"I love having benzos after my coke shot": The use of psychotropic medication among cocaine users in downtown Montreal

Int J Drug Policy. 2017 Nov;49:15-23. doi: 10.1016/j.drugpo.2017.07.012. Epub 2017 Aug 18.

Abstract

Background: Cocaine abuse is a major public health issue due to its role in the HIV and hepatitis C virus (HCV) epidemics in North America. A significant area of concern among people who use cocaine (PWUC), injected or smoked, is their frequent misuse of prescription drugs, particularly psychotropic medication (PM), such as tranquilizers, sedatives, stimulants, and antipsychotics. This paper aims to describe and understand practices of PM use among PWUC in downtown Montreal.

Method: Ethnographic methods including participant observation and semi-structured interviews were used in an iterative manner.

Results: Two thirds of the 50 participants were male. They ranged in age from 20 to 60 and most were homeless. A significant proportion of them reported polydrug use patterns that included frequent concomitant opioid use (heroin and/or prescription opioids (PO)). Benzodiazepine-based tranquilizers and the atypical antipsychotic quetiapine were the most frequently used PM. Routes of PM administration were oral, nasal and, to a lesser degree, intravenous. Five main PM use practices were identified: 1) "downers" from cocaine high (benzodiazepines and quetiapine); 2) enhancers of heroin/PO effects (benzodiazepines); 3) reducers or suppressors of heroin/PO withdrawal symptoms (benzodiazepines); 4) enablers of a different type of "trip" (benzodiazepines); and 5) treatment for mental and physical problems (benzodiazepines and quetiapine).

Conclusion: PM use practices showed several complementary functions that PM fulfill in a context of polydrug use. The soothing and stimulating effects of PM reinforce the patterns of drug use among participants, posing various risks including overdose, HIV/HCV transmission, PM dependence and accidents. The results highlight the need for clinicians to assess clients' substance use patterns when prescribing PM and to question PWUC about PM use. The findings also underline certain unmet service needs in relation to overdose, HIV/HCV and mental health prevention/treatment among cocaine users.

Keywords: Cocaine use; Ethnographic methods; HIV/HCV risk behaviours; Mental health; Overdose; Prescription drugs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Anxiety Agents
  • Antipsychotic Agents
  • Benzodiazepines
  • Cocaine-Related Disorders / complications
  • Cocaine-Related Disorders / psychology*
  • Drug Interactions
  • Drug Users
  • Female
  • Heroin Dependence / psychology
  • Homeless Persons
  • Humans
  • Hypnotics and Sedatives
  • Male
  • Middle Aged
  • Psychotropic Drugs*
  • Quebec
  • Quetiapine Fumarate
  • Risk-Taking
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / psychology*
  • Young Adult

Substances

  • Anti-Anxiety Agents
  • Antipsychotic Agents
  • Hypnotics and Sedatives
  • Psychotropic Drugs
  • Benzodiazepines
  • Quetiapine Fumarate