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Table 3 Approximate quantities of prescribed and illicit benzodiazepine and opioid used, other prescribed and illicit medication taken reported by participants in each co-use pattern

From: A qualitative study of benzodiazepine/z-drug and opioid co-use patterns and overdose risk

 

No pattern reporteda

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

Prescribed BZ, Z and OP (including total daily doses where stated)

Methadone 70-80mgb(n = 4)

Long acting injectable buprenorphine 128 mg (n = 1)

Dihydrocodeine

NSc (n = 1)

Methadone

NSc (n = 1)

Buprenorphine 14mgb (n = 2)

Buprenorphine 6-16mgb (n = 2)

Methadone

60-160mgb (n = 4)

Heroin Assisted treatment

140 mg total dose taken in 2 sittings (n = 1)

Methadone

38-120mgb (n = 8)

Buprenorphine 8- 16mgb (n = 1)

Long acting injectable buprenorphine

NSc (n = 1)

Morphine (110 mg) (n = 1)

Methadone

40-160mgb (n = 7)

Buprenorphine 8-16mgb (n = 2)

Long acting injectable buprenorphine NSc (n = 2)

Methadone

80-90mgb (n = 3)

Buprenorphine 8mgb (n = 2)

Long acting injectable buprenorphine

NSc (n = 2)

Prescribed BZ and Z (including total daily doses where stated)

Diazepam

6-30 mg (n = 2)

Diazepam 30 mg (n = 1)

None reported

Nitrazepam 20mgd (n = 1)

Diazepam 30mgd (n = 1)

Diazepam

25-30 mg (n = 5)

Diazepam 22 mg (n = 1) this is prescribed on a weekly pick-up and this participant takes all 7 doses for the week in one day (154 mg)

Diazepam

12-35 mg (n = 6)

Diazepam

4 mg (n = 2)

Diazepam 30 mg (splits the dose, spreading the 6 5 mg tablets throughout the afternoon and evening) (n = 1)

Illicit OP (including total daily doses where stated)e

Heroin

NSc (n = 1)

Heroin

3 × 0.4 g bags/day, smoked (n = 1) / a couple of lines (n = 1)

Co-codamol 20/day (n = 1)

None reported

Heroin

NSc (n = 2)

Oxycontin

NSc (n = 1)

Heroin

NSc (n = 5)

Oxycodone

NSc (n = 1)

Heroin

0.2–1.75 g (n = 10)

Morphine

NSc (n = 1)

(very occasional) heroin

0.2–1.2 g (n = 4)

Illicit BZ and Z (including total daily doses where stated)f

Zopiclone

3 a day approx. 22.5 mg (n = 1)

Street diazepam

15 a day (150 mg) (n = 1) / NSc (n = 1)

Zopiclone

2 a day

approx. 15 mg (n = 1)

Street diazepam 1–5 tablets / day approx. 10-50 mg (n = 3)

Street BZ (clonazepam, diazepam, alprazolam or temazepam) aims to take approx. 40 mg BZ dose each day – but varies which BZ they take each day (n = 1)

Zopiclone up to 10 × 7.5 mg (n = 1)

Zopiclone 10 a day approx. 75 mg

(n = 1)

Street diazepam approx. 40 mg (n = 1) / up to 12 tablets / day NSc (n = 1)

Zopiclone

10 approx. 75 mg

(n = 3)

Street diazepam (20 -75 tablets or more) NSc (n = 3)

diverted diazepam 18 × 2 mg tablets (36 mg) (n = 1)

alprazolam (120 mg)(n = 1)

online or diverted clonazepam 200 × 2 mg tablets (0.2 g) (n = 1), NSc (n = 1)

Zopiclone, 30–40 3.75 mg blue tablets approx. 150 mg (n = 1)

Street diazepam 20—500 tablets /day NSc (n = 11)

Diverted/online diazepam sold as 10 mg takes approx. 40 mg in the morning and then as and when needed throughout the day (total daily dose not stated) (n = 1)

Online BZ alprazolam, diazepam, nitrazepam or clonazepam 30 tablets a day day NSc (n = 1)

Zopiclone 12 tablets a day NSc (n = 1)

Online BZ—takes alprazolam, diazepam, or clonazepam, 30 tablets, of one of the above BZ, each sold as 2 mg strength, approx. 60 mg total dose (n = 1)

Street diazepam (yellows, sold as 5 mg) taken in handfuls (estimates up to 80 tablets) 400 mg total dose (n = 1)

Diverted diazepam (20 mg) (n = 1)

Diverted or street diazepam 15 (n = 1), 50 (n = 1), 100 per day (n = 1) NSc

Other illicit /bought substances takene

Pregabalin NSc (n = 2)

Cocaine (n = 1) NSc

Crack cocaine NSc (n = 1)

Alcohol (n = 1) approx. 18 units/week

Ketamine NSc (n = 1)

Cocaine NSc (n = 2)

Crack cocaine NSc (n = 1)

Alcohol (n = 2, 3—12 units/day)

Occasional alcohol (a few units/week) (n = 1)

Alcohol (up to 10 units, 2–3 times / week) (n = 1)

Pregabalin NSc (n = 1)

Cocaine NSc (n = 1)

Crack cocaine NSc (n = 1)

Cannabis NSc (n = 2)

Alcohol (4–6 cans cider or lager /day) (n = 1)

Pregabalin NSc (n = 2)

Crack cocaine NSc (n = 1)

Cocaine NSc (n = 2)

Cannabis NSc (n = 3)

Alcohol (up to 20 units/week) (n = 3)

Pregabalin (300-700 mg/day)(n = 6)

Crack cocaine (0.2–0.8 g) (n = 4)

Cocaine NSc (n = 5)

Cannabis NSc (n = 4)

Spice NSc (n = 1)

Alcohol (n = 4) 1–12 cans cider/beer/day)

Pregabalin (300-700 mg/day)(n = 1)

Crack cocaine NS (n = 3)

Cocaine NSc (n = 2)

Cannabis NSc (n = 4)

Alcohol (n = 1) up to 4 cans beer/cider /day)

Other prescribed drugs

Mirtazapine (45 mg, n = 2), Olanzapine (10 mg),

Pregabalin (600 mg)

Amitriptyline (10 mg) (n = 1)

none

Quetiapine 25 mg (n = 1)

Quetiapine NSc (n = 1)

Risperidone NSc (n = 1)

Sertraline NSc (n = 1)

Mirtazapine NSc (n = 2)

Amitriptyline NSc

(n = 1)

Pregabalin NSc (n = 1)

Fluoxetine NSc (N = 1)

Mirtazapine 30 mg (n = 3)

Pregabalin (100-500 mg) (n = 2)

Amitriptyline 25 mg (n = 1)

Dosulepin (75 mg in 2 doses) (n = 1)

Mirtazapine 30 mg (n = 2)

Naproxen NSc (n = 1)

  1. aSome participants could not be mapped to a pattern because their interview did not capture sufficient information on when they took their opioids and benzodiazepines
  2. bMethadone and buprenorphine doses refer to total daily amount prescribed usually taken as a single dose (unless stated otherwise)
  3. cNS = No dose or strength of drug stated or known
  4. dTotal daily dose split into a morning and evening dose (e.g. 20 mg in the morning and 10 mg in the evening)
  5. eRoute of administration of illicit opioids, cocaine, crack cocaine and ketamine are not reported here as we did not have consistent data on this from participants. Doses of heroin reported are as reported to us by participants, which is typically described as the weight of the bag of heroin purchased
  6. fApproximate daily doses are reported based on participant’s reports of the strength that illicit z-drugs and benzodiazepine tablets were sold as