Minimising the extent of diversion and injection of the pharmaceutical opioids used in opioid substitution treatment (OST) reduces harms to the individual (such as dependence, injection-related injuries and diseases, and overdose) and protects the integrity of the OST program. Reports of buprenorphine or methadone injection can undermine public support for OST. This in turn may limit future investment and development, and hinder efforts to make OST more attractive and accessible.
The ongoing surveillance of the diversion and injection of the pharmaceutical opioids used in OST will build on the post-marketing studies of buprenorphine-naloxone (Suboxone® sublingual tablets) conducted by the National Drug and Alcohol Research Centre over the period 2006-2008. The diversion of methadone, buprenorphine and buprenorphine-naloxone (Suboxone® sublingual film) will be monitored throughout 2012-2013 using a comparable methodology.
A/Prof Nicholas Lintzeris
Sydney South West Area Health Service
A/Prof Robert Ali
Drug and Alcohol Services South Australia and Adelaide University
Dr Rebecca Jenkinson
Burnet Institute
A/Prof Paul Dietze
Burnet Institute
- To monitor the extent of diversion and injection of the pharmaceutical opioids used in OST
- To monitor the harms associated with the diversion and injection of the pharmaceutical opioids used in OST
The following data sources (utilised by the original post-marketing surveillance studies) will continue to be collected by the ongoing surveillance studies:
- indicators of availability of OST medications (sales/prescription data)
- interviews with regular IDU (via IDRS);
- interviews with OST clients
- interviews with key experts
- population-level indicators of injection (NSP data)
The project has completed its main data collections, including research interviews and peer-reviewed publications.
Peer reviewed publications:
Larance, B. Mattick, R.P., Ali, R., Lintzeris, N., Jenkinson, R., White, N., Kihas, I., Cassidy, R., Degenhardt, L. (2015) Diversion and injection of buprenorphine-naloxone film two years post-introduction in Australia. Drug and Alcohol Review. 2015 Oct 9. doi: 10.1111/dar.12344. [Epub ahead of print]
Larance, B., Dietze, P., Ali, R., Lintzeris, N., White, N., Jenkinson, R., Degenhardt, L. (2015). The introduction of buprenorphine-naloxone film in opioid substitution therapy in Australia: Uptake and issues arising from changing buprenorphine formulations. Drug and Alcohol Review, Advance online publication, 1-8. <e4091> http://onlinelibrary.wiley.com/doi/10.1111/dar.12277/full
White, N., Ali, R., Larance, B., Zador, D., Mattick, R., Degenhardt, L. (2015) The extra-medical use and diversion of opioid substitution medications and other medications in prison settings in Australia following the introduction of buprenorphine-naloxone film. Drug and Alcohol Review.doi: 10.1111/dar.12317[Epub ahead of print]
White, N., Flaherty, I., Higgs, P., Larance, B., Nielsen, S., Degenhardt, L., Ali, R., Lintzeris, N. (2015). Injecting buprenorphine-naloxone film: Findings from an explorative qualitative study. Drug and Alcohol Review, DOI: 10.1111/dar.12308 [Epub ahead of print]
Larance, B., Lintzeris, N., Ali, R., Dietze, P., Mattick, R.P., Jenkinson, R., White, N., Degenhardt, L. (2014) The diversion and injection of a buprenorphine-naloxone soluble film formulation. Drug and Alcohol Dependence, 136, 21–27.
Conference papers:
Larance, B., Lintzeris, N, Ali, R., Mattick, R.P., White, N., Jenkinson, R., Dietze, P., Degenhardt, L. (2013) Buprenorphine-naloxone sublingual film: 2012 findings from the Australian post-marketing surveillance studies. Oral presentation to APSAD Conference, Brisbane, 24-27 November 2013.
Larance, B., Mattick, R.P., Ali, R., Dietze, P., Jenkinson, R., Lintzeris, N., Degenhardt, L. (2013) The diversion and injection of buprenorphine-naloxone film: Findings from the Australian post0marketing surveillance studies, 2012. Poster presentation to NDARC Annual Symposium, Sydney, 4 September 2013.
Larance, B. & Degenhardt, L. (2013) The diversion and injection of buprenorphine-naloxone film. Presentation presented at expert workshop at the 7th Albatros conference. Paris, France, June 6-8 2013.
Larance, B., Degenhardt, L., Lintzeris, N., Mattick, R., Ali, R. (2013) The diversion and injection of buprenorphine-naloxone film among people who inject drugs: Findings from the Australian post-marketing surveillance studies, 2012. Poster presented at CPDD Conference 2013, San Diego, 15-20 May 2013.
Larance, B. (2013) The diversion and injection of the medications used in opioid substitution therapy. Oral presentation made to the Pharmacy Guild Workshop: Drugs on the Street, 25 May 2013.
Larance, B. (2013) The diversion and injection of buprenorphine-naloxone film. NDARC Inhouse Seminar, 30 May 2013.
The project will allow policy makers to determine the extent of diversion and injection of pharmaceutical opioids used in OST, and therefore to make decisions to minimise these problems and the harms associated with them.