BENZODIAZEPINE DEPENDENCE AMONG MULTIDRUG USERS IN THE CLUB SCENE. Steven P. Kurtz and Mance E. Buttram

Transcription

1 BENZODIAZEPINE DEPENDENCE AMONG MULTIDRUG USERS IN THE CLUB SCENE Steven P. Kurtz and Mance E. Buttram Global Addiction October 2016 Venice, Italy

2 This research was supported by grant number DA from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. There are no conflicts to report.

3 Miami is an international center of nightclub culture Every night is like New Year s Eve on South Beach, and drugs and sex are all part of it.

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6 Illicit club drugs include: Ecstasy Cocaine Methamphetamine LSD GHB Designer stimulants and hallucinogens

7 In this scene, prescription drugs opioids benzodiazepines (BZDs) amphetamines are increasingly used in combination with alcohol and traditional club drugs.

8 BZDs are Schedule III medications that are easily available on the street in the U.S. Young adults report the highest rates of BZD misuse. Studies of BZD dependence and related health and social problems among not-in-treatment populations are rare.

9 RCT of behavioral interventions to reduce substance use and HIV transmission risk among young adults.

10 Eligibility criteria: 1) Ages ) Past 90 day behaviors Heterosexual sex Used club drugs at least 3 times Misused a scheduled Rx drug Attends large EDM clubs

11 Respondent Driven Sampling Enrollment

12 MEASURES Substance dependence: 3 or more of 7 DSM IV items, including withdrawal symptoms and tolerance. Severe mental distress: 7 or more of 24 DSM IV items assessing past year anxiety, depression and somaticism. Heavy substance use: 75 th percentile and above in past 90 day frequency of use. Heavy marijuana use: daily use, which was reported by 42.7% of the sample.

13 ANALYSES Bivariate logistic regression models: demographics, substance overdose and treatment histories, mental health, victimization, non BZD substance use, and BZD dependence. A multivariate logistic regression model used BSTEP LR method. Compared results to a similar study with same location, recruitment procedures, eligibility criteria and instrumentation.

14 PAST 90 DAY DRUG USE * Alcohol and Marijuana not shown, as both approach 100% Club and Street Drugs 100% 96.6% 92.1% 50.5% 41.9% 29.0% 20.5% 19.5% 16.2% 0%

15 PAST 90 DAY DRUG USE Prescription Drugs 100% 91.0% 80% 60% 53.7% 40% 20% 0% 29.8% 16.1%

16 DEMOGRAPHICS BY PAST YEAR BZD DEPENDENCE Non dependent Dependent misusers misusers N (311) % (87.4) N (45) % (12.6) Age (mean; SD) 23.0 (3.1) 21.5 (3.2)** Gender Male Female Race/ethnicity Hispanic Black non Hispanic White non Hispanic Other Education High school diploma or less Some college or more

17 Non dependent Dependent misusers misusers N % N % Substance abuse tx history Drug overdose history *** Severe mental distress *** Victimized before age * Heavy substance use Alcohol (65+ days) Marijuana (daily) ** Cocaine (50+ days) MDMA (48 + days) Rx opioids (60 + days) **

18 BENZODIAZEPINE HISTORIES Mean (SD) Mean (SD) Age at first misuse 19 (3.4) 16 (2.3) *** Days misuse lifetime 436 (618.3) 886 (763.6) *** Days misuse past 90 days 35 (28.7) 62 (26.5) *** Pills misused past 90 days 63 (87.2) 156 (149.4) *** Route of ingestion N % N % Whole pill only Crush, snort, smoke, inject * Sources of BZD supply N % N % Medical sources Theft *** Dealer *** Sharing / trading

19 p OR 95% CI Demographic characteristics Age , Female , Black non Hispanic , Education > high school , Health and social characteristics Substance abuse treatment history , Drug overdose history < , Severe mental distress (GMDS scale) < , Victimized before age , Heavy substance use Alcohol , Marijuana , Cocaine , MDMA , Rx opioids , 5.252

20 p OR 95% CI Age , Drug overdose history , Severe mental distress < , Heavy marijuana use , Heavy Rx opioid misuse , 4.828

21 Compared to the study: 12.6% vs. 7.9% BZD prevalence Age of BZD onset was 16 vs. 18 years BZD misuse averaged 38 vs. 20 days Average use was 75 vs. 51 pills/ 90 days Comparison has limitations but these may be sentinel indicators.

22 Connection to the US opioid epidemic Opioid epidemic heaviest impact is young adults BZD opioid polydrug treatment admissions BZD opioid polydrug overdose deaths BZD dependence connected to heavy opioid misuse In , BZD dependence heavy cocaine use

23 Comorbidities childhood victimization severe mental distress: > 8 times higher odds the link is likely complex people with psychiatric disorders experience high rates of BZD misuse and dependence depressive symptoms tend to decline as BZD use declines

24 LIMITATIONS Data are self reported Eligibility criteria limit generalizability Diagnostics not clinician administered Comparative study data are cross sectional

25 Findings agree with public health data re: BZDs & the opioid epidemic in the U.S. Research into psychosocial, environmental, structural, and policy aspects of BZD misuse is urgently needed BZDs are Schedule IV, inexpensive and widely available in informal markets. FDA should require improved labeling, rigorous postmarketing surveillance, consider upscheduling Demand reduction measures are needed Peer based approaches likely more successful than governmental messaging

26 Thank you Steven P. Kurtz and Mance E. Buttram arsh.nova.edu