The diversion and injection of the pharmaceutical opioids used in opioid substitution treatment: Findings from the Australian post-marketing surveillance studies of buprenorphine-naloxone, 2006-2008

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Resource Type: Technical Reports

NDARC Technical Report No. 302.

Opioid substitution treatment (OST) is effective in treating opioid dependence, and results in significant reductions in the negative health consequences and adverse effects on public order. In Australia, OST is highly regulated: it is available only with an individual patient authority, there is licensing of doctors, and a strong focus on supervised administration of medication. Adherence with OST is important for maximising a range of positive treatment outcomes, but is especially important in preventing injection, “leakage” of prescribed medication to the illicit market, overdose and mortality.

The introduction of an opioid agonist-antagonist formulation in Australia was a new approach that was hoped to result in lower levels of injection of the medication. By deterring injection, buprenorphine-naloxone (registered as Suboxone®) may reduce its attractiveness in illicit markets.
Post-marketing surveillance of the diversion and injection of Suboxone® was required as a condition of the product’s registration in Australia. Reckitt Benckiser approached the National Drug and Alcohol Research Centre to conduct the study independently, by way of an untied educational grant.

This report seeks to answer the following questions:

  1. Is there injection of the agonist-antagonist formulation - buprenorphine naloxone - following its large-scale introduction into treatment programs for opioid dependence?
  2. To what extent is buprenorphine-naloxone injected compared to existing OST formulations, and in particular compared to the mono-buprenorphine product, among those receiving treatment and among out-of-treatment injecting drug users (IDU)?
  3. Is diverted buprenorphine-naloxone less attractive in illicit markets?
  4. What influences the diversion and/or injection of buprenorphine-naloxone?

Citation: Larance, BK, Degenhardt, LJ, Mattick, RP, O`Brien, SM, Lintzeris, N, Bell, JR, Winstock, A & Ali, RL (2009), The diversion and injection of the pharmaceutical opioids used in opiod substitution treatment: Findings from the Australian post-marketing surveillance studies of buprenorphine-naloxone, 2006-2008, Sydney: National Drug and Alcohol Research Centre.