Affiliations: [a] Department of Health Sciences, University of Florence, Florence, Italy | [b] Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy | [c] Department of Psychology, Sigmund Freud University, Milan, Italy | [d] Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Verona, Italy | [e] Department of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
Correspondence:
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Address for correspondence: Fiammetta Cosci, Department of Health Sciences, University of Florence, via di San Salvi 12, 50135, Florence, Italy. Tel.: +39 055 623 7811; E-mail: fiammetta.cosci@unifi.it
Abstract: BACKGROUND:Using benzodiazepines (BZDs) or Z-drugs in poly-therapy is a critical issue. OBJECTIVE:Identifying factors influencing the use of BZDs/Z-drugs in poly- vs mono-therapy in patients with or without substance use disorders (SUDs). METHODS:986 inpatients were analysed. Socio-demographic and clinical variables were collected. BZD/Z-drug doses were compared via the Defined Daily Dose (DDD) and standardized as diazepam dose equivalents. Mann-Whitney, Chi-square, Fisher test, hierarchical multivariate regression analyses were run referring to the whole sample and to subjects with current SUDs, lifetime SUDs, current and lifetime SUDs, non-SUDs. RESULTS:In the whole sample the variance of being mono- vs poly-therapy users was explained by BZD/Z-drug formulation, DDD, duration of treatment, age of first BZDs/Z-drugs use (ΔR2 = 0.141, p < 0.001). Among those with current SUDs (ΔR2 = 0.278, p = 0.332) or current and lifetime SUDs (ΔR2 = 0.154, p = 0.419), no variables explained the variance of being mono-vs poly-therapy users. Among lifetime SUDs subjects, the variance of being mono- vs poly-therapy users was explained by BZD/Z-drug formulation and age of first BZD/Z-drug use (ΔR2 = 0.275, p < 0.001). Among non-SUDs subjects, the variance of being mono- vs poly-therapy users was explained by DDD and duration of treatment (ΔR2 = 0.162, p = 0.001). CONCLUSIONS:Tablets, high drug doses, long duration of treatment, and early age of first use were more likely associated to poly- than mono-therapy. This suggests that patients have different clinical features and a pharmacological prescription should be tailored to them also based on the variables here analysed.
Keywords: Mono-therapy, poly-therapy, poly-pharmacy, substance use disorder, benzodiazepine, Z-drug
