Table 2 Summary of co-use patterns, motivations for co-use and approximate numbers of benzodiazepine (BZ), z-drug (Z) and opioid (OP) doses per day
From: A qualitative study of benzodiazepine/z-drug and opioid co-use patterns and overdose risk
Co-use patterns | ||||||
|---|---|---|---|---|---|---|
More controlled co-use | Less controlled co-use | |||||
Co-use to aid sleep or come down | Curated co-use | Morning and evening BZ/Z doses with OP throughout the day | Co-use binges | Co-use throughout the day | BZ/Z use throughout the day, OAT only no other OP | |
Frequency of BZ/Z and OP co-use | Variable, some co-used daily, others a few times per week | Daily | Daily | Ranging from a rare occurrence to once a week, to a few times a week | Daily | Daily |
Approx number of times people took BZ/Z and OP doses each day | BZ/Z: Usually one to two doses in the evening / early morning Opioid: Daily OAT taken in the morning. For some, illicit OP also taken during the day (e.g. 3–4 doses of intravenous heroin) | BZ/Z: Variable, can range from one dose / day to a few doses OP: Daily OAT taken, no other OP taken | BZ/Z: Twice a day OP: Daily OAT taken in the morning by all participants, further 1–3 OP doses prescribed or illicit throughout the day | BZ/Z: multiple doses throughout the day sustained for 1–3 consecutive days OP: Daily OAT taken (if remembered) and approximately 2–3 doses (or more) of illicit OP throughout the day sustained for 1–3 consecutive days | BZ/Z: Multiple doses throughout the day (quantity taken, and frequency of re-dosing varied according to availability, perceived strength of BZ) OP: For those prescribed it, daily OAT taken (usually but not exclusively) in the morning, 2–3 (or more) further OP doses of diverted prescription OP or heroin taken throughout the day (amounts varied with availability of finances) | BZ/Z: Multiple doses throughout the day (quantity taken, and frequency of re-dosing varied according to availability, perceived strength of BZ) OP: OAT only, no other OP taken. OAT taken once a day or as long-acting injectable buprenorphine |
Motivation for co-usea | Self-medicating (racing thoughts and difficulties sleeping) —issues which are linked to their diagnosed Anxiety, ADHD or Tourette’s. BZ also used to help come-down from cocaine, crack cocaine or ketamine use | To achieve specific mental states (e.g. reduce anxiety, and give confidence or to achieve euphoria) | Self-medicating (anxiety/sleep) and to feel calm / like themselves | Seeking a glow or buzz (euphoria), attempts at self-medicating for anxiety / to give confidence but loss of control and inhibitions leads to binge. Three participants in this group report BZ binge as part of an intentional overdose | Seeking a glow or buzz (euphoria) or seeking oblivion to self-medicating for trauma to escape their current reality (hostel, homelessness), also to remove withdrawal effects | Removal of withdrawal effects, seeking a glow, buzz or oblivion from benzodiazepine co-use |