Mateu-Gelabert Pedro, Jessell Lauren, Goodbody Elizabeth, Kim Dongah, Gile Krista, Teubl Jennifer, Syckes Cassandra, Ruggles Kelly, Lazar Jeffrey, Friedman Sam, Guarino Honoria
National Development & Research Institutes, Inc., 71 West 23rd Street 4th Floor, New York, NY 10010, USA.
Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA.
Int J Drug Policy. 2017 Aug;46:17-27. doi: 10.1016/j.drugpo.2017.05.016. Epub 2017 May 31.
Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular-a combination that can increase the risk for fatal and non-fatal overdose. This mixed-methods study examines nonmedical use of benzodiazepines among young adults in New York City and its relationship with opioid use.
For qualitative analysis, 46 90-minute semi-structured interviews were conducted with young adult opioid users (ages 18-32). Interviews were transcribed and coded for key themes. For quantitative analysis, 464 young adult opioid users (ages 18-29) were recruited using Respondent-Driven Sampling and completed structured interviews. Benzodiazepine use was assessed via a self-report questionnaire that included measures related to nonmedical benzodiazepine and opioid use.
Participants reported using benzodiazepines nonmedically for a wide variety of reasons, including: to increase the high of other drugs; to lessen withdrawal symptoms; and to come down from other drugs. Benzodiazepines were described as readily available and cheap. There was a high prevalence (93%) of nonmedical benzodiazepine use among nonmedical opioid users, with 57% reporting regular nonmedical use. In bivariate analyses, drug-related risk behaviours such as polysubstance use, drug binging, heroin injection and overdose were strongly associated with regular nonmedical benzodiazepine use. In multivariate analysis, growing up in a middle-income household (earning between $51,000 and $100,000 annually), lifetime overdose experience, having ever used cocaine regularly, having ever been prescribed benzodiazepines, recent drug binging, and encouraging fellow drug users to use benzodiazepines to cope with opioid withdrawal were consistently strong predictors of regular nonmedical benzodiazepine use.
Nonmedical benzodiazepine use may be common among nonmedical opioid users due to its drug-related multi-functionality. Harm reduction messages should account for the multiple functions benzodiazepines serve in a drug-using context, and encourage drug users to tailor their endorsement of benzodiazepines to peers to include safer alternatives.
苯二氮䓬类药物是一种广泛使用的精神活性药物；在美国，过去15年中苯二氮䓬类药物的医疗和非医疗使用均显著增加。长期使用会导致耐受性和依赖性，突然停药会引发癫痫或其他危及生命的症状。苯二氮䓬类药物常被非医疗性地与其他药物，尤其是阿片类药物联合使用——这种组合会增加致命和非致命过量用药的风险。这项混合方法研究考察了纽约市年轻成年人中苯二氮䓬类药物的非医疗使用情况及其与阿片类药物使用的关系。
为进行定性分析，对46名年轻成年阿片类药物使用者（年龄在18 - 32岁之间）进行了90分钟的半结构化访谈。访谈内容被转录并编码以找出关键主题。为进行定量分析，采用应答驱动抽样招募了464名年轻成年阿片类药物使用者（年龄在18 - 29岁之间），并完成了结构化访谈。通过一份自我报告问卷评估苯二氮䓬类药物的使用情况，该问卷包括与苯二氮䓬类药物和阿片类药物非医疗使用相关的测量指标。
参与者报告非医疗性使用苯二氮䓬类药物的原因多种多样，包括：增强其他药物的效果；减轻戒断症状；从其他药物作用中恢复过来。苯二氮䓬类药物被描述为容易获取且价格便宜。在非医疗性阿片类药物使用者中，苯二氮䓬类药物非医疗使用的患病率很高（93%），57%的人报告有规律的非医疗使用。在双变量分析中，多药使用、药物滥用、海洛因注射和过量用药等与药物相关的风险行为与有规律的苯二氮䓬类药物非医疗使用密切相关。在多变量分析中，在中等收入家庭（年收入在51,000美元至100,000美元之间）长大、有过过量用药经历、曾经常规使用可卡因、曾被开过苯二氮䓬类药物、近期药物滥用以及鼓励其他吸毒者使用苯二氮䓬类药物来应对阿片类药物戒断，始终是有规律的苯二氮䓬类药物非医疗使用的有力预测因素。
由于其与药物相关的多功能性，苯二氮䓬类药物的非医疗使用在非医疗性阿片类药物使用者中可能很常见。减少伤害的信息应考虑到苯二氮䓬类药物在吸毒环境中的多种功能，并鼓励吸毒者向同龄人宣传苯二氮䓬类药物时采用更安全的替代方法。
