Benzodiazepine abuse in a methadone maintenance treatment clinic in Israel: Characteristics and a pharmacotherapeutic approach

Objective: 1) To study the prevalence, course and correlates of benzodiazepine (BZD) abuse in an Israeli methadone maintenance treatment (MMT) clinic; and 2) to present preliminary results of an open clinical study on the treatment of BZD addiction in MMT patients using BZD maintenance. Method: Study 1 was carried out on 196 patients who were in MMT for at least one year. Objective information on drug use (urine testing) was recorded, and the one-year retention rate was measured. Demographic data and history of abuse were obtained, and a self-rated psychopathology and psychological distress questionnaire was administered. The second study was an open one. Twenty BZD-addicted patients were given clonazepam maintenance treatment (CMT) and were started on a daily regimen of 6 mg. followed by a gradual tapering until an individual dose was reached. This maintenance dose was the lowest level at which the patient still expressed satisfaction with the BZD dose without reporting craving or overdose. Failure was defined by three daily consecutive BZD uses above the permitted dose. Results: BZD abuse was significantly reduced during the first year of MMT (from 55 to 43%, P<.000), although a number of patients started to abuse BZDs during this period. BZD abusers (BAs) were found more often to be polydrug abusers, their methadone dosage was higher than non-abusers (NBAs), they started to abuse drugs in general and heroin in particular earlier than NBA, and they had higher self-rated psychopathology and psychological distress scores. The second study showed that CMT was successful in 75% of the patients over a period of six months and that it is, therefore, a promising mode of treatment for BZD-dependent MMT patients. Conclusions: MMT patients who abuse BZDs are at an increased risk for continuing polydrug abuse. Although our results are to be taken cautiously due to the inherent limitation of a non-controlled non-randomized pilot study, ongoing maintenance with clonazepam seems to be well tolerated and a stabilizing and satisfying pharmacotherapy for BZD dependent MMT patients.