New York University, Silver School of Social Work, 1 Washington Square North, New York, NY 10003, USA.
New York University, Silver School of Social Work, 1 Washington Square North, New York, NY 10003, USA.
J Subst Abuse Treat. 2020 Feb;109:56-60. doi: 10.1016/j.jsat.2019.10.001. Epub 2019 Nov 22.
One class of drugs increasingly involved in overdose fatalities is benzodiazepines. Prescribing benzodiazepines to people with co-occurring substance use disorders (SUDs) poses risk for overdose and dependence and is not recommended. The current study reports prevalence rates of prescribing benzodiazepines to people with and without co-occurring SUDs in community mental health settings. Clinical and socio-demographic factors associated with receipt of a benzodiazepine were examined, including whether factors potentially indicative of prescribing biases (older age and race) moderated the relationship between having a co-occurring SUD and receiving a benzodiazepine prescription.
Retrospective chart review data from service users treated between August 2014 and August 2017 were collected as part of an NIMH-funded RCT of Person-Centered Care Planning. Data were assessed from 774 charts collected across 14 sites nested within ten community mental health centers (CMHCs). Mixed effects logistic regression models examined direct and interaction effects related to receipt of a benzodiazepine.
Of the 774 service users, 19.9% (N = 154) were prescribed at least one benzodiazepine. Of those prescribed a benzodiazepine, 35.1% (N = 54) had a co-occurring SUD and 31.8% (N = 49) had an anxiety disorder. Our main effects model did not find a significant difference in the odds of receiving a benzodiazepine among service users with and without a co-occurring SUD (OR = 0.77, CI: 0.50-1.17). However, moderation analyses found that the odds of being prescribed a benzodiazepine among people with co-occurring SUDs was greater among service users of older age (OR: 2.01, CI: 1.01-4.02) and non-Hispanic white race (OR = 3.34, CI: 1.55-7.22).
Our findings demonstrate that a considerable number of people with a documented co-occurring SUD are prescribed benzodiazepines in CMHCs, a practice that poses risks for dependence and overdose. Prescribing decisions may be influenced by service user age and race.
越来越多与过量死亡有关的药物类别是苯二氮䓬类药物。给同时患有物质使用障碍（SUD）的人开苯二氮䓬类药物会有过量和依赖的风险，因此不建议这样做。本研究报告了在社区心理健康环境中同时患有和不患有 SUD 的人开苯二氮䓬类药物的流行率。研究检查了与接受苯二氮䓬类药物治疗相关的临床和社会人口因素，包括是否存在可能表明处方偏见的因素（年龄较大和种族）会调节同时患有 SUD 和接受苯二氮䓬类药物处方之间的关系。
作为 NIMH 资助的以人为中心的护理计划 RCT 的一部分，从 2014 年 8 月至 2017 年 8 月期间接受治疗的服务使用者的回顾性图表审查数据被收集。数据来自嵌套在十个社区心理健康中心（CMHC）中的 14 个站点收集的 774 份图表。混合效应逻辑回归模型检查了与接受苯二氮䓬类药物相关的直接和交互影响。
在 774 名服务使用者中，19.9%（N=154）至少开了一种苯二氮䓬类药物。在开了苯二氮䓬类药物的人中，35.1%（N=54）同时患有 SUD，31.8%（N=49）患有焦虑症。我们的主要效应模型没有发现同时患有 SUD 和没有 SUD 的服务使用者在接受苯二氮䓬类药物的几率上有显著差异（OR=0.77，CI：0.50-1.17）。然而，调节分析发现，在同时患有 SUD 的人中，年龄较大（OR：2.01，CI：1.01-4.02）和非西班牙裔白人种族（OR=3.34，CI：1.55-7.22）的服务使用者被开苯二氮䓬类药物的几率更大。
我们的研究结果表明，在 CMHC 中，相当数量的同时患有记录在案的 SUD 的人被开了苯二氮䓬类药物，这种做法会增加依赖和过量的风险。处方决策可能受到服务使用者年龄和种族的影响。
