 61% of those had only one or two maintained patients. Buprenorphine prescription by French GPs is a procedure with no particular requirements, allowing many patients to easily access maintenance treatments. However, a high risk of abuse exists, which demands extensive investigation and evaluation of these practices.
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Affiliation(s)
- X Thirion
- Centre for Evaluation and Information on Pharmacodependence, Public Health Department, School of Medicine, 27 Boulevard Jean Moulin, 13005 Marseilles, France.
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Berg JE, Andersen S. Mortality 5 Years After Detoxification and Counseling as Indicated by Psychometric Tests. Subst Abus 2001; 22:1-10. [PMID: 12466665 DOI: 10.1080/08897070109511441] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Residential detoxification of substance abusers, using medication to alleviate withdrawal symptoms, often fails to ensure further abstention and predict which clients have the greatest risk of morbidity after detoxification. Prolonging the detoxification period with a counseling period has been shown to enhance compliance to counseling. Sixty-one (61) substance abusers (mean age: 31.3 years; 22 women) with a mean length of abuse of 16 years in 1993-1994 were tested using two psychometric tests and then followed up in 1999 according to mortality. Mean value on Antonovsky's Sense of Coherence (SOC) scale was 2.98 and on Hopkins Symptom Checklist (HSCL-24) was 2.06, indicating postdetoxification coping problems and distress. Thirteen (13) abusers died during follow-up. Cox regression of mortality showed increased risk in men, and also an increased risk of dying in the observation period with lower SOC score (p <.01), but not with increasing HSCL-24 score. Logistic regression indicated a 3.6 times higher risk of dying in the observation period if the SOC score was 1 point lower (on a scale range from 1 to 5). An increased mortality in drug addicts leaving the facility with an SOC value below 3.00 after a 4-week detoxification and counseling stay is thus strongly supported by the data. Antonovsky's SOC scale thus seems to be a good indicator of future mortality.
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Affiliation(s)
- John E. Berg
- Drug Research Group, Department of Community Medicine, University of Oslo Blindern, 0318 Oslo, Norway. Phone: 47-22858283; Fax: 47-22858280
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Green H, James RA, Gilbert JD, Harpas P, Byard RW. Methadone maintenance programs--a two-edged sword? Am J Forensic Med Pathol 2000; 21:359-61. [PMID: 11111797 DOI: 10.1097/00000433-200012000-00012] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Retrospective review was undertaken of all autopsies in which methadone was detected at the Forensic Science Centre, South Australia, during a 3-year period from July 1996 to June 1999. Thirty-five cases were found in which methadone had either caused or contributed to death (age range = 14-54 years; average = 31 years; M:F = 3.4:1). Ten victims were participating in a methadone maintenance program, of whom four died within a week of enrollment. Eight victims (23%) not enrolled in a methadone maintenance program were found who had died after the use of "diverted" methadone (i.e., prescribed for someone else) (age range = 14-34 years; average = 25 years; M:F = 6:2). Deaths were directly attributable to methadone toxicity in seven of the eight cases, with additional drugs or alcohol being found in seven cases. Prevention of ongoing deaths caused by methadone diversion could be achieved by allowing only daily releases of methadone, with the addict having to consume the drug under close supervision.
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Affiliation(s)
- H Green
- Forensic Science Centre, Adelaide, South Australia
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