Page 36 - ITPS-8-3

INNOSC Theranostics and
Pharmacological Sciences Benzodiazepine use and retention in OAT

increases the likelihood of 1-year treatment retention but influence treatment retention. There was also a significant
was not statistically significant at 2 years. This suggests that lack of information in the studies about the patterns of illicit
BZD’s effect on treatment retention may be more impactful BZD use among subjects, and the psychological reasons
at the start of OAT. This relationship could be present for for its use. Concurrent BZD use with opioids can occur
two reasons: (1) BZD use is helpful with alleviating opioid for diverse reasons, including self-medication of opioid
withdrawal symptoms which are much more prevalent withdrawal symptoms, concomitant mental health issues
15
at the start of OAT (2) BZDs are typically intended for such as underlying anxiety, to increase the euphoric effects
short-term use, and if used for longer periods it may be of each drug, and as a broader pattern of polysubstance
prescribed at lower doses or tolerance may develop, 61,62 abuse. 24,63 More detailed information about motives for
diminishing their positive impact on treatment retention. BZD use with opioids would be clinically informative
Montalvo et al. did not report the BZD doses, thus for healthcare providers and could help guide clinical
51
further experiments are required to test our hypotheses. management. In addition to more detailed information
Another conclusion by the authors is that the increase in about patterns of drug use, it would be informative for
treatment retention seen with a BZD prescription was not studies to include more granular details about the patients
a result of a change in MOUD adherence. This finding and treatment characteristics, as these are critical factors
51
is consistent with prior reports that BZD use, specifically in treatment retention. Patient characteristics including
under a prescription, is to alleviate comorbidities caused age, sex, psychiatric comorbidities, and substance use all
by opioid withdrawal. heavily influence treatment adherence, 64-66 while treatment
38
The study by Ray-Griffith et al. addressed the complex characteristics including MOUD dose, dosing flexibility,
67-69
issue of BZD use in OAT programs by pregnant and and treatment setting similarly influence adherence.
postpartum women. To our knowledge, this is the only study From Table 3, it was evident that these details are frequently
of its kind, and so comparison is not possible. Nonetheless, not included in relevant publications.
this study provides an important investigation, specifically It must also be noted that the studies we evaluated were
for the effects of illicit BZD use history on treatment conducted across many different regions and countries,
retention during pregnancy. Two participants within the where drug protocols and laws for BZD, MOUD, and OAT
cohort had a BZD prescription. Following the removal programs differ, although approximately half of the studies
of the two participants from the statistical analysis, the were completed in the North East US (Table 3). Given the
treatment dropout group had a relatively high rate of widespread use of opioids throughout North America
BZD use compared to the treatment retained group. The (and increasingly elsewhere) studies in more diverse
treatment dropout group was statistically more likely to regions would be a welcome addition to the literature. The
be BZD-positive during the first trimester. The correlation included studies also had slightly varying definitions of
between BZD use in the third trimester and postpartum treatment retention (Table 2). Standardizing the definition
treatment retention suggests that BZD use history is a of treatment retention may help prevent the presence of
predictor of treatment retention. Thus, BZD use might be biases within the data.
only beneficial to OAT during the treatment itself, where
regulation and monitoring are present. Further analysis is 6. Conclusion
required to evaluate if the increased treatment dropout is The existing literature on this topic consists of diverse
solely due to having a history of BZD use, or if having BZD studies of substantially different methodologies and
use specifically in the third trimester is significant to OAT outcome measures. Due to the intrinsic complexity
retention. and variability of many of the outcome measures, in a
typically polysubstance-using population, and a lack of
5. Limitations
standardized instruments with which to measure these
It is important to note that this literature review was outcome variables, drawing firm conclusions that can
conducted using data from 14 different studies. Some be generalized to this field as a whole is not yet possible.
methodologies and primary outcomes were frequently Future studies should include a more comprehensive and
used to provide additional opportunities for comparison, precise methodology in the evaluation of BZD use during
while others were limited to one or two articles on the OAT programs, using more rigorous methodological
topic. Thus, more studies must be conducted to validate evaluations if possible. Thus, until there are interventional,
present experimental results. In addition, while our randomized clinical trials with head-to-head comparisons
included studies have investigated the effects of concurrent of treatment interventions, the benefits of different
BZD use in OAT on treatment retention, there is a gap in approaches to BZD management can only be indirectly
how specific aspects of individual OAT programs might inferred from the existing literature. It may be helpful for

Volume 8 Issue 3 (2025) 30 doi: 10.36922/itps.5151