Motivations underlying co-use of benzodiazepines and opioids in the UK: a qualitative study

BackgroundDrug-related deaths have substantially increased over the past decade in the UK, particularly in Scotland. Co-using opioids and benzodiazepines (prescribed and/or illicit) is a risk factor contributing to rising mortality. This study identified motivations in peoples co-use with the aim of informing prescribing and harm reduction interventions to address drug-related deaths. MethodsWe interviewed 48 people who co-use opioids and benzodiazepines and/or z-drugs (zopiclone and zolpidem) in Glasgow (n=28), Teesside (n=10) and Bristol (n=10). Most participants self-identified as male (n=37, 77%), white (n=45, 94%) and had a mean age of 43 years (range: 25-61 years). The majority reported at least one overdose experience, and poor mental health including trauma. Interviews were semi-structured, conducted by an academic and/or peer researcher, and analysed using reflexive thematic analysis. ResultsParticipants motivations for co-using drugs mapped onto two interlinked meta-themes: (1) Functional motivations included co-using to augment drug effects, self-medicate or help to generate income. (2) Experiential motivations described participants desires to achieve (a) buzz (feeling energised), (b) glow (feeling comforted) (c) oblivion (escaping trauma and adversity), and (d) feeling gouchy (physical and mental sensations of ebbing in and out of glow and oblivion). Those typically seeking a glow or buzz wished to minimise the risks of co-use. Participants aiming to achieve oblivion or feeling gouchy felt ambivalent about the risk of overdose. ConclusionsThe importance of assessing motivations to co-use should be recognised and routinised as part of harm reduction, (co-)prescribing and medication assisted treatments to reduce mortality risk.