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Published in: BMC Psychiatry 1/2011

Open Access 01-12-2011 | Research article

Benzodiazepine Use and Misuse Among Patients in a Methadone Program

Authors: Kevin W Chen, Christine C Berger, Darlene P Forde, Christopher D'Adamo, Eric Weintraub, Devang Gandhi

Published in: BMC Psychiatry | Issue 1/2011

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Abstract

Background

Benzodiazepines (BZD) misuse is a serious public health problem, especially among opiate-dependent patients with anxiety enrolled in methadone program because it puts patients at higher risk of life-threatening multiple drug overdoses. Both elevated anxiety and BZD misuse increase the risk for ex-addicts to relapse. However, there is no recent study to assess how serious the problem is and what factors are associated with BZD misuse. This study estimates the prevalence of BZD misuse in a methadone program, and provides information on the characteristics of BZD users compared to non-users.

Methods

An anonymous survey was carried out at a methadone program in Baltimore, MD, and all patients were invited to participate through group meetings and fliers around the clinic on a voluntary basis. Of the 205 returned questionnaires, 194 were complete and entered into final data analysis. Those who completed the questionnaire were offered a $5 gift card as an appreciation.

Results

47% of the respondents had a history of BZD use, and 39.8% used BZD without a prescription. Half of the BZD users (54%) started using BZD after entering the methadone program, and 61% of previous BZD users reported increased or resumed use after entering methadone program. Compared to the non-users, BZD users were more likely to be White, have prescribed medication for mental problems, have preexistent anxiety problems before opiate use, and had anxiety problems before entering methadone program. They reported more mental health problems in the past month, and had higher scores in anxiety state, depression and perceived stress (p < .05).

