TY - JOUR
KW - Adolescent
KW - Adult
KW - Benzodiazepines/therapeutic use
KW - Child
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Opiate Substitution Treatment/methods
KW - Opioid-Related Disorders/etiology
KW - Retrospective Studies
KW - Young Adult
KW - benzodiazepine
KW - Addiction
KW - Maintenance
KW - Opiate
KW - Substitution
AU - Adam Bakker
AU - Emmanuel Streel
A1 - 
AB - BACKGROUND: Co-prescribing benzodiazepines to patients in opiate substitution treatment is controversial and often alleged to increase mortality. In an inner-London general practice, patients with problematic benzodiazepine co-dependence were allowed benzodiazepine maintenance treatment (BMT) since 1994, providing an opportunity for analysis. METHOD: 1) Case-note review of all 278 opiate substitution treatment patients, accruing 1289 patient treatment years; 46% had concurrent BMT. 2) National Health Service database search for patients who died after leaving accrued a further 883 years of information; only patients who left the UK were unaccounted for (4%). Three groups were studied: 1) never obtained benzodiazepine prescription (NOB): n=80); 2) briefly/occasionally prescribed benzodiazepines (BOP): n=71; 3) BMT: n=127. OUTCOMES MEASURED: Treatment retention (months); deaths/100 patient treatment years; deaths after leaving the service/100 years of information. RESULTS: Treatment retention: NOB: 34 months; BOP: 51 months; BMT: 72 months. In-treatment mortality: NOB: 1.79/100 patient treatment years; BOP: 0.33/100 patient treatment years; BMT: 1.31/100 patient treatment years. Deaths after leaving service: NOB: 2.24/100 years of information, BOP: 0.63/100 years of information. However, mortality for previously BMT-patients increased by 450% to 5.90/100 years of information. DISCUSSION: BMT patients had longer treatment retention than NOB or BOP and lower mortality than NOB patients. It is unlikely that patients had access to prescribed benzodiazepines on leaving the service because of restrictions in the national guidelines but co-dependent patients are a high-risk group who may stand to gain most benefit from opiate substitution treatment if combined with benzodiazepine-maintenance.
AD - 1 NHS England, London, UK.; 2 Free University of Brussels, Brussels, Belgium.
BT - Journal of psychopharmacology (Oxford, England)
C5 - Education & Workforce; Opioids & Substance Use
CP - 1
CY - United States
DO - 10.1177/0269881116675508
IS - 1
JF - Journal of psychopharmacology (Oxford, England)
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Co-prescribing benzodiazepines to patients in opiate substitution treatment is controversial and often alleged to increase mortality. In an inner-London general practice, patients with problematic benzodiazepine co-dependence were allowed benzodiazepine maintenance treatment (BMT) since 1994, providing an opportunity for analysis. METHOD: 1) Case-note review of all 278 opiate substitution treatment patients, accruing 1289 patient treatment years; 46% had concurrent BMT. 2) National Health Service database search for patients who died after leaving accrued a further 883 years of information; only patients who left the UK were unaccounted for (4%). Three groups were studied: 1) never obtained benzodiazepine prescription (NOB): n=80); 2) briefly/occasionally prescribed benzodiazepines (BOP): n=71; 3) BMT: n=127. OUTCOMES MEASURED: Treatment retention (months); deaths/100 patient treatment years; deaths after leaving the service/100 years of information. RESULTS: Treatment retention: NOB: 34 months; BOP: 51 months; BMT: 72 months. In-treatment mortality: NOB: 1.79/100 patient treatment years; BOP: 0.33/100 patient treatment years; BMT: 1.31/100 patient treatment years. Deaths after leaving service: NOB: 2.24/100 years of information, BOP: 0.63/100 years of information. However, mortality for previously BMT-patients increased by 450% to 5.90/100 years of information. DISCUSSION: BMT patients had longer treatment retention than NOB or BOP and lower mortality than NOB patients. It is unlikely that patients had access to prescribed benzodiazepines on leaving the service because of restrictions in the national guidelines but co-dependent patients are a high-risk group who may stand to gain most benefit from opiate substitution treatment if combined with benzodiazepine-maintenance.
PP - United States
PY - 2017
SN - 1461-7285; 0269-8811
SP - 62
EP - 66
EP - 
T1 - Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review
T2 - Journal of psychopharmacology (Oxford, England)
TI - Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review
U1 - Education & Workforce; Opioids & Substance Use
U2 - 28072037
U3 - 10.1177/0269881116675508
VL - 31
VO - 1461-7285; 0269-8811
Y1 - 2017
Y2 - Jan
ER -