title: Same-day use of opioids and other central nervous system depressants amongst people who tamper with pharmaceutical opioids: A retrospective 7-day diary study.
abstract: 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.
  
  
  
  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".
  
  
  
  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.
  
  
  
  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.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; School of Medicine, University of Tasmania, Tasmania, Australia. Electronic address: Amy.Peacock@unsw.edu.au.
authors.forename: Amy
authors.initials: A
authors.lastname: Peacock
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; School of Medicine, University of Tasmania, Tasmania, Australia.
authors.forename: Raimondo
authors.initials: R
authors.lastname: Bruno
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.affiliation: Sydney Medical School, Sydney University, New South Wales, Australia; Drug and Alcohol Services, South East Sydney Local Health District, New South Wales, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Lintzeris
authors.affiliation: 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.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: University of Adelaide, South Australia, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Ali
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Dobbins
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control / Q000639:trends*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000008:administration & dosage*; D002492:Central Nervous System Depressants / Q000008:administration & dosage; D015331:Cohort Studies; D004339:Drug Compounding; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009517:New South Wales / Q000453:epidemiology; D058850:Opiate Substitution Treatment / Q000639:trends; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000453:epidemiology; D063487:Prescription Drug Misuse / Q000517:prevention & control / Q000639:trends*; D011446:Prospective Studies; D012189:Retrospective Studies; D013021:South Australia / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D002492:Central Nervous System Depressants; D001569:Benzodiazepines; D009020:Morphine
keywords: Alcohol; Benzodiazepine; Concurrent use; Opioid; Overdose; Polydrug abuse