T.R. Srinivas, J. Raka, B.M. Tripathi, and P. Hemraj Centre for Behavioral Sciences, All India Institute of Medical Sciences, New Delhi
Background: Alcohol and opioid disorders are common in drug dependence treatment centers. Benzodiazepines are prescribed for the treatment of alcohol- and opioid-dependent subjects. There is also a high rate of concomitant abuse of benzodiazepines in these two populations.
Objectives: To determine the extent and patterns of benzodiazepine use in subjects with alcohol- and opioid-dependence syndrome.
Methods: Cross-sectional study design. Fifty-one consecutive male subjects, each with alcohol and opioid dependence were taken from an outpatient setting of the National Drug Dependence Treatment Centre, New Delhi, India. The demographic details and clinical history of the subjects were obtained with the help of semistructured pro forma. The instruments used in the study were the Composite International Diagnostic Instrument for Substance Abuse Module (CIDI-SAM) and Addiction Severity Index (ASI). Urine samples were analyzed specifically for benzodiazepines. The statistical analysis was done using SPSS version 7.5.
Findings: Opioid-dependent subjects were found to be from a lower age group and had less education than alcohol-dependent subjects. Opioid-dependent subjects commonly used nitrazepam (82%), whereas alcohol-dependent subjects used diazepam (94%). There was significant difference (P<0.05) in the duration of benzodiazepine prescribed and the maximum dose prescribed per day between opioid- and alcohol-dependent subjects. The harmful use of benzodiazepines was found to be 50 percent in both groups. Urine analysis results showed high positive predictive value for nitrazepam and diazepam in both opioid- and alcohol-dependent subjects. The addiction severity with benzodiazepine use was found to be significant in medical, legal, and family domains.
Conclusions: Benzodiazepine use in opioid- and alcohol-dependent subjects is common, with over half of the sample having abused benzodiazepines. The severity of prediction increased in subjects who are abusing benzodiazepines. The findings of this study imply that medical practitioners need to exercise caution when prescribing benzodiazepines, particularly to opioid- and alcohol-dependent subjects. Rigorous measures also are needed from the medical policy makers to prevent the unrestricted use of benzodiazepines.