buprenorphine and Sleep-Initiation-and-Maintenance-Disorders

For individuals dependent on opioids, recovery efforts begin with a period of withdrawal that typically includes discomfort from symptoms, possibly precipitating a return to drug use. The study described here investigated whether the provision of ancillary medications for opioid withdrawal symptoms affected treatment outcomes in 139 participants receiving buprenorphine in a 13-day detoxification trial. Outcome measures include the number of opioid-free urine samples collected and retention in treatment. Ancillary medications were provided to 70% of participants: 59% received medication for insomnia, 45% for anxiety, 40% for bone pain, 35% for nausea, and 28% for diarrhea. Findings indicate no difference in the number of opioid-free urine samples between the group receiving ancillary medication and the group who did not, although tests of specific ancillary medications indicate that those who received diarrhea medication had fewer opioid-free urines than those who did not (P = .004). Results also indicate that participants attended fewer days of treatment if they received anxiety, nausea, or diarrhea medication compared to no medication (all P values < .05).

Topics: Adult; Analgesics, Opioid; Anxiety; Buprenorphine; Diarrhea; Female; Humans; Inactivation, Metabolic; Male; Middle Aged; Narcotics; Nausea; Opioid-Related Disorders; Pain; Receptors, Opioid, delta; Sleep Initiation and Maintenance Disorders; Substance Withdrawal Syndrome; Treatment Outcome

In adult populations, women are more likely than men to be prescribed benzodiazepines. However, such disparities have not been investigated in people with opioid use disorder (OUD) and insomnia receiving buprenorphine, a population with particularly high sedative/hypnotic receipt. This retrospective cohort study used administrative claims data from Merative MarketScan Commercial and MultiState Medicaid Databases (2006-2016) to investigate sex differences in the receipt of insomnia medication prescriptions among patients in OUD treatment with buprenorphine.. We included people aged 12-64 years with diagnoses of insomnia and OUD-initiating buprenorphine during the study timeframe. The predictor variable was sex (female versus male). The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g. hydroxyzine, trazodone, and mirtazapine). Associations between sex and benzodiazepine, Z-drug, and other insomnia medication prescription receipt were estimated using Poisson regression models.. Our sample included 9510 individuals (female n = 4637; male n = 4873) initiating buprenorphine for OUD who also had insomnia, of whom 6569 (69.1%) received benzodiazepines, 3891 (40.9%) Z-drugs, and 8441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR = 1.17 [1.11-1.23]), Z-drugs (RR = 1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR = 1.07, [1.02-1.12]).. Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment with buprenorphine, with sex-based disparities indicating a higher prescribing impact among female than male OUD treatment patients.

Topics: Adult; Benzodiazepines; Buprenorphine; Female; Humans; Hypnotics and Sedatives; Insurance; Male; Opioid-Related Disorders; Prescriptions; Retrospective Studies; Sleep; Sleep Initiation and Maintenance Disorders; United States

