Abstract
Background: Drug overdoses (OD) have substantially increased over the past decade in the UK, particularly in
Scotland. Co-using prescribed and/or illicit opioids and benzodiazepines or z-drugs [BZ/z-drugs] contributes
to overdose (OD) risk. It is, however, unclear why and how people co-use, and what strategies people use to
minimise OD risk.
Methods: Forty-eight semi-structured interviews were conducted with people who co-use opioids and BZ/zdrugs in community settings in Glasgow (n=28), Teesside (n=10) and Bristol (n=10). Most identified as male
(77%), white British, Scottish or English (94%) with a mean age of 43 years. Eighteen (38%) interviews were
(co-)facilitated by qualitatively trained local peer researchers. Reflexive thematic and framework analysis
were used.
Results: Participants’ motivations mapped onto functional and experiential motivations. Functional
motivations included augmentation, self-medicating mental health symptoms and trauma and being able to
generate income. Experiential motivations were (1) buzz, (2) glow, (3) feeling ‘gouchy’ and (4) oblivion. These
were linked to six co-use patterns: (a) low-dose BZ/z-drugs (am and pm), (b) coming down with street BZ/zdrugs (am and pm, various doses), (c) co-use throughout the day (regular, high doses), (d) BZ/z-drugs/opioid
binges (irregular, high doses), (e) curated co-use (structured, controlled) and (f) BZ/z-drugs use throughout the
day (BZ unstructured, opioid use structured). Overdose risk perceptions ranged from self-efficacy driven ‘I can
help myself’ to self-efficacy-lacking evaluations ‘there is nothing I can do’. Perceived lack of tailored support
for co-use reinforced beliefs of help- and hopelessness. People expressing high self-efficacy employed their
own risk reduction strategies, e.g., using a trusted seller, limiting alcohol co-use.
Conclusions and Implications: Tailored harm reduction, and mental health support for people who co-use is
desperately needed. Our findings identify opportunities for psychosocial and prescribing interventions tailored
to people’s motivations and patterns of co-use that build upon their existing harm reduction behaviours and
OD risk perceptions.
Scotland. Co-using prescribed and/or illicit opioids and benzodiazepines or z-drugs [BZ/z-drugs] contributes
to overdose (OD) risk. It is, however, unclear why and how people co-use, and what strategies people use to
minimise OD risk.
Methods: Forty-eight semi-structured interviews were conducted with people who co-use opioids and BZ/zdrugs in community settings in Glasgow (n=28), Teesside (n=10) and Bristol (n=10). Most identified as male
(77%), white British, Scottish or English (94%) with a mean age of 43 years. Eighteen (38%) interviews were
(co-)facilitated by qualitatively trained local peer researchers. Reflexive thematic and framework analysis
were used.
Results: Participants’ motivations mapped onto functional and experiential motivations. Functional
motivations included augmentation, self-medicating mental health symptoms and trauma and being able to
generate income. Experiential motivations were (1) buzz, (2) glow, (3) feeling ‘gouchy’ and (4) oblivion. These
were linked to six co-use patterns: (a) low-dose BZ/z-drugs (am and pm), (b) coming down with street BZ/zdrugs (am and pm, various doses), (c) co-use throughout the day (regular, high doses), (d) BZ/z-drugs/opioid
binges (irregular, high doses), (e) curated co-use (structured, controlled) and (f) BZ/z-drugs use throughout the
day (BZ unstructured, opioid use structured). Overdose risk perceptions ranged from self-efficacy driven ‘I can
help myself’ to self-efficacy-lacking evaluations ‘there is nothing I can do’. Perceived lack of tailored support
for co-use reinforced beliefs of help- and hopelessness. People expressing high self-efficacy employed their
own risk reduction strategies, e.g., using a trusted seller, limiting alcohol co-use.
Conclusions and Implications: Tailored harm reduction, and mental health support for people who co-use is
desperately needed. Our findings identify opportunities for psychosocial and prescribing interventions tailored
to people’s motivations and patterns of co-use that build upon their existing harm reduction behaviours and
OD risk perceptions.
| Original language | English |
|---|---|
| Pages | 90 |
| Number of pages | 1 |
| Publication status | Published - 25 Mar 2025 |
| Event | UK Society for Behavioural Medicine Annual Conference - Mercure Bristol Grand Hotel , Bristol , United Kingdom Duration: 25 Mar 2025 → 26 Mar 2025 Conference number: 20 https://uksbm.org.uk |
Conference
| Conference | UK Society for Behavioural Medicine Annual Conference |
|---|---|
| Country/Territory | United Kingdom |
| City | Bristol |
| Period | 25/03/25 → 26/03/25 |
| Internet address |