Tae Woo Park1, Jennifer Sikov2, Vanessa dellaBitta2, Richard Saitz3, Alexander Y Walley4, Mari-Lynn Drainoni5. 1. 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. Electronic address: taewoo.park@bmc.org. 2. Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, United States of America. 3. Grayken Center for Addiction, Boston Medical Center, United States of America; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, United States of America; Department of Community Health Sciences, Boston University School of Public Health, United States of America. 4. Grayken Center for Addiction, Boston Medical Center, United States of America; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, United States of America. 5. Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, United States of America; Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, United States of America; Department of Health Law, Policy & Management, Boston University School of Public Health, United States of America.
Abstract
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.
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.
Authors: Tae Woo Park; Marc R Larochelle; Richard Saitz; Na Wang; Dana Bernson; Alexander Y Walley Journal: Addiction Date: 2020-01-20 Impact factor: 6.526
Authors: Eric J Hawkins; Carol A Malte; Hildi J Hagedorn; Douglas Berger; Anissa Frank; Aline Lott; Carol E Achtmeyer; Anthony J Mariano; Andrew J Saxon Journal: Pain Med Date: 2017-03-01 Impact factor: 3.750
Authors: Kevin W Chen; Christine C Berger; Darlene P Forde; Christopher D'Adamo; Eric Weintraub; Devang Gandhi Journal: BMC Psychiatry Date: 2011-05-19 Impact factor: 3.630