Dr Gabriele Vojt is a senior research associate at the University of Bristol, with a PhD in Forensic Psychology and Psychiatry from the University of Edinburgh (2014). She has qualitative and quantitative research experience in criminal justice, (forensic) mental health and public health (e.g. substance use, blood-borne viruses) within the NHS and the third sector. Her research interests focus on marginalised and vulnerable populations, behaviour change, intervention optimisation and development.

Abstract

A qualitative study of key partners’ views on interventions for people who co-use benzodiazepines/z-drugs and opioids: Recommendations from the UK

Drug-related deaths have doubled in the past decade in the UK. Co-using opioids and benzodiazepines/z-drugs (prescribed and/or illicit) is a risk factor contributing to overdoses. Guidance on managing complex co-use and risks within treatment is lacking in detail or absent altogether. We explored staff and healthcare professionals’ views of navigating treatment and prescribing decisions, focusing on risk and responsibility sharing with people who co-use. We conducted semi-structured individual interviews with 24 professionals from drug treatment, harm reduction, mental health and wider support services in England and Scotland, UK. We used reflexive thematic analysis and applied a behavioural coding framework (COM-B) to translate findings into recommendations. We co-finalised recommendations and intervention needs in two workshops with key partners (including people with lived/living experience, clinical leads policy makers and frontline staff). Staff described professional dilemmas in balancing their understanding ‘People need a safe supply’ against the potential risks of contributing to poor health outcomes in the short-and long-term (‘I don’t want to cause harm’). Professional risks and responsibilities in treatment decisions were reinforced by lacking mental health and co-prescribing support (‘Prescribing isn’t enough’) and by prescribers’ concerns of enabling potential misuse of prescriptions (‘Fear of manipulation’). Our findings highlighted multiple motivation and opportunity barriers to providing support for people who co-use. There is a need to define professionals’ ‘zone of acceptable risk’ in treatment and prescribing decisions and to better understand how this aligns with the risk and need perceptions of people who co-use. Future research is aimed at intervention development to address this and support prescribing and harm reduction approaches.