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Motivations underlying co-use of benzodiazepines and opioids in the UK: a qualitative study

Motivations underlying co-use of benzodiazepines and opioids in the UK: a qualitative study
Motivations underlying co-use of benzodiazepines and opioids in the UK: a qualitative study
Background Drug-related deaths have substantially increased over the past decade in the UK, particularly in Scotland. Co-use of opioids and benzodiazepines (prescribed and/or illicit) is contributing to rising mortality. This study identified motivations in people’s co-use with the aim of informing prescribing and harm reduction interventions to address drug-related deaths. Methods We interviewed 48 people who co-use opioids and benzodiazepines and/or z-drugs (zopiclone and zolpidem) in Glasgow (n = 28), Teesside (n = 10) and Bristol (n = 10). Most participants self-identified as male (n = 37, 77%), white (n = 45, 94%) and had a mean age of 43 years (range: 25–61 years). The majority reported at least one overdose experience, and poor mental health including trauma. Interviews were semi-structured, conducted by an academic and/or peer researcher, and analysed using reflexive thematic analysis. Results Participants’ motivations for co-using mapped onto two interlinked meta-themes: (1) Functional motivations included co-using to augment drug effects, self-medicate or help to generate income. (2) Experiential motivations described participants’ desires to achieve a ‘buzz’ (feeling energised), ‘glow’ (feeling comforted), ‘oblivion’ (escaping trauma and adversity), and ‘gouching’ (physical and mental sensations of ebbing in and out of glow and oblivion). Functional and experiential motivations were dynamic, interrelated and often co-occurred. Conclusions The importance of assessing motivations to co-use should be routinely recognised as part of harm reduction and medication assisted treatments to reduce mortality risk.
Benzodiazepines, Co-use, Harm reduction, Motivations, Opioids, Overdose, Qualitative, Substance use
1477-7517
Vojt, Gabriele
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Family, Hannah E
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Poulter, Hannah L
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Bailey, Chris P
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Cavallo, Damiana
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Sheikh, Ana Paula Abdala
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Karimi, Sara
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Booth, N
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Silva, Peter Da
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Aitken, Louise
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Stewart, Samantha
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Hickman, Matt
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Henderson, Graeme
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Scott, Jennifer
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Kesten, Joanna M.
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Vojt, Gabriele
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Family, Hannah E
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Poulter, Hannah L
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Bailey, Chris P
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Cavallo, Damiana
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Sheikh, Ana Paula Abdala
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Karimi, Sara
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Booth, N
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Silva, Peter Da
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Aitken, Louise
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Stewart, Samantha
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Hickman, Matt
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Henderson, Graeme
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Scott, Jennifer
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Kesten, Joanna M.
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Vojt, Gabriele, Family, Hannah E, Poulter, Hannah L, Bailey, Chris P, Cavallo, Damiana, Sheikh, Ana Paula Abdala, Karimi, Sara, Booth, N, Silva, Peter Da, Aitken, Louise, Stewart, Samantha, Hickman, Matt, Henderson, Graeme, Scott, Jennifer and Kesten, Joanna M. (2025) Motivations underlying co-use of benzodiazepines and opioids in the UK: a qualitative study. Harm Reduction Journal, 22 (1), [152]. (doi:10.1186/s12954-025-01312-x).

Record type: Article

Abstract

Background Drug-related deaths have substantially increased over the past decade in the UK, particularly in Scotland. Co-use of opioids and benzodiazepines (prescribed and/or illicit) is contributing to rising mortality. This study identified motivations in people’s co-use with the aim of informing prescribing and harm reduction interventions to address drug-related deaths. Methods We interviewed 48 people who co-use opioids and benzodiazepines and/or z-drugs (zopiclone and zolpidem) in Glasgow (n = 28), Teesside (n = 10) and Bristol (n = 10). Most participants self-identified as male (n = 37, 77%), white (n = 45, 94%) and had a mean age of 43 years (range: 25–61 years). The majority reported at least one overdose experience, and poor mental health including trauma. Interviews were semi-structured, conducted by an academic and/or peer researcher, and analysed using reflexive thematic analysis. Results Participants’ motivations for co-using mapped onto two interlinked meta-themes: (1) Functional motivations included co-using to augment drug effects, self-medicate or help to generate income. (2) Experiential motivations described participants’ desires to achieve a ‘buzz’ (feeling energised), ‘glow’ (feeling comforted), ‘oblivion’ (escaping trauma and adversity), and ‘gouching’ (physical and mental sensations of ebbing in and out of glow and oblivion). Functional and experiential motivations were dynamic, interrelated and often co-occurred. Conclusions The importance of assessing motivations to co-use should be routinely recognised as part of harm reduction and medication assisted treatments to reduce mortality risk.

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Accepted/In Press date: 5 September 2025
Published date: 29 September 2025
Additional Information: © 2025. The Author(s).
Keywords: Benzodiazepines, Co-use, Harm reduction, Motivations, Opioids, Overdose, Qualitative, Substance use

Identifiers

Local EPrints ID: 505623
URI: http://eprints.soton.ac.uk/id/eprint/505623
ISSN: 1477-7517
PURE UUID: 3d2eeeb5-84fd-43dd-b224-1e182341d882
ORCID for Gabriele Vojt: ORCID iD orcid.org/0000-0002-9135-0684

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Date deposited: 14 Oct 2025 16:59
Last modified: 15 Oct 2025 02:16

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Contributors

Author: Gabriele Vojt ORCID iD
Author: Hannah E Family
Author: Hannah L Poulter
Author: Chris P Bailey
Author: Damiana Cavallo
Author: Ana Paula Abdala Sheikh
Author: Sara Karimi
Author: N Booth
Author: Peter Da Silva
Author: Louise Aitken
Author: Samantha Stewart
Author: Matt Hickman
Author: Graeme Henderson
Author: Jennifer Scott
Author: Joanna M. Kesten

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