The co-association of benzodiazepines and opioids is associated with an increased risk of overdose, death, and poorer psychosocial prognosis. The aim of this study is to characterize the prevalence, pattern of use, and primary clinical outcomes in benzodiazepines users in a public opioid maintenance treatment unit.. We conducted a cross-sectional study involving 236 patients treated with opioid substitutes (methadone and buprenorphine). We conducted a descriptive, bivariable, and multivariable analysis to determine clinical differences between benzodiazepines users and non-users.. The prevalence of consumption of benzodiazepines was 25.4% (60). The benzodiazepines were obtained with a medical prescription (49.8%) or on the black market (42.6%). The most prescribed benzodiazepine was diazepam (29.1%), and the main reasons were to relieve insomnia (27.7%) or anxiety (26.9%) and to enhance the psychoactive effects of other drugs (19.7%). Regarding the clinical outcomes, we highlight: a very high prevalence of hepatitis C (51.7%); severe ongoing consumption of psychoactive drugs (73.7%); and a high rate of depression and anxiety (> 60%), significantly higher in the benzodiazepines-user group. In the multivariable analysis of benzodiazepine use, we found alcohol consumption (OR 0.482; IC 95% 0.247, 0.238) had a negative association and having hepatitis C (OR 2.544, IC 95% 1.273, 5.084) or anxiety symptoms (OR 5.591; IC 95% 2.345, 13.326) had positive associations.. Our results suggest the BZD users had a complex drug addiction problem and underline the importance of adequately addressing BZD use, contemplating psychological and psychiatric approach in this particular population.. Past or current use of benzodiazepines is associated with poor clinical and psychiatric outcomes. A multidisciplinary approach with a focus on infectious diseases and mental health is critical in order to enhance the treatment effectiveness and overall prognosis.. Introdução: A co-associação entre benzodiazepinas e opióides associa-se a risco aumentado de overdose, morte e pior prognóstico psicossocial. Pretendemos determinar a prevalência, o padrão de consumo e as principais co-morbilidades do uso de benzodiazepinas, em utentes sob tratamento de manutenção opióide. Material e Métodos: Conduzimos um estudo transversal, envolvendo 236 doentes tratados com substitutos opióides (metadona e buprenorfina). Realizou-se uma análise descritiva, bivariável e multivariável das características clínicas entre os usuários de benzodiazepinas e os não-usuários de benzodiazepinas. Resultados: A prevalência do uso de benzodiazepinas foi de 25,4% (60). A obtenção de benzodiazepinas foi através de prescrição médica (49,8%) ou mercado negro (42,6%). A substância mais prescrita foi o diazepam (29,1%), e as principais razões para a toma foi insónia (27,7%), ansiedade (26,9%), e para potenciar os efeitos psicoativos de outras drogas (19,7%). No que respeita aos resultados clínicos sublinhamos: prevalência elevada de hepatite C (51,7%); elevado consumo continuado de substâncias psicoativas (73,7%); elevada taxa de depressão e ansiedade (> 60%), significativamente mais elevada nos utilizadores de benzodiazepinas. Na análise multivariável para o uso de benzodiazepinas, verificámos que o consumo de álcool (OR 0,482; IC 95% 0,247, 0,238) tem associação negativa; a hepatite C (OR 2,544; IC 95% 1,273, 5,084) e a ansiedade (OR 5,591; IC 95% 2,345, 13,326) tiveram associações positivas. Discussão: Os resultados obtidos sugerem que os utilizadores de BZD têm um problema complexo de dependência de drogas e sublinham a importância de abordar adequadamente o uso de BZD, contemplando uma abordagem psicológica e psiquiátrica nesta população em particular. Conclusão: O uso de benzodiazepinas, no passado ou atualmente, associa-se a piores indicadores físicos e psiquiátricos. A abordagem multidisciplinar com foco nas doenças infeciosas e na saúde mental é uma necessidade crítica para a efetividade do tratamento e prognóstico global.

Topics: Adult; Analgesics, Opioid; Anxiety; Benzodiazepines; Buprenorphine; Cross-Sectional Studies; Diazepam; Female; Humans; Male; Mental Disorders; Methadone; Middle Aged; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders; Portugal; Prevalence; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires; Treatment Outcome

Topics: Adult; Analgesics, Opioid; Anxiety; Buprenorphine; Comorbidity; Cross-Sectional Studies; Depression; Female; Humans; Male; Methadone; New South Wales; Opiate Substitution Treatment; Opioid-Related Disorders; Prevalence; Sleep Initiation and Maintenance Disorders; Sleepiness; Young Adult

Topics: Adolescent; Brain Diseases; Buprenorphine; Cysts; Extremities; Humans; Injections, Intravenous; Leukoencephalopathy, Progressive Multifocal; Magnetic Resonance Imaging; Male; Narcotics; Sleep Initiation and Maintenance Disorders; Spasm