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Int J Drug Policy. 2017 Aug;46:17-27. doi: 10.1016/j.drugpo.2017.05.016. Epub 2017 May 31.

High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City.

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National Development & Research Institutes, Inc., 71 West 23rd Street 4th Floor, New York, NY 10010, USA. Electronic address:
Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA.
National Development & Research Institutes, Inc., 71 West 23rd Street 4th Floor, New York, NY 10010, USA.
Department of Mathematics and Statistics, Lederle Graduate Research Tower, Box 34515, University of Massachusetts Amherst, Amherst, MA 01003, USA.
Department of Medicine, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, USA.
Saint Barnabas Health System, Department of Emergency Medicine, 4422 Third Avenue, Bronx, NY 10457, USA.



Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular-a combination that can increase the risk for fatal and non-fatal overdose. This mixed-methods study examines nonmedical use of benzodiazepines among young adults in New York City and its relationship with opioid use.


For qualitative analysis, 46 90-minute semi-structured interviews were conducted with young adult opioid users (ages 18-32). Interviews were transcribed and coded for key themes. For quantitative analysis, 464 young adult opioid users (ages 18-29) were recruited using Respondent-Driven Sampling and completed structured interviews. Benzodiazepine use was assessed via a self-report questionnaire that included measures related to nonmedical benzodiazepine and opioid use.


Participants reported using benzodiazepines nonmedically for a wide variety of reasons, including: to increase the high of other drugs; to lessen withdrawal symptoms; and to come down from other drugs. Benzodiazepines were described as readily available and cheap. There was a high prevalence (93%) of nonmedical benzodiazepine use among nonmedical opioid users, with 57% reporting regular nonmedical use. In bivariate analyses, drug-related risk behaviours such as polysubstance use, drug binging, heroin injection and overdose were strongly associated with regular nonmedical benzodiazepine use. In multivariate analysis, growing up in a middle-income household (earning between $51,000 and $100,000 annually), lifetime overdose experience, having ever used cocaine regularly, having ever been prescribed benzodiazepines, recent drug binging, and encouraging fellow drug users to use benzodiazepines to cope with opioid withdrawal were consistently strong predictors of regular nonmedical benzodiazepine use.


Nonmedical benzodiazepine use may be common among nonmedical opioid users due to its drug-related multi-functionality. Harm reduction messages should account for the multiple functions benzodiazepines serve in a drug-using context, and encourage drug users to tailor their endorsement of benzodiazepines to peers to include safer alternatives.


Drug use; Heroin use; Nonmedical benzodiazepine use; Nonmedical prescription opioid use; Young adults

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