Developing an Intervention to Manage Benzodiazepine Dependence and High-Risk Use in the Context of Escalating Drug Related Deaths: A feasibility study

Background: The problematic use of benzodiazepines contributes to mortality among people who use drugs (PWUD). Clinical practice and guidance to date has focussed on managing BZD dependence through gradual reduction of a prescribed benzodiazepine. An epidemiological study indicated that DRD risk was increased in patients on ORT if they are co-prescribed a benzodiazepine, although treatment engagement was improved. The Scottish situation is slightly different from other parts of the world (and UK) because escalating drug deaths are strongly associated with increasing use of ‘street’ benzodiazepines in polydrug combinations. A survey of Scottish clinicians identified some prescribing of benzodiazepines alongside ORT does already occur.

Methods: Following the MRC complex intervention framework, three workshops and three PPI groups were held. A systems approach was applied in which an initial basic logic model was developed from existing research evidence on motivations for benzodiazepine use and clinician willing to prescribe replacement benzodiazepines. The logic model was developed through small group discussion and system thinking exercises. Workshop participants included people with lived experience of using street benzodiazepines, clinicians, academics, psychologists, pharmacists. Outputs from workshops were discussed and refined by the PPI group then fed back into the next workshop.

Results: A finalised, agreed logic model for the intervention was successfully achieved that was acceptable to all. Key components of the intervention were: prescribing of diazepam, anxiety, sleep and pain management and harm reduction resources (locked box and a range of tips) as well as personal safety conversations. Recruitment of up to 40 people on ORT and using street benzodiazepines at a clinically harmful level will now proceed in three sites across Scotland to test the feasibility of the intervention.

Conclusion: A co-produced intervention was developed for next stage clinical feasibility testing. Data on recruitment to the intervention will be available by November.