title: Treatment or "high": benzodiazepine use in patients on injectable heroin or oral opioids.
abstract: Benzodiazepine (BZD) use is widespread among opioid-maintained patients worldwide. We conducted a cross-sectional survey to investigate motives and patterns of BZD use and psychiatric comorbidity in a convenience sample of patients (n=193) maintained on oral opioid agonists or diacetylmorphine (DAM). Prolonged BZD use and high-risk behaviors like parenteral use were common. After principal component analysis, motives were divided into those related to negative affect regulation, positive affect regulation (i.e. reward-seeking) and somato-medical problems. Negative affect regulation and somato-medical motives were associated with prolonged use. Psychiatric comorbidity was associated with several self-therapeutic motives, most importantly to lose anxiety. Patients maintained on DAM were more likely to be ex-users of BZD and report high positive affect regulation. Therefore, patients maintained on different agonists may have deviating motives for BZD use, which could be of importance when addressing this issue. Treatment of psychiatric comorbidity, in particular anxiety, depressive and sleeping disorders, may be helpful in reducing BZD use, particularly in patients maintained on oral opioids.
authors.affiliation: Division of Substance Use Disorders, Psychiatric Hospital of the University of Basel, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland. Marc.Vogel@upkbs.ch
authors.forename: Marc
authors.initials: M
authors.lastname: Vogel
authors.forename: Bina
authors.initials: B
authors.lastname: Knöpfli
authors.forename: Otto
authors.initials: O
authors.lastname: Schmid
authors.forename: Mari
authors.initials: M
authors.lastname: Prica
authors.forename: Johannes
authors.initials: J
authors.lastname: Strasser
authors.forename: Luis
authors.initials: L
authors.lastname: Prieto
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Wiesbeck
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Dürsteler-Macfarland
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy / Q000453:epidemiology; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D058850:Opiate Substitution Treatment / Q000379:methods* / Q000523:psychology; D063487:Prescription Drug Misuse; D012651:Self Medication / Q000523:psychology / Q000706:statistics & numerical data*; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines; D003932:Heroin
keywords: Diacetylmorphine; Motive; Opioid dependence; Psychiatric comorbidity; Sedative