In ten short years, substance abuse treatment admissions for combined benzodiazepine and narcotic pain reliever abuse jumped a startling 569.7 percent—from 5,032 in 2000 to 33,701 in 2010—while all other admissions dropped 9.6 percent.
These figures come from the Treatment Episode Data Set (TEDS) Report issued December 13 by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report notes that benzodiazepines, used to treat anxiety and drug and alcohol withdrawal symptoms, are commonly used— licitly and illicitly—to boost the effects of narcotic pain relievers, such as oxycodone.
The “Combination” Group: A Treatment-Resistant Population
TEDS describes the characteristics of people who abuse benzodiazepines and narcotic pain relievers—we’ll call them the “combination” group—compared to the “other” admissions, those who did not abuse drugs of either type. People who co-abuse the two drugs are a “high-need, treatment-resistant population.” They report more severe withdrawal symptoms and higher treatment attrition rates than people withdrawing from narcotic pain medications alone. This is no surprise, as benzodiazepine withdrawal is notoriously difficult—similar to alcohol and barbiturate withdrawal.
Compared to the “other” group, the “combination” group was
- Mostly non-Hispanic white, with a low percentage of Hispanic and non-Hispanic black
- More likely to be from the South
- Evenly divided by sex (70% of the “other” group was male)
- More likely to report a co-occurring psychiatric disorder
- Concentrated in the age group 18-34 years (Chart 1)
- Most often self-referred to treatment rather than referred by the criminal justice system (Chart 2)
- Less likely to be receiving regular outpatient treatment
- More likely to report daily use of any substance during the month before admission
There was no difference between the groups in education or employment status.
Implications for Treatment Programs
According to the report, daily use before admission points to “behavioral patterns that may be difficult to change.” Programs need to be prepared for the severe withdrawal effects from both drugs, “particularly since benzodiazepines compound the withdrawal effects of narcotic pain relievers. Providing medical and supportive services to mitigate the severe withdrawal effects may be critical to avoid treatment attrition and relapse.”
The report notes that the high rate of mental health disorders in the combination admissions group—perhaps partly due to using benzodiazepines for self-medication— may give programs a “unique opportunity to facilitate access to both substance abuse treatment and mental health services for people who co-abuse these drugs.”
A current review article summarizing data from about 200 articles on opioid and benzodiazepine combination use agrees with the self-medication possibility, but adds that the data suggest that the benzodiazepine use is primarily recreational. Co-users report seeking benzodiazepines to enhance “opioid intoxication or ‘high,’” and use doses exceeding therapeutic range. The review encourages further investigation and more cautious prescribing practices.
Chart I: Age Distribution of Benzodiazepine and Narcotic Pain Reliever Combination Admissions and Other Admissions*: 2010
Chart 2: Sources of Referral to Treatment among Benzodiazepine and Narcotic Pain Reliever Combination Admissions and Other Admissions*: 2010
Review article: Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012; Sep 1; 125(1-2):8-18. doi: 10.1016/j.drugalcdep.2012.07.004. Epub 2012 Aug 2