Page 34 - ITPS-8-3

INNOSC Theranostics and
Pharmacological Sciences Benzodiazepine use and retention in OAT

In the retrospective study by Mortford et al., 31% of by Montalvo et al. reported that a BZD prescription was
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participants in both BZD and non-BZD groups remained a statistically significant predictor of treatment retention at
in OAT after 12 months. Multivariable Cox regression 1 year, with an adjusted multivariate-OR=2.44. However,
showed no significant difference in treatment duration at 2 years, a BZD prescription was no longer a significant
between the two groups. Similarly, Cox regression analysis predictor of treatment retention. Buprenorphine adherence
by Brands et al. indicated that BZD was not a predictor of as a secondary outcome was high in both 1-year (95.8%)
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1-year treatment retention. Treatment retention was found and 2-year (97.3%) treatment retention groups, with no
to be 60% within the cohort. difference in buprenorphine adherence between the BZD
Conversely, in the retrospective cohort study by prescription group and no-BZD prescription.
Franklyn et al., BZD use was found to be a negative A retrospective study conducted by Hallowell et al.
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predictor of treatment retention, with a lower median showed that individuals who were dispensed overlapping
retention of 215 days, compared to 265 days compared to BZD and buprenorphine prescriptions (30 days or more
non-users. BZD-positive subjects were found to be more supply) had higher odds of successful treatment retention
likely to drop out from treatment compared to non-users than those who were prescribed supplies of 7 days or less
using baseline urine toxicology, with an adjusted hazard (adjusted OR = 1.99). It is important to note, though, that
ratio of 1.15. The observational study by Dayal et al. in clinical practice, patients given larger drug prescriptions
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reported a significant increase in treatment retention of drugs with potentially harmful side-effects are more
among patients who did not report concurrent BZD use likely to be medically stable, thus providing a possible
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at intake. cofound. Conversely, in this study, it is possible that
those given the shorter-duration prescriptions may have
3.4. Studies that did not distinguish between illicit been less medically stable. The observational study by
and prescription BZD use Durand et al. reported that a BZD prescription within
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Five retrospective and two observational studies were 90 days before OAT initiation showed no significant effect
conducted on treatment retention in OAT where the on treatment retention. In the retrospective study by
authors did not distinguish between illicit and prescription Schuman-Olivier, the 12-month treatment retention was
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BZD use. All four studies separated subjects into groups 40% among all participants. The study found that retention
based on intake UDTs 39,40,42,43 and did not include in treatment or the use of illicit opioids was not linked to
BZD prescription as an independent variable. In the either prescription or past abuse of BDZs.
retrospective study by Peles et al., subjects who were
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BZD-negative upon admission were found to stay in 3.6. Studies that consider the frequency of BZD use
treatment significantly longer compared to their BZD- Two studies included a comparison of BZD’s effect on OAT
positive counterparts, respectively. The observational study treatment retention by grouping patients by the frequency
by Durand et al. reported an increased risk of treatment of BZD UDT screens. In the study by Franklyn et al.
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dropout at 12 months associated with BZD use, with a subjects had an increased risk of treatment discontinuation
hazard ratio of 1.22. In contrast, the retrospective study by with higher frequency of BZD use. Compared to subjects
Raffa et al. noted a small (3.25%) but significant increase with a BZD frequency of <25%, subjects who were 25‒50%
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in methadone adherence associated with BZD use. BZD-positive were 26.6% more likely to discontinue
treatment. Patients who had 50 ‒ 75% BZD-positive
3.5. Studies that include BZD prescription as a frequency were 37.4% more likely to terminate treatment.
variable Strikingly, patients with a BZD frequency >75% were
Seven articles included BZD prescription as an independent 174.4% more likely to terminate treatment. Similarly, the
variable when comparing BZD’s effect on OAT treatment. study by Eibl et al. showed a two-fold greater likelihood
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A retrospective study by Eibl et al. reported that subjects of treatment discontinuation of patients without a BZD
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with a BZD prescription had a statistically similar prescription but were heavily using BZD. Comparing
likelihood of treatment retention, regardless of the the BZD-/UDS+ group to the reference group (BZD-/
frequency of the BZD use. In the retrospective study by UDS-) had an adjusted OR=0.38. Other BZD use groups
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Park et al., a BZD prescription during buprenorphine were not statistically different than the BZD-/UDS- group
treatment was associated with significantly decreased risk concerning treatment retention.
of treatment discontinuation (HR=0.78). In the study by
White et al., 42% of patients who used illicit BZDs left the 3.7. OAT program for postpartum women
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program during the follow-up period, compared to only A retrospective study by Ray-Griffith et al. investigated
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10% of subjects with no drug use. The retrospective study factors affecting treatment retention in an OAT program

Volume 8 Issue 3 (2025) 28 doi: 10.36922/itps.5151