Polydrug use is prevalent among opioid users:

  • One in five patients seeking MMT are likely also to be dependent on benzodiazepines
  • 5% are likely to be alcohol dependent.
  • High percentages of patients are likely to be using benzodiazepines or alcohol at hazardous or harmful levels.
Patients at high risk from polydrug use:
  • Frequently present intoxicated or with signs of benzodiazepine or alcohol withdrawal;
  • Regularly use other drugs at levels above normal therapeutic doses.
It is recommended that specialist advice be sought when treating patients at high risk from polydrug use especially where sedatives are involved.

Benzodiazepines

Benzodiazepine users exhibit overall patterns of increased risk and poorer psychological functioning than other patients.

Benzodiazepine injection is associated with vascular damage as well as mortality. Injection of the gel capsule formulation of temazepam has been reported to lead to limb amputations. This formulation should not be prescribed.

Advise patients about the interactions of benzodiazepines and methadone.

Caution should be exercised in prescribing benzodiazepines in MMT. The clinical supervision of patients receiving maintenance benzodiazepines must be of the same high standard as for MMT.