Употреба на бензодијазепини кај пациенти на метадонски третман

INTRODUCTION: In Macedonia, the general trend is increasing number of addicts with a medical indication for therapeutic substitution treatment with methadone (MMT). Benzodiazepines (BZD) use is common in patients who are on methadone treatment, and must be taken into account in order to optimize the results of treatment. MOTIVE: In our country, so far, there is not conducted any systematic research which suggests epidemiology of use/abuse of benzodiazepines among drug addicts who are on methadone treatment for any characteristics (differentiation from other patients on treatment). This study is the first of its kind in the country and suggests original observations with respect to this issue. It provides country results to be compared with the results from other countries, to indicate them and to recommend intervention. OBJECTIVES: The study aimed to explore the use/abuse of benzodiazepines by patients on methadone treatment and to indicate needs and to recommend intervention. MATERIAL AND METHODS: The research is quantitative analytical study (cross-sectional study) which was implemented from December 2012 to July 2013.  A randomized anonymous survey, in terms of the use/abuse of benzodiazepines, was conducted on 458 addicts who are on treatment with methadone substitution treatment. The selection of respondents for the study (experimental and control group) was made according to predetermined inclusion and exclusion criteria. Secrecy of the answers and comments was guaranteed. A standardized questionnaire was used, designed for this type of research, consists of five sections, and socio-demographic data, history of use of psychoactive substances, the use of BZD, health and personal views on the assertions of various life situations and feelings. RESULTS: The prevalence of abuse of BZD in patients on methadone treatment is 86.66%. The average age in the first try of BZD is 21.9 ± 6.1 years. For 24.1% BZD were prescribed by a doctor the first time when it was used. BZD without prescription were use by 85.8% of the respondents. At the moment treatment with BZD prescription receive 22.4%; usually 38.7% use more than the prescribed dose of BZD, use prescribed dose 17.3%, use less than the prescribed 6.8% and never had a prescription for BZD 37.2% vs. 50%. BZD use before entering the methadone program was 70.7% of respondents in the experimental group. BZD has increased/started after the methadone program 60.1%. In the life always used only BZD, which were prescribed by a doctor, said 7.8% of respondents in the experimental group. For start of use of not prescribed BZD, in the experimental group, 41.9% had selected cause "so I can sleep," followed by "probing - to see the effect of", 38.1% "to be relax” i.e., to reduce the pressure/tension "36.4%" to deal with stress and anxiety, "and 29%" to feel good" 26.3%. At least selected reason was "to the spent good time with my friends" 5.8% and to feel "high" 7.7%. In the last month, 50% of patients in the experimental group used BZD over 20 days in the last 3 months, 50% or 70% of respondents used BZD consequently over 66 days or 90 days. Analysis for the use of BZD within a day has shown use more than three times daily, and over 50% of respondents used consequently BZD over 10 or more than 7.5 years in their lifetime. In the last month, the daily dose of 70% of patients in the experimental group was over 50 mg. In the total sample of patients on methadone treatment as the most common health problem is selected heroin at 42% followed by hepatitis C in 41.6% and anxiety/stress at 33.5%. Prescribed treatment for psychological/emotional problems (including depression or anxiety), are receiving 54.3% of the participants in the experimental group. In 75% of respondents feeling of depression is present in more than 3 days a week. CONCLUSIONS: The analysis have shown that patients who started/increased intake of BZD during the MMT treatment has significantly increased risk behavior in favor of prolongation and/or repeated drug intake, possibility for overdosing and infections with blood transmitted diseases. Because of that, it is necessary effective programs for treatment which in the same time will aimed the goal for overcome of the problems with opiate dependence, symptoms of anxiosity and misuse of BZD.