Conclusions

Important information on epidemiology of BZD misuse among methadone-maintenance patients suggests that most methadone programs do not address co-occurring anxiety problems, and methadone treatment may trigger onset or worsening of BZD misuse. Further study is needed to explore how to curb misuse and abuse of BZD in the addiction population, and provide effective treatments targeting simultaneously addiction symptoms, anxiety disorders and BZD misuse.
Literature
1.
go back to reference Ashton H: The diagnosis and management of benzodiazepine dependence. Current opinion in Psychiatry. 2005, 18 (3): 249-10.1097/01.yco.0000165594.60434.84.CrossRefPubMed Ashton H: The diagnosis and management of benzodiazepine dependence. Current opinion in Psychiatry. 2005, 18 (3): 249-10.1097/01.yco.0000165594.60434.84.CrossRefPubMed
2.
go back to reference Posternak MA, Mueller TI: Assessing the risks and benefits of benzodiazepines for anxiety disorders in patients with a history of substance abuse or dependence. The American Journal on Addictions. 2001, 10 (1): 48-68. 10.1080/105504901750160484.CrossRefPubMed Posternak MA, Mueller TI: Assessing the risks and benefits of benzodiazepines for anxiety disorders in patients with a history of substance abuse or dependence. The American Journal on Addictions. 2001, 10 (1): 48-68. 10.1080/105504901750160484.CrossRefPubMed
3.
go back to reference Kamal F, Flavin S, Campbell F, Behan C, Fagan J, Smyth R: Factors affecting the outcome of methadone maintenance treatment in opiate dependence. Ir Med J. 2007, 100 (3): 393-PubMed Kamal F, Flavin S, Campbell F, Behan C, Fagan J, Smyth R: Factors affecting the outcome of methadone maintenance treatment in opiate dependence. Ir Med J. 2007, 100 (3): 393-PubMed
4.
go back to reference Meiler A, Mino A, Chatton A, Broers B: Benzodiazepine use in a methadone maintenance programme: patient characteristics and the physician's dilemma. Schweizer Archiv für Neurologie und Psychiatrie. 2005, 156 (6): 310-317. Meiler A, Mino A, Chatton A, Broers B: Benzodiazepine use in a methadone maintenance programme: patient characteristics and the physician's dilemma. Schweizer Archiv für Neurologie und Psychiatrie. 2005, 156 (6): 310-317.
5.
go back to reference Peles E, Schreiber S, Adelson M: 15-Year survival and retention of patients in a general hospital-affiliated methadone maintenance treatment (MMT) center in Israel. Drug Alcohol Depend. 2010, 107 (2-3): 141-148. 10.1016/j.drugalcdep.2009.09.013.CrossRefPubMed Peles E, Schreiber S, Adelson M: 15-Year survival and retention of patients in a general hospital-affiliated methadone maintenance treatment (MMT) center in Israel. Drug Alcohol Depend. 2010, 107 (2-3): 141-148. 10.1016/j.drugalcdep.2009.09.013.CrossRefPubMed
6.
go back to reference Lavie E, Fatséas M, Denis C, Auriacombe M: Benzodiazepine use among opiate-dependent subjects in buprenorphine maintenance treatment: Correlates of use, abuse and dependence. Drug Alcohol Depend. 2009, 99 (1-3): 338-344. 10.1016/j.drugalcdep.2008.07.017.CrossRefPubMed Lavie E, Fatséas M, Denis C, Auriacombe M: Benzodiazepine use among opiate-dependent subjects in buprenorphine maintenance treatment: Correlates of use, abuse and dependence. Drug Alcohol Depend. 2009, 99 (1-3): 338-344. 10.1016/j.drugalcdep.2008.07.017.CrossRefPubMed
7.
go back to reference Chouinard G: Issues in the clinical use of benzodiazepines: potency, withdrawal, and rebound. Eur Neuropsychopharmacol. 2004, 65 (5): 7-12. Chouinard G: Issues in the clinical use of benzodiazepines: potency, withdrawal, and rebound. Eur Neuropsychopharmacol. 2004, 65 (5): 7-12.
8.
go back to reference Uzun S, Kozumplik O, Jakovljević M, Sedić B: Side effects of treatment with benzodiazepines. Psychiatria Danubina. 2010, 22 (1): 90-93.PubMed Uzun S, Kozumplik O, Jakovljević M, Sedić B: Side effects of treatment with benzodiazepines. Psychiatria Danubina. 2010, 22 (1): 90-93.PubMed
9.
go back to reference Khong E, Sim MG, Hulse G: Benzodiazepine dependence. Aust Fam Physician. 2004, 33: 923-926.PubMed Khong E, Sim MG, Hulse G: Benzodiazepine dependence. Aust Fam Physician. 2004, 33: 923-926.PubMed
10.
go back to reference Darke S, Ross J, Mills K, Teesson M, Williamson A, Havard A: Benzodiazepine use among heroin users: Baseline use, current use and clinical outcome. Drug Alcohol Rev. 2010, 29 (3): 250-255.CrossRefPubMed Darke S, Ross J, Mills K, Teesson M, Williamson A, Havard A: Benzodiazepine use among heroin users: Baseline use, current use and clinical outcome. Drug Alcohol Rev. 2010, 29 (3): 250-255.CrossRefPubMed
11.
go back to reference O Brien CP: Benzodiazepine use, abuse, and dependence. J Clin Psychiatry. 2005, 66 (2): 9-13. O Brien CP: Benzodiazepine use, abuse, and dependence. J Clin Psychiatry. 2005, 66 (2): 9-13.
12.
go back to reference Kaplan EM, DuPont RL: Benzodiazepines and anxiety disorders: a review for the practicing physician. J Clin Psychiatry. 2005, 21 (6): 941-950. Kaplan EM, DuPont RL: Benzodiazepines and anxiety disorders: a review for the practicing physician. J Clin Psychiatry. 2005, 21 (6): 941-950.
13.
go back to reference Hertz JA, Knight JR: Prescription drug misuse: a growing national problem. Adolesc Med Clin. 2006, 17 (3): 751-69. abstract xiiiPubMed Hertz JA, Knight JR: Prescription drug misuse: a growing national problem. Adolesc Med Clin. 2006, 17 (3): 751-69. abstract xiiiPubMed
14.
go back to reference Farnsworth MG: Benzodiazepine abuse and dependence: misconceptions and facts. J Fam Pract. 1990, 31 (4): 393-400.PubMed Farnsworth MG: Benzodiazepine abuse and dependence: misconceptions and facts. J Fam Pract. 1990, 31 (4): 393-400.PubMed
