Benzodiazepine Use Did Not Have an Adverse Impact on Treatment Retention in an Open-access Methadone Program

Concurrent medical and non-medical use of benzodiazepines is common among individuals receiving methadone for opioid use disorder (OUD), and is associated with an increased risk of overdose. However, guidelines recommend that providers not withhold medications for OUD (including methadone) from people with benzodiazepine use because of these concerns. Researchers investigated the impact of baseline benzodiazepine exposure on 12-month retention in a US open-access methadone program (i.e., a program offering low-barrier access to methadone).

• Between January 2015 and February 2017, 2698 patients initiated methadone in this program. The majority were male (63%) and non-Hispanic white (77%); the mean age was 37 years.
• At intake, 545 (18%) of patients tested positive for benzodiazepines; these individuals were more likely to be female, white, non-Hispanic, of higher education, unemployed, and receiving disability benefits.
• At 12 months, 171 individuals with benzodiazepine exposure (31%) remained in treatment compared with 757 of the patients without exposure (31%). In multivariable analyses, there was no difference in treatment retention when controlling for covariates (hazard ratio, 1.03).

Comments: Overall retention is this program was relatively low, probably reflecting the low-barrier approach to treatment entry. Nonetheless, people who are receiving methadone should be counseled on the risks of concurrent benzodiazepine use, but it should not be a reason to deny access to methadone, or to create barriers to OUD treatment.

Darius A. Rastegar, MD

Reference: Morford KL, Tetrault JM, Zhou B, et al. The impact of benzodiazepine exposure on treatment retention in an open-access methadone program: a retrospective cohort study. Drug Alcohol Depend. 2022;241:109707.