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REVIEW ARTICLE

The impact of benzodiazepine use on treatment retention in opioid agonist treatment: A literature review

Caitlin Lawrence1 ,  Rachel McLellan-Carich1,2 ,  Alasdair M. Barr1,2*
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1 Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
2 British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
INNOSC Theranostics and Pharmacological Sciences, 5151 https://doi.org/10.36922/itps.5151
Submitted: 15 October 2024 | Revised: 25 January 2025 | Accepted: 11 February 2025 | Published: 27 February 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

It is well established that there is an elevated overdose risk with benzodiazepine (BZD) use during opioid agonist treatment (OAT). However, further studies regarding other aspects of how BZDs influence OAT are necessary. This review summarizes the literature on concurrent BZD use with medications for opioid use disorder (MOUD) and how they affect treatment retention in OAT. EMBASE (Ovid), PubMed, and Google Scholar database search tools were used to search for studies that examined the effect of concurrent BZD and MOUD on treatment retention in OAT. Studies published up to January 30th, 2024, were included with no restriction applied other than English language. The criteria for included literature were the presence of both BZD and at least one MOUD as a variable and treatment retention or MOUD adherence as an outcome. Fourteen articles met the criteria for review: eleven retrospective studies and three observational studies. Methadone was utilized in seven studies, buprenorphine in five, naltrexone in one, and suboxone (buprenorphine + naloxone) in one study. The included studies indicated that when BZDs are taken as prescribed and for shorter periods in conjunction with OAT, subjects are retained in their MOUD programs just as well as patients who do not take BZDs. Any potential benefits of increased treatment retention must be balanced against potential harmful effects of BZD use, such as drug overdose and addiction. Further studies must be performed to validate the results of treatment retention and to evaluate other factors that might affect OAT.

Keywords
Benzodiazepine
Opioid agonist therapy
Treatment retention
Funding
The present review was supported in part by a NSERC Discovery grant to AMB.
Conflict of interest
The authors declare they have no competing interests.
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