"It could potentially be dangerous... but nothing else has seemed to help me.": Patient and clinician perspectives on benzodiazepine use in opioid agonist treatment.
Benzodiazepines
Buprenorphine
Methadone
Journal
Journal of substance abuse treatment
ISSN: 1873-6483
Titre abrégé: J Subst Abuse Treat
Pays: United States
ID NLM: 8500909
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
25
02
2021
revised:
26
04
2021
accepted:
26
04
2021
pubmed:
8
6
2021
medline:
22
3
2022
entrez:
7
6
2021
Statut:
ppublish
Résumé
Benzodiazepine use among patients receiving opioid agonist treatment (OAT) presents a conundrum: benzodiazepines increase overdose risk, yet can treat anxiety and insomnia. How best to balance the risks and benefits of benzodiazepines among OAT patients is unclear. Using qualitative methods, we examined patient motivations for benzodiazepine use and understanding of risks, and the context in which benzodiazepine use and prescribing occurs. We conducted semi-structured interviews with 26 OAT patients using benzodiazepines and 10 OAT clinicians. Participants were recruited from an office-based buprenorphine clinic at an academic medical center and a methadone opioid treatment program using purposive sampling. The study team reviewed transcripts and double-coded 100% of interviews. Data analysis combined both deductive and inductive methods. Major emergent themes were: 1) patients focus on benefits over risks of benzodiazepines, 2) patients can learn to use benzodiazepines safely, 3) patients want to use benzodiazepines now but discontinue in the future, 4) clinicians and patients weigh the risks and benefits of benzodiazepine use differently, 5) clinicians and patient have differences in treatment goals, and 6) clinicians struggle with benzodiazepine discontinuation. OAT patients and clinicians can weigh the risks and benefits of benzodiazepines differently leading to a difference in treatment goals. The risk-benefit analysis of benzodiazepine prescribing may depend on whether the patient is engaged in opioid treatment. Future work among patients and clinicians is warranted to determine how to better balance patient and clinician priorities in order to deliver safer prescribing practices and maintain patient engagement in care.
Sections du résumé
BACKGROUND
Benzodiazepine use among patients receiving opioid agonist treatment (OAT) presents a conundrum: benzodiazepines increase overdose risk, yet can treat anxiety and insomnia. How best to balance the risks and benefits of benzodiazepines among OAT patients is unclear. Using qualitative methods, we examined patient motivations for benzodiazepine use and understanding of risks, and the context in which benzodiazepine use and prescribing occurs.
METHODS
We conducted semi-structured interviews with 26 OAT patients using benzodiazepines and 10 OAT clinicians. Participants were recruited from an office-based buprenorphine clinic at an academic medical center and a methadone opioid treatment program using purposive sampling. The study team reviewed transcripts and double-coded 100% of interviews. Data analysis combined both deductive and inductive methods.
RESULTS
Major emergent themes were: 1) patients focus on benefits over risks of benzodiazepines, 2) patients can learn to use benzodiazepines safely, 3) patients want to use benzodiazepines now but discontinue in the future, 4) clinicians and patients weigh the risks and benefits of benzodiazepine use differently, 5) clinicians and patient have differences in treatment goals, and 6) clinicians struggle with benzodiazepine discontinuation.
CONCLUSIONS
OAT patients and clinicians can weigh the risks and benefits of benzodiazepines differently leading to a difference in treatment goals. The risk-benefit analysis of benzodiazepine prescribing may depend on whether the patient is engaged in opioid treatment. Future work among patients and clinicians is warranted to determine how to better balance patient and clinician priorities in order to deliver safer prescribing practices and maintain patient engagement in care.
Identifiants
pubmed: 34098286
pii: S0740-5472(21)00181-1
doi: 10.1016/j.jsat.2021.108455
pmc: PMC8556389
mid: NIHMS1699033
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Benzodiazepines
12794-10-4
Buprenorphine
40D3SCR4GZ
Methadone
UC6VBE7V1Z
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
108455Subventions
Organisme : NIDA NIH HHS
ID : K23 DA044321
Pays : United States
Organisme : NIAAA NIH HHS
ID : R01 AA021335
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Références
Pain Med. 2017 Mar 1;18(3):454-467
pubmed: 27558857
Drug Alcohol Depend. 2017 May 1;174:58-64
pubmed: 28315808
BMC Psychiatry. 2011 May 19;11:90
pubmed: 21595945
Dialogues Clin Neurosci. 2017 Jun;19(2):93-107
pubmed: 28867934
BMC Fam Pract. 2013 Dec 13;14:191
pubmed: 24330388
Addiction. 2020 May;115(5):924-932
pubmed: 31916306
BMJ. 2009 Jun 16;338:b2225
pubmed: 19535400
J Subst Abuse Treat. 2016 Sep;68:57-61
pubmed: 27431047
Drug Alcohol Depend. 1999 Jun 1;55(1-2):63-8
pubmed: 10402150
Aust N Z J Psychiatry. 2003 Aug;37(4):458-63
pubmed: 12873331
J Subst Abuse Treat. 2009 Dec;37(4):407-11
pubmed: 19339146
J Psychopharmacol. 2017 Jan;31(1):62-66
pubmed: 28072037
Psychiatr Serv. 2014 Jan 1;65(1):4
pubmed: 24382761
MedGenMed. 2001 Mar 05;3(2):2
pubmed: 11549951
J Subst Abuse Treat. 2017 Jun;77:67-71
pubmed: 28476275
Expert Opin Pharmacother. 2018 Jun;19(8):883-894
pubmed: 29806492
Drug Alcohol Depend. 2013 Oct 1;132(3):580-6
pubmed: 23688843
Patient. 2017 Feb;10(1):1-15
pubmed: 27282559
J Gen Intern Med. 2007 Sep;22(9):1335-50
pubmed: 17619935
BMC Fam Pract. 2002 May 08;3:9
pubmed: 12019038
PLoS Med. 2019 Nov 26;16(11):e1002965
pubmed: 31770388
Acad Emerg Med. 2018 Jan;25(1):15-24
pubmed: 28791786
Fam Pract. 1997 Oct;14(5):361-8
pubmed: 9472369
Addiction. 2007 Apr;102(4):616-22
pubmed: 17286641