RTI uses cookies to offer you the best experience online. By clicking “accept” on this website, you opt in and you agree to the use of cookies. If you would like to know more about how RTI uses cookies and how to manage them please view our Privacy Policy here. You can “opt out” or change your mind by visiting: http://optout.aboutads.info/. Click “accept” to agree.
Benzodiazepines and opioid co-use among rural people who use drugs
Findings from the rural opioid initiative
Mixson, L. S., Venkataraman, A., Drumright, L. N., Whitney, B. M., Jenkins, W. D., Friedmann, P. D., Zule, W. A., Havens, J., Ruderman, S. A., Stopka, T. J., Korthuis, P. T., Pho, M. T., Westergaard, R. P., Seal, D. W., Go, V. F., Miller, W. C., Feinberg, J., Smith, G., Tsui, J. I., ... Crane, H. M. (2025). Benzodiazepines and opioid co-use among rural people who use drugs: Findings from the rural opioid initiative. Substance Use & Addiction Journal, 46(4), 847-858. https://doi.org/10.1177/29767342251331701
BACKGROUND: Benzodiazepines and opioids are among the most frequently misused psychoactive substances, but their patterns of co-use (polysubstance use) in rural areas are unclear. As resources to address substance use are disproportionally scarce in rural areas, a better understanding of this polysubstance use is critical to allocate and direct interventions.
METHODS: The Rural Opioid Initiative comprises 8 research cohorts spanning 10 states and 65 rural counties. Participants were recruited from January 2018 to March 2020 and eligibility included past 30-day opioid use by any route or past 30-day injection of any substance. Analyses were restricted to participants reporting past 30-day opioid use and either benzodiazepine or stimulant use. We described bivariate cross-sectional associations between benzodiazepine+opioid use, compared with stimulant+opioid use, and substance use behaviors, health outcomes, injection drug use, addiction treatment, and criminal legal system involvement.
RESULTS: Of the 1107 ROI participants that met inclusion criteria, 10% (n = 107) reported benzodiazepine+opioid use, and 90% (n = 1000) reported stimulant+opioid use. The benzodiazepine+opioid group, compared with the stimulant+opioid group, had a higher use of opioid pain medication (73% vs 55%), gabapentin (43% vs 23%), and clonidine (12% vs 4%) to get high and used these substances more frequently; they also reported more frequent heavy episodic drinking (6.1 days per 30 days, SD = 9.4 vs 4.1 days, SD 7.5). The benzodiazepine+opioid group reported a lower prevalence in the past 6 months of law enforcement stop-and-search incidents (29% vs 48%), arrests (11% vs 28%), probation (22% vs 34%), jail/prison (18% vs 41%), and fewer days in jail/prison (4.7, SD = 19.1 days vs 15.9, SD = 35.7 days).
CONCLUSION: We found that benzodiazepines+opioids use was associated with more heavy episodic drinking and gabapentin use, and lower prevalence of criminal legal system involvement. These data suggest that individuals reporting benzodiazepines+opioids use have distinct behavioral patterns and outcomes that require targeted interventions for rural populations.
RTI shares its evidence-based research - through peer-reviewed publications and media - to ensure that it is accessible for others to build on, in line with our mission and scientific standards.