Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, United States of America; Grayken Center for Addiction, Boston Medical Center, United States of America.
Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, United States of America.
J Subst Abuse Treat. 2021 Dec;131:108455. doi: 10.1016/j.jsat.2021.108455. Epub 2021 Apr 30.
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.
苯二氮䓬类药物在接受阿片类激动剂治疗（OAT）的患者中使用存在一个难题：苯二氮䓬类药物会增加过量风险，但可以治疗焦虑和失眠。如何在 OAT 患者中平衡苯二氮䓬类药物的风险和益处尚不清楚。本研究使用定性方法，研究了患者使用苯二氮䓬类药物的动机和对风险的理解，以及苯二氮䓬类药物使用和处方发生的背景。
我们对 26 名正在使用苯二氮䓬类药物的 OAT 患者和 10 名 OAT 临床医生进行了半结构化访谈。参与者是从一家学术医疗中心的门诊丁丙诺啡诊所和一家美沙酮阿片类药物治疗项目中通过目的性抽样招募的。研究小组审查了转录本并对 100%的访谈进行了双重编码。数据分析结合了演绎和归纳方法。
主要的主题包括：1）患者关注苯二氮䓬类药物的益处超过风险，2）患者可以学会安全使用苯二氮䓬类药物，3）患者现在希望使用苯二氮䓬类药物，但将来会停止使用，4）临床医生和患者对苯二氮䓬类药物使用的风险和益处的看法不同，5）临床医生和患者的治疗目标不同，6）临床医生在苯二氮䓬类药物停药方面存在困难。
OAT 患者和临床医生对苯二氮䓬类药物的风险和益处的评估可能不同，导致治疗目标不同。苯二氮䓬类药物处方的风险-效益分析可能取决于患者是否参与阿片类药物治疗。需要在患者和临床医生中开展进一步的工作，以确定如何更好地平衡患者和临床医生的优先事项，从而提供更安全的处方实践并维持患者对治疗的参与。
