Motivations underlying co-use of benzodiazepines and opioids in the UK: a qualitative study
Background: Drug-related deaths have substantially increased over the past decade in the UK, particularly in Scotland. Co-using opioids and benzodiazepines (BZ) (prescribed and/or illicit) is a risk factor contributing to overdoses (OD). It is, however, unclear why exactly people co-use. This study identified motivations in people’s co-use with the aim of informing pharmaceutical and harm reduction interventions to address drug-related deaths.
Methods: We conducted semi-structured individual interviews with a heterogenous sample of 48 people who co-use opioids and BZ in community settings in Greater Glasgow (n=28), Teesside (n=10) and Bristol (n=10). Most participants self-identified as male (n=37, 77.1%), white British, Scottish or English (n=45, 93.7%) and with a mean age of 42.6 years (SD=8.7) ranging from 25-61 years. 18 (37.5%) interviews were facilitated by qualitatively trained local peer researchers supporting insights into local drug cultures, drug use preferences and practices. All interview data were pooled and analysed using reflexive thematic analysis. Findings were sense-checked with expert stakeholders including peer researchers, people who use drugs in each study location and the wider multi-disciplinary research team.
Results: Participants’ motivations for co-using drugs mapped broadly onto two interlinked drivers: (1) functional and (2) experiential. Functional influences included patterned co-using in order to prevent withdrawal, address poor mental health, regulate emotions and manage pain. Experiential influences described participants’ desires to achieve (a) the ‘glow’ (feeling comforted), (b) the ‘buzz’ (feeling invincible and energised), (c) ‘oblivion’ (forgetting or escaping previous and/or current trauma and adversity), and (d) feeling ‘gouchy’ (physical and mental sensations of ebbing in and out of glow and oblivion). In pursuit of these experiences, those typically seeking the glow or buzz described OD risk awareness and a wish to avoid or minimise this risk. Participants aiming to achieve oblivion or feeling ‘gouchy’ considered OD risk as less important when compared to their needs. We observed some differences in motivations to drug co-use according to study location, drug preferences/availability, co-morbidity, alcohol consumption and gender.
Conclusions: These findings provide context to neuropharmacological interventions and research to prevent drug related deaths. The identified motivational patterns may help to inform harm reduction, health care management and planning, BZ and/or assisted heroin treatment plans. Future research should explore the expansion and delivery of therapeutic interventions alongside harm reduction advice, and incorporating the underlying primary motivations for co-using drugs.
