INNOVATION FUND Innovation, Integration, & Implementation Mental Health and Geriatric Care SHOWCASE 2016 INNOVATION FUND Innovation, Integration, & Implementation Mental Health and Geriatric Care SHOWCASE 2016

Evaluating the Impact of Benzodiazepine Use in Patients Enrolled in Opioid Agonist Therapy

Mental Health and Geriatric Care

david_marsh

David Marsh

dmarsh@nosm.ca

705-662-7200

Northern Ontario School of Medicine

Joe Eibl

Highlights

There is knowledge gap in how to manage patients with opiate dependence and co-occurring mental health disorders for which a patient has a benzodiazepine (BZD) prescription.  Some studies suggests that patients enrolled in opioid agonist therapy (OAT) do best when they are not concurrently using benzodiazepines, and other studies demonstrate no difference in treatment outcome. Part of the challenge to date has been that these studies have had relatively small sample sizes (n<100), and the study design often have not distinguished between patients with a BZD prescription versus those who were using these drugs in a non-prescribed manner. The innovation in this study is that we have an extremely large sample size (n > 27,000), and we are able to distinguish between patients with a BZD prescription from their physician, non-prescribed BZD use, and no BZD use.  We test the hypothesis that patients with a benzodiazepine prescription will be retained in OAT at an equal or higher rate than patient who are using the drug in a non-prescribed manner.   The logic supporting this hypothesis is that patients with diagnosed and medicated mental health issues will have higher probability of retention in OAT as compared to patients using non-prescribed BZDs or those with an untreated mental health disorder.  The outcome of this project will have important implications on how patients with opioid-dependence and mental health issues are clinically managed.

Abstract

Patients suffering from opiate dependence are recognized to often have co-occurring mental health disorders.  The most common strategy to treat opiate addiction is through opiate agonist therapy (OAT). At the outset of OAT, the physician managing treatment will often encourage the patient to stop using other psychoactive drugs (particularly sedating drugs like benzodiazepines (BZD)), which may increase the risk of overdose when combined with opioids; moreover, BZD  have also been linked to poorer treatment outcomes in previous studies. However, we do not yet know if abstaining from benzodiazepine (BZD) use during methadone therapy is beneficial or detrimental to patients with co-occurring mental health issues including depression, anxiety and insomnia where a BZD may actually be clinically indicated.  In this proposal, we retrospectively evaluate the course of OAT for patients entering therapy who have a BZD prescription, those who are using non-prescribed BZD and those do not use BZD.  The results will inform clinical practice guidelines for physicians treating opiate dependent patients with co-occurring BZD use.

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