Catriona Matheson

Managing benzodiazepine dependence and high-risk use with opiates: a feasibility study of a co-produced intervention

Background: Problematic benzodiazepine (BZD) use alongside opiates contributes to mortality among people who use drugs. Clinical practice currently focuses on managing BZD dependence through tapered dosing. An intervention to address the root causes of benzodiazepine use with opiates was needed.

Aims: This study designed and tested the feasibility of a co-designed intervention to address concurrent benzodiazepine and opiate use. Recruitment and outcome measures were piloted to inform the feasibility of a future randomised controlled trial.

Methods: Phase one was intervention development following the Medical Research Council (MRC) complex intervention framework, and phase two was feasibility testing and piloting. Three workshops (with people who use benzodiazepines, clinicians, academics, psychologists, and pharmacists) and patient and public involvement (PPI) groups were held. The co-produced intervention included: maintenance prescribing of diazepam, anxiety, sleep and pain management, harm reduction resources and safety conversations. In phase two, 41 people were recruited in three Scottish sites to test intervention feasibility and pilot recruitment and data collection. Inclusion criteria were people who were stable on ORT but at ongoing risk due to ‘harmful’ use of street benzodiazepines. Outcomes measures included GAD, PHQ-9, EQ5D, SURE, ACE-III (cognitive function) and oral fluid testing. An economic evaluation was undertaken from an NHS perspective.

Results: Two people were excluded following baseline, leaving 39 participants to receive the intervention (30 male, nine female), mean age 41.9 years. Data collection is being finalised (end of June 2023). Thirty-one of 39 participants were retained. Final outcome data and the economic evaluation will be presented.

Conclusion: A co-produced intervention was successfully developed and implemented. Recruitment and retention proved feasible.