A feasibility study of a co-designed intervention to manage benzodiazepine dependence and high-risk use in those receiving opioid agonist treatment

Abstract

Background Problematic benzodiazepine use alongside opioids contributes to drug-related deaths among people who use drugs. Clinical management varies considerably. An intervention to address the root causes of benzodiazepine use with opioids has been developed, which included maintenance prescribing of diazepam with anxiety, sleep, and pain management, harm reduction, and safety conversations. This study tested the feasibility of recruiting and retaining people in the intervention to address ‘street’ benzodiazepine use. Outcome measures and economic evaluation data collection were piloted to determine the feasibility of a future trial. Methods The study tested the intervention in three sites (Grampian, Lothian and Fife) with a target of 15 patients per site. Inclusion criteria were people who were stable on opioid agonist treatment (OAT) with ongoing street benzodiazepine use. The intervention duration was 4–6 months depending on the site. Validated tools were used to monitor outcomes covering: anxiety (GAD-7), depression (PHQ-9), quality of life (EQ-5D-5L), substance use recovery (SURE), and cognitive function (ACE-III). ‘Street’ drug use was measured through oral fluid tests and self-report. Resource use data were collected from an NHS perspective using a bespoke questionnaire to inform a future economic evaluation. Results After revisions to the inclusion criteria, 39 people were recruited (9 women, 30 men), mean age: 42 yrs. Almost all had diagnosed anxiety (n = 38) and depression (n = 39,); sleep problems were common (n = 34), and over half had chronic pain (n = 21). Retention was 77% at final data collection at 4–6 months (n = 30). There were indications of improvement in anxiety, depression, self-reported recovery, and quality of life. Cognitive function was stable. Self-reported ‘street’ benzodiazepine use reduced from 100% (n = 39) at baseline to 35% at follow-up (n = 10). The economic data indicated good completion of the resource use and quality of life questionnaires, but this was dependent on the participants attending clinic appointments. Conclusion Recruitment was feasible, and there were signs of clinical improvements across anxiety, depression, quality of life, and recovery measures. Findings justify a randomised controlled trial of this intervention vs. standard care of a benzodiazepine tapering dose. However, accurate, objective measurement of current ‘street’ drug use is required.