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.
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.
| Original language | English |
|---|---|
| Article number | 152 |
| Journal | Harm Reduction Journal |
| Volume | 22 |
| Early online date | 29 Sept 2025 |
| DOIs | |
| Publication status | Published - 29 Sept 2025 |
Data Availability Statement
Data are available on application at the University of Bristol data repository (data.bris). Data access is restricted to bona fide researchers for ethically approved research and subject to approval by the University’s Data Access Committee.Acknowledgements
We would like to thank the research participants for sharing their experiences with us and the services and staff that worked with us in Bristol, Teesside and Glasgow. We would also like to thank the peer co-researchers, Joanna Green, Chris Shilvock, Jade Ritchie, Louise Aitken, Nick Booth and Peter Da Silva. Thanks also to the expert stakeholders who have acted as 'critical friends', reviewed the findings and gave feedback on the relevance for future policy and practice. The views expressed are those of the authors and not necessarily those of the Medical Research Council.Funding
This work was supported by the Medical Research Council (MRC) grant number MR/W029162/1. CPB, AP, AS, HP, HF, GV, DC, SK, MH, GH, JK are partially funded by this MRC grant. JK and HF are partly funded by National Institute for Health Research Applied Research Collaboration West (NIHR ARC West). HF, MH, GV and JK acknowledge support from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol (NIHR200877).
| Funders | Funder number |
|---|---|
| Medical Research Council | MR/W029162/1 |
