Factors Associated with Benzodiazepine Misuse Among Those Who Misused Opioids Within the Past Year: A U.S. National...

Rarely lethal in isolated ingestion, benzodiazepines show an increasing degree of morbidity and mortality associated with overdose when co-ingested with opioids. Several studies have identified a limited number of associated risk and protective factors surrounding concomitant use. Of those studies that used national data, most focused on the consequences of benzodiazepine and opioid co-ingestion rather than risk factors associated with their misuse. Consequently, we aim to elucidate risk factors associated with benzodiazepine and opioid misuse using national data.

This was a retrospective study of National Survey on Drug Use and Health data collected from 2015-2019. We analyzed the characteristics of the population that reported both opioid and benzodiazepine misuse in the past year, analyzed trends, and then conducted a backward stepwise regression (controlling for demographics) to determine predictors.

Between 2015-2019, 13,584 survey participants reported both misusing benzodiazepines and opioids in the past year. There was no significant increase in misuse, with 24.2% of those who misused opioids also reporting misuse of benzodiazepines in 2015 and 22.0% in 2019 (p = 0.37). The strongest predictors of misuse of both substances included misuse of several other substances in the past year: soma products (adjusted odds ratio (aOR): 6.1, p < 0.001), cyclobenzaprine products (aOR: 3.31, p < 0.001) and cocaine (aOR: 2.4, p < 0.001). Selling illegal drugs 1-2 times (aOR = 1.8, p < 0.001) also was found to be predictive.

This study identifies risk factors for benzodiazepine and opioid misuse. Future studies should further investigate these findings to help implement targeted interventions for risk reduction in this population.