Same-day use of opioids and depressants: A retrospective diary study

Abstract

Aims: Increased prescribing of pharmaceutical opioids has been accompanied by an increase in harms. Use of other CNS depres- sants (e.g. alcohol, benzodiazepines) with opioids may alter opioid pharmacokinetics and elevate risk of adverse outcomes, includ- ing overdose. As such, the aim was to determine the consumption patterns associated with same-day use of prescription opioids, ben- zodiazepines, and alcohol amongst people who regularly tamper with prescription opioids. Methods: A cohort of 431 people who regularly tamper with pharmaceutical opioids completed a retrospective past 7-day diary detailing their licit and illicit substance use. Results: Nearly half (47%) reported use of pharmaceutical opi- oids only; 26% opioid and benzodiazepine same-day use, 14% opioid and alcohol same-day use; and 11% opioid, benzodi- azepine and alcohol same-day use. Half (51%) of the latter group reported co-ingestion of all three on only one occasion within the past week. Median oral morphine equivalence when consum- ing pharmaceutical opioids only was 393 mg (inter-quartile range (IQR) 199–621 mg); opioids and benzodiazepines 400 mg (IQR 180–595 mg); opioids and alcohol 352 mg (IQR 182–559 mg); and opioids, benzodiazepines and alcohol 410 mg (IQR 270–616 mg). Same-day pharmaceutical opioids use with other depressants was not significantly associated with an increased risk of overdose in the past 12 months after controlling for demographics (although a low overdose rate should be noted). Conclusions: Same-day use of opioids with other CNS depres sants is common amongst people who regularly tamper with pharmaceutical opioids, with little indication of variation in opioid dose in compensation.