A qualitative study of Benzodiazepine/Z-drug and Opioid co-use patterns and overdose risk (2024)

Abstract

Background Co-use of benzodiazepines and/or ‘z-drugs’ along with opioids is linked to the rise in drug related deaths (DRD) in the UK. Understanding patterns of co-use could inform harm reduction strategies for reducing DRDs. This study explored how people co-use, including dosages, timings, methods of administration, use of other substances and desired effects sought.

Methods Forty-eight semi-structured interviews across Glasgow in Scotland (n=28), Bristol (n=10) and Teesside (n=10) in England with individuals who co-use illicit and/or prescribed opioids and benzodiazepines/z-drugs were conducted. Eighteen interviews were co-facilitated with qualitatively trained local peer researchers. Interviews were analysed using the Framework method.

Results Six co-use patterns were generated: (1) co-use to aid sleep or come down, (2) curated co-use, opioid agonist therapy (OAT) only (3) morning and evening benzodiazepine doses with opioids throughout the day (4) co-use binges (5) co-use throughout the day, (6) benzodiazepine use throughout the day plus OAT. Patterns one to three reflected more controlled co-use with a focus on self-medicating to give confidence, manage anxiety, promote sleep and come-down from cocaine/ketamine. Patterns four to six involved greater poly-drug use, and less controlled co-use with a focus on seeking euphoria (“warm glow”, “gouching out”) or oblivion (to escape untreated mental health conditions and trauma). Patterns two, three, five and six involved daily co-use. People switched between patterns depending on available resources (e.g. finances) or changes to prescriptions (opioids or benzodiazepines). Near-fatal overdoses were reported by participants across all co-use patterns. Patterns four to six were conceptualised as presenting greater overdose risk due to less controlled co-use and more extensive polydrug use.

Conclusions The patterns identified provide opportunities for future harm reduction strategies, tailoring advice, updated prescribing guidance and policies, and the need for better access to mental health care, for people who co-use benzodiazepines and opioids to reduce DRDs.

Footnotes

• 1. Title shortened (removed - implications for policy and practice)2. Highlights section removed3. Heading changed - from Introduction to Background4. Additional information provided in the methods as follows - (a) Under the data collection section - we added information on the conceptual framework for the study as follows “The socioecological framework (22) formed the conceptual framework for the qualitative work, which includes this analyses, and two further separate analyses exploring motivations for co-use and experiences of harm reduction advice and near fatal overdose experiences. The framework provided a lens to understand when and why people co-use within the context of sociological, cultural, economic and political structures. This conceptual framework guided the development of the interview topic guide” (b) a justification for near data analysis is presented in the Analysis section as follows “The analysis presented in this paper, is intentionally “near the data” and descriptive (27, 28) to provide a detailed picture of how people co-use, in order to inform policy and practice related to co-prescribing and wider harm reduction efforts to address DRD among people who co-use. In addition, the data is informing the neuropharmacology experiments running alongside the interviews, that were testing the mechanisms underlying fatal overdoses. We have also been intentionally descriptive in the naming of the patterns in order that they highlight the specificity of which types of drugs are co-used and when during the day. Further papers (29, 30) present more interpretive analyses of the qualitative data, and capture the motivations for, and experiences of co-use, as well as the socioecological context that co-use occurs in, and the support available to them, and the harm reduction strategies they have available to keep themselves safe.”Declarations at the end of the paper reformatted, and a list of abbreviations included at the endA few additional references included to support sections added to methods

Data Availability

Data are available on application at the University of Bristol data repository data.bris. Data access is restricted to bona fide researchers for ethically approved research and subject to approval by the University's Data Access Committee.

https://data.bris.ac.uk/data/