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Data on concurrent use of heroin, benzodiazepines alarm researchers

August 2, 2016
by Gary A. Enos, Editor
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The latest Prescription Drug Monitoring Report from Quest Diagnostics' medical informatics unit sought to give specific focus to trends in polypharmacy, and a finding regarding street heroin users appears dramatic and troubling.

The 2016 report, based on 2015 data, found that nearly one in three heroin users (28.6%) also used benzodiazepines. Moreover, the report states that more than 90% of these opioid users are not receiving the benzodiazepines (such as Xanax and Valium) from a prescriber, but from another source.

This particular trend of concurrent use is by no means a brand-new phenomenon, but the magnitude of these newly reported numbers indicates how pervasive it has become.

“For patients who are being prescribed benzodiazepines, this is a wake-up call,” says F. Leland McClure, MSci, PhD, director of the Medical Science Liaison at Quest Diagnostics. “Are they taking the drugs? Are they allowing these drugs to be diverted? This is an important question in terms of monitoring.”

Dangerous trend

In opioid prescribing guidelines released earlier this year, the Centers for Disease Control and Prevention (CDC) warned of the risk of prescribing both opioids and benzodiazepines to an individual because of the threat of respiratory depression. Clearly, that risk also is being played out on the street.

“Many times, heroin is actiually cut with benzos,” McClure tells Addiction Professional, “which provides the user with a potentiation of the effect of heroin.”

The Quest survey mainly examined prescription drug misuse patterns based on physician-ordered laboratory tests, and found a rate of 54% of patient tests in 2015 showing signs of drug misuse (that is up from 53% in 2014 but down from 63% in 2011).

Other heroin-related findings indicated a positive heroin test rate of around 1.6% overall, with the highest percentage seen in the 25-to-34 age group (3.6%). Positive test rates for men were more than 50% higher than those for women.

McClure concludes with regard to a heroin/benzodiazepines finding that he termed “alarming” that “the key thing for practitioners is to integrate objective lab data, not just patient history, into patient management decision-making.”

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Comments

I work with a population of people with an average age that approaches 50. Some have very long histories of benzo & opiate abuse. A use history of 20 to 30+ years is not uncommon. Withdrawal management for this population is far from traditional. The withdrawal management phase of treatment can be around 30 days, Families and patients need to be aware of this before treatment begins. They also need to know that an older adult with a long history of benzo & opiate abuse (probably alcohol as well) take a long time to clear.
The trend described in Gary Enos's article is going to lead us to examine treatment protocols.