Barriers to harm reduction: Heating and filtration of oxycodone tablets prior to intravenous use by people who inject drugs in Australia

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Author: Amy Peacock, Barbara de Graaff, Raimondo Bruno

Resource Type: Drug Trends Bulletins

Key findings:
  • Intravenous use of oxycodone was examined among people who regularly inject drugs (PWID) interviewed as part of the Illicit Drug Reporting System (IDRS) from 2005 to 2013; behaviours reported by the Tasmanian subsample were specifically examined to illustrate trends associated with an illicit drug market characterised by low heroin availability and high pharmaceutical opioid use.
  • The proportion of PWID in the national sample reporting recent injecting use of oxycodone increased from 2005 (17%) to 2013 (31%). Rates of intravenous use in the Tasmanian sample were high, rising from 26% in 2005 to 60% reporting recent use in 2013. The increase in price over time in Tasmania ($40 in 2005 to $80 in 2013 for an 80mg tablet) reflected this increase in demand.
  • Injection of oxycodone tablets can cause harms both from the drug itself but also from the presence of tablet contaminants. The majority of participants nationally had used some sort of filter to remove these contaminants (2012: 99%; 2013: 97%). However, less than one-fifth had used filters capable of removing the majority of particulate contaminants present (i.e., wheel filters; 2012: 22%, 2013: 14%). Most of the 2012 and 2013 national sample also heated their oxycodone drug preparation, a risky practice as warmed particles may pass any filter but resolidify in the bloodstream. Since 2007, Tasmanian data showed an increase in harm reduction practices by PWID via use of a filter. However, analyses indicated relatively low uptake of wheel filters relative to cigarette/cotton wool filters. The finding that those who used less effective filters were more likely to adopt heat extraction provides a basis for further harm reduction endeavours.
  • The typical profile of PWID who used cigarette/ cotton wool filters versus wheel filters were quite similar, with the exception of indications that the latter used oxycodone intravenously more frequently, and were more likely to report intravenous use of pharmaceutical stimulants. While the rates of overall injecting-related harms typically did not vary according to oxycodone filtering practices, the high rate of other intravenous tablet use may have contributed to these outcomes.