15.
go back to reference Busto U, Sellers EM, Naranjo CA, Cappell HD, Sanchez‐Craig M, Simpkins J: Patterns of benzodiazepine abuse and dependence. Br J Addict. 1986, 81 (1): 87-94. 10.1111/j.1360-0443.1986.tb00299.x.CrossRefPubMed Busto U, Sellers EM, Naranjo CA, Cappell HD, Sanchez‐Craig M, Simpkins J: Patterns of benzodiazepine abuse and dependence. Br J Addict. 1986, 81 (1): 87-94. 10.1111/j.1360-0443.1986.tb00299.x.CrossRefPubMed
16.
go back to reference Lankenau SE, Sanders B, Bloom JJ, Hathazi DS, Alarcon E, Tortu S, Clatts M: Prevalence and patterns of prescription drug misuse among young ketamine injectors. J Drug Iss. 2007, 37 (3): 717-CrossRef Lankenau SE, Sanders B, Bloom JJ, Hathazi DS, Alarcon E, Tortu S, Clatts M: Prevalence and patterns of prescription drug misuse among young ketamine injectors. J Drug Iss. 2007, 37 (3): 717-CrossRef
17.
go back to reference Kahan M, Srivastava A, Wilson L, Gourlay D, Midmer D: Misuse of and dependence on opioids. Can Fam Physician. 2006, 52: 1081-1087.PubMedPubMedCentral Kahan M, Srivastava A, Wilson L, Gourlay D, Midmer D: Misuse of and dependence on opioids. Can Fam Physician. 2006, 52: 1081-1087.PubMedPubMedCentral
18.
go back to reference Browne R, Sloan D, Fahy S, Keating S, Moran C, O'Connor J: Detection of benzodiazepine abuse in opiate addicts. Ir Med J. 1998, 91 (1): 18-19.PubMed Browne R, Sloan D, Fahy S, Keating S, Moran C, O'Connor J: Detection of benzodiazepine abuse in opiate addicts. Ir Med J. 1998, 91 (1): 18-19.PubMed
19.
go back to reference El Rasheed AH: Alexithymia in Egyptian substance abusers. Substance Abuse. 2001, 22 (1): 11-21.PubMed El Rasheed AH: Alexithymia in Egyptian substance abusers. Substance Abuse. 2001, 22 (1): 11-21.PubMed
20.
go back to reference Peles E, Schreiber S, Adelson M: Documented poor sleep among methadone-maintained patients is associated with chronic pain and benzodiazepine abuse, but not with methadone dose. European Neuropsychopharmacology. 2009, 19 (8): 581-588. 10.1016/j.euroneuro.2009.04.001.CrossRefPubMed Peles E, Schreiber S, Adelson M: Documented poor sleep among methadone-maintained patients is associated with chronic pain and benzodiazepine abuse, but not with methadone dose. European Neuropsychopharmacology. 2009, 19 (8): 581-588. 10.1016/j.euroneuro.2009.04.001.CrossRefPubMed
21.
go back to reference Peles E, Schreiber S, Adelson M: Variables associated with perceived sleep disorders in methadone maintenance treatment (MMT) patients. Drug Alcohol Depend. 2006, 82 (2): 103-110. 10.1016/j.drugalcdep.2005.08.011.CrossRefPubMed Peles E, Schreiber S, Adelson M: Variables associated with perceived sleep disorders in methadone maintenance treatment (MMT) patients. Drug Alcohol Depend. 2006, 82 (2): 103-110. 10.1016/j.drugalcdep.2005.08.011.CrossRefPubMed
22.
go back to reference Gelkopf M, Bleich A, Hayward R, Bodner G, Adelson M: Characteristics of benzodiazepine abuse in methadone maintenance treatment patients: a 1 year prospective study in an Israeli clinic. Drug Alcohol Depend. 1999, 55 (1-2): 63-68. 10.1016/S0376-8716(98)00175-6.CrossRefPubMed Gelkopf M, Bleich A, Hayward R, Bodner G, Adelson M: Characteristics of benzodiazepine abuse in methadone maintenance treatment patients: a 1 year prospective study in an Israeli clinic. Drug Alcohol Depend. 1999, 55 (1-2): 63-68. 10.1016/S0376-8716(98)00175-6.CrossRefPubMed
23.
go back to reference Iguchi MY, Handelsman L, Bickel WK, Griffiths RR: Benzodiazepine and sedative use/abuse by methadone maintenance clients. Drug Alcohol Depend. 1993, 32 (3): 257-266. 10.1016/0376-8716(93)90090-D.CrossRefPubMed Iguchi MY, Handelsman L, Bickel WK, Griffiths RR: Benzodiazepine and sedative use/abuse by methadone maintenance clients. Drug Alcohol Depend. 1993, 32 (3): 257-266. 10.1016/0376-8716(93)90090-D.CrossRefPubMed
24.
go back to reference Spielberger CD: State-Trait Anxiety Inventory for Adults (Form Y). 1983, Redwood City, CA: Mind Garden Inc Spielberger CD: State-Trait Anxiety Inventory for Adults (Form Y). 1983, Redwood City, CA: Mind Garden Inc
25.
go back to reference Deacon BJ, Abramowitz JS, Woods CM, Tolin DF: The Anxiety Sensitivity Index-Revised: psychometric properties and factor structure in two nonclinical samples. Behav Res Ther. 2003, 41 (12): 1427-1449. 10.1016/S0005-7967(03)00065-2.CrossRefPubMed Deacon BJ, Abramowitz JS, Woods CM, Tolin DF: The Anxiety Sensitivity Index-Revised: psychometric properties and factor structure in two nonclinical samples. Behav Res Ther. 2003, 41 (12): 1427-1449. 10.1016/S0005-7967(03)00065-2.CrossRefPubMed
26.
go back to reference Radloff LS: The CES-D Scale: A Self Report Depression Scale for Research in the General. Applied psychological measurement. 1977, 1 (3): 385-401. 10.1177/014662167700100306.CrossRef Radloff LS: The CES-D Scale: A Self Report Depression Scale for Research in the General. Applied psychological measurement. 1977, 1 (3): 385-401. 10.1177/014662167700100306.CrossRef
27.
go back to reference Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav. 1983, 24 (4): 385-396. 10.2307/2136404.CrossRefPubMed Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav. 1983, 24 (4): 385-396. 10.2307/2136404.CrossRefPubMed
Metadata
Title
Benzodiazepine Use and Misuse Among Patients in a Methadone Program
Authors
Kevin W Chen
Christine C Berger
Darlene P Forde
Christopher D'Adamo
Eric Weintraub
Devang Gandhi
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2011
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-11-90

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