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PhD Thesis - Ross, J

Benzodiazepine use among heroin users in Sydney, Australia
Ross J (1997)

Abstract:
The thesis explored the nature of benzodiazepine use among heroin users in Sydney. Three studies were conducted with cross-sectional samples of heroin users, recruited through various means from all regions of Sydney. Study one assessed the availability of benzodiazepines among heroin users, in addition to examining the patterns of use and methods of benzodiazepine procurement used. Benzodiazepines were considered easy to obtain, and while the majority of benzodiazepine users had most recently acquired them from a doctor, procurement through illicit sources in the preceding six months was common. A notable proportion had given or sold benzodiazepines to others, suggesting that doctors are medicating more people than intended when prescribing benzodiazepines to this population.

A disturbingly high proportion of benzodiazepine users had injected these drugs, prompting study two, which examined the factors associated with transitions between routes of benzodiazepine administration. Predictors of having made a transition to injecting benzodiazepines were greater benzodiazepine dependence, higher levels of polydrug use, and higher scores on the OTI criminality scale. Injectors of benzodiazepines reported higher levels of harm than oral and non-users of benzodiazepines, highlighting the fact that injectors of benzodiazepines are a particularly at risk sub-set of heroin users. It is recommended that interventions focus on the negative health effects that may result from injecting benzodiazepines, since the primary reason ex-injectors gave for ceasing the injection of benzodiazepines pertained to health concerns.

A high proportion of participants in studies one and two showed signs of benzodiazepine dependence, as assessed by the SDS. Using DSM-III-R criteria study three determined that the symptoms of benzodiazepine dependence reported by heroin users are of clinical significance. Participants with a lifetime diagnosis of benzodiazepine dependence were more likely than the rest of the sample to have had either an anxiety or depressive disorder, and to have had other substance use disorders. Lifetime benzodiazepine injectors were also more likely to have had such disorders than exclusive swallowers of benzodiazepines. Benzodiazepine dependence and the parenteral use of benzodiazepines should be considered significant markers of comorbidity among heroin users. Future research needs to assess the efficacy of various treatment options for benzodiazepine dependence.

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