NDARC Technical Report No. 27 (1995)
The current study examined the nature of benzodiazepine use among heroin users in Sydney with a particular focus on patterns of use, preferences and methods of procurement.
Of 329 heroin users two thirds (64%) had used benzodiazepines during the preceding six months and completed the structured face to face interview. All subjects were volunteers who had either been on a methadone programme or used heroin during the preceding three months. Using purposive sampling almost equal numbers of treatment and non-treatment subjects were recruited.
The median number of days on which benzodiazepines were used during the six months preceding interview was 19. However, 41% of the sample reported having used them more than once a week during that time. The most common reason given for having first used benzodiazepines related to their intoxicating effects (38%). In contrast, only 16% of subjects gave this as their reason for continuing to use benzodiazepines, with management of heroin withdrawal (23%) being the more common justification given.
A disturbingly high proportion of the sample (48%) had injected benzodiazepines, with a fifth (17%) having done so during the six months preceding interview. Diazepam and temazepam were equally the most commonly injected benzodiazepines. The parenteral use of benzodiazepine tablets, intended solely for oral administration, can lead to serious health effects such as thromboses and vascular morbidity.
Further cause for concern is the reported ease with which heroin users are able to procure benzodiazepines. The vast majority of subjects (86%) indicated that these drugs are easy or very easy to obtain. Over a half of the sample (58%) reported having given or sold benzodiazepines to someone in the preceding six months, with only a third (34%) having obtained them exclusively through a doctor. When asked which was the easiest benzodiazepine to procure a third of subjects (34%) specified diazepam and a fifth (19%) nominated oxazepam.
The sample exhibited distinct preferences for certain benzodiazepines. In preference ratings flunitrazepam and diazepam emerged as the two most favoured benzodiazepines. They were also reported to be among the most widely used. The reasons given for preferring these drugs related to their intoxicating effects.
The clear preferences that heroin users have for particular benzodiazepines should be borne in mind by clinicians when prescribing for this population. In this way the abuse potential and harms associated with benzodiazepine use may be lessened. Given the high prevalence of injecting of benzodiazepines among heroin users and the related health risks, further research into this practice is justified so that an appropriate intervention can be formulated.