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Injectable opioid treatment – an important option for a minority of people who use drugs

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Date Published:
24 Nov 2020

Opioid agonist therapy (OAT) is an effective treatment for opioid addiction, including drugs such as heroin, oxycodone and fentanyl. It involves taking a regular dose of opioid medicines such as methadone or buprenorphine, usually orally or in films that go under the tongue, and is very effective in reducing illicit drug use and the risk of death. However, these treatments do not work for all people who inject drugs.

A recent study led by the National Drug and Alcohol Research Centre (UNSW Sydney) surveyed Australians who inject opioids and found their perceptions were that offering injectable opioid agonist treatment (iOAT) could deliver important benefits.

Injectable opioid agonist treatment (iOAT) involves injecting a pharmaceutical-quality opioid, such as hydromorphone, up to three times a day under medical supervision. Typically, iOAT is used as a second-line treatment option for those that don’t benefit from first-line oral treatments. It is more expensive than oral OAT, and more intensive, requiring attendance at a clinic multiple times per day. However, there is growing evidence that these treatments reduce drug use and related harms, and are cost effective.

This study involved 344 people who regularly use opioids from a range of demographics, settings and locations across Australia. Structured interviews were conducted to determine participants’ perceptions of injectable treatment, including if they would be interested in receiving it if it were available in Australia.

Participants who were interested in iOAT had attempted other treatment options more often than those who were not interested in iOAT, and had a range of other risk factors, such as more frequent substance use.

Lead author Associate Professor Suzanne Nielsen of the Monash Addiction Research Centre at Monash University, says this suggests that iOAT could be an important option to benefit high-risk groups who had not had good results from existing approaches.

“The evidence shows that injectable treatments delivered as part of a structured program can work where methadone and buprenorphine have been ineffective.”

Many participants believed iOAT would help them stop injecting illicit drugs, while others felt it would be safer than illicit drug use. Participants who were not interested in iOAT cited having to attend a clinic up to three times a day for supervised treatment was a major barrier.

“This wasn’t appealing for everyone - a minority were both interested in this treatment, and likely to meet common eligibility criteria. This supports that iOAT would be an important treatment option for a small number of people, rather than a commonly used treatment.”

Injectable treatments have now been implemented in a number of countries including Canada, Denmark, Switzerland, the United Kingdom, Germany and the Netherlands, yet typically, only a small percentage of the overall treatment population receive this specialised treatment. The health gains for those that do are clear, supporting the need for more options where current treatments are ineffective.

“What we found interesting was that people who regularly use opioids felt that iOAT should be limited to those with more severe opioid use disorder, and where other treatments had not worked, which is consistent with common criteria in countries where iOAT is already an established treatment option” said Associate Professor Nielsen.

Interest in this treatment varied between states, with the highest interest in Victoria “Those who were interested in iOAT were more likely to live in Victoria, which is consistent with elevated rates of heroin‐related deaths in the state, which are double that seen in New South Wales” said Associate Professor Nielsen.

Opioid-related deaths have been increasing in Australia over the past decade, and while there is no injectable opioid currently registered to treat opioid dependence, this study provides important insights into the preferences of those most affected. It is timely to consider whether iOAT may have a place in responding to opioid-related harms in Australia.

Read the full paper in Addiction titled: Perceptions of injectable opioid agonist treatment (iOAT) among people who regularly use opioids in Australia: findings from a cross-sectional study in three Australian cities. DOI: 10.1111/add.15297