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INNOSC Theranostics and
Pharmacological Sciences Benzodiazepine use and retention in OAT

for pregnant women. Seventy-three percent of subjects Studies that examined the impact of having a BZD
were retained in treatment and 26% dropped out of prescription on treatment retention found no significant
treatment by 12 weeks postpartum. The percent positive difference in treatment retention between individuals who
UDT BDZ tests were significantly greater for the drop-out were BZD-negative and those with a BZD prescription. 41,45,49
group (30%) than the retained group (9%). A BDZ positive However, there was a substantial increase in treatment
UDT did not differ significantly between the groups at retention in individuals with a BZD prescription compared
enrollment (29% versus 17.0%) or proximate to delivery to participants who used illicit BZD. 44,46,48,51 These findings
(24% versus 13%), but a positive UDT for BDZ any time highlight potential importance of prescriptions for
during the third trimester was significantly more likely in individuals in OAT programs who are known to use illicit
the dropout group (47% versus 16%). BZD, as BZDs are regulated substances of known purity
and concentration monitored and adjusted by medical
4. Discussion professionals. In contrast, illicit BZD use is self-regulated
4.1. Interpretation of results by participants, potentially resulting in increased dosage
and side-effects, especially if impure drugs are consumed.
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The increased overdose risk with concurrent BZD and Overall, these findings trend to suggest that retention may
MOUD use is well established, 26,52,53 but further exploration be greater in OAT programs where BZDs – if used - are
is necessary to understand other aspects of OAT that are under the management of a clinical expert. However, the
affected by concurrent BZD and MOUD use. This review evidence is far from conclusive, and any modest increases
included studies that examined how concurrent BZD in OAT program retention must be considered in balance
and MOUD use in OAT influences treatment retention. with other risks associated with concurrent MOUD and
Our review encompasses 11 retrospective cohort BZD use. Further studies will be required to address this
studies 38-40,42,44-47,49-51,54 and three observational studies. 41,43,48 balance in more depth.
The reviewed studies are consistent with previous When analyzing whether the frequency of concurrent
reports of high polysubstance use among subjects in BZD use affects treatment retention, studies indicated
OAT. 19,55-58 BZD-positive subjects ranged from a frequency an increased risk of treatment discontinuation with
of 15% at intake to a high of 61.7% at intake, similar prolonged BZD use. 42,49 The increased risk of treatment
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42
to the range of BZD use (18 – 50%) reported by Lintzeris discontinuation may stem from the appearance of
et al. in OATs. Furthermore, evidence of high BZD and withdrawal effects from continued BZD use, subsequently
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40
opioid co-use before the initiation of OAT has been resulting in more OAT discontinuation. In addition,
documented. Overall, these findings underscore the comparing the effects of a BZD prescription and the
relevance of our review, as BZDs are commonly consumed frequency of BZD use, Eibl et al. noted that subjects with
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alongside opioid agonists in OAT programs. a BZD prescription had a statistically similar likelihood
Disparate results were observed in studies that separated of treatment retention regardless of their frequency of
subjects into BZD and no-BZD groups, based on intake BZD use. This suggests that a BZD prescription may
toxicology results. Two studies 42,43 indicated that BZD use be a stronger predictor of treatment retention than the
is a predictor of treatment discontinuation whereas two frequency of BZD use. However, it is worth noting that the
other studies 39,40 found no association between BZD use study grouped participants into high BZD frequency and
at intake and treatment retention. A similar relationship is low BZD frequency using a fraction of positive urine drug
seen with the seven studies that separated the participants screening for BZD of 30%, a threshold they believe denoted
into BZD-positive and BZD-negative groups without a high versus low frequency of BZD use. Future studies
distinguishing between prescription and illicit BZD use39 in this area would benefit from considering alternate
– 43,47,50. Four studies showed that BZD use is a predictor possible thresholds, based on clinically relevant criteria.
of treatment discontinuation, 40,42,43,50 while two studies 42,43 For instance, implementing a similar grouping to Frankyn
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indicated no relationship between BZD use and treatment et al., where subjects were divided into four groups based
retention. Finally, Raffa et al. showed increased treatment on the percentage of BZD-positive urine samples would
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retention with concurrent BZD and MOUD use. These allow for a more complex analysis, if sufficiently well
inconsistent findings may suggest the relationship between statistically powered.
concurrent BZD and MOUD use on treatment retention is In addition to the primary outcome of 1-year treatment
complex and varies based on additional variables that do retention, Montalvo et al. included secondary outcomes
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not remain constant between studies and require further of 2-year treatment retention and buprenorphine
evaluation. adherence. The study indicated that a BZD prescription

Volume 8 Issue 3 (2025) 29 doi: 10.36922/itps.5151