Use and Misuse of Opioid Replacement Therapies: A Queensland Study

Abstract

Buprenorphine/naloxone has recently been introduced in Australia and is available for unsupervised dosing within Queensland. A retrospective observational study of data collected during 2000–2007 for clients obtaining injecting equipment from the Brisbane Harm Reduction Centre in Queensland is presented. The numbers of service occasions and needles and syringes were used as surrogate drug use measures. Buprenorphine and naloxone were misused at lower rates when compared with buprenorphine and methadone. Furthermore, the misuse of opioid replacement therapies represented less than 5% of all illicit opioid injections. Implications and study limitations are discussed.

RÉSUMÉ

Utilization normale et abusive des traitements de substitution aux opioïdes - Etude réalisée dans le Queensland

Le traitement à base de buprénorphine et de naloxone a été récemment introduit en Australie. Il peut être utilisé dans le Queensland sans contrôle des dosages. Nous allons vous présenter une étude observationnelle rétrospective de données collectées au cours de la période 2000–2007 sur des personnes ayant obtenu du matériel d'injection de la part du Centre de réduction des risques de Brisbane, sis dans le Queensland. Le nombre de soins pratiqués, d'aiguilles et de seringues utilisées a permis de déterminer le taux d'utilisation des médicaments. Le taux d'utilisation abusive des traitements à base de buprénorphine et de naloxone est plus faible que celui des traitements à base de buprénorphine et de méthadone. Par ailleurs, l'utilisation abusive des traitements de substitution aux opioïdes représente moins de 5% des injections illicites d'opioïde.

RESUMEN

Uso y Abuso de las Terapias de Sustitución de los Opioides

La buprenorfina/naloxona ha sido recientemente introducida en Australia y está disponible para su utilización en dosis sin supervisión en Queensland. Presentamos un estudio observacional retrospectivo de datos recogidos entre los años 2000 y 2007 para clientes que recibieron equipamiento para inyecciones del Centro de Reducción del Dolor de Brisbane, en Queensland. Las cifras de uso de los servicios y de las agujas y jeringuillas se utilizaron como medida sobre drogas de sustitución. La buprenorfina/naloxona obtuvo menos índice de abuso que la buprenorfina y la metadona. Además, el abuso de terapias de reemplazo de opioides representó menos del 5% de todas las inyecciones ilícitas de opioides.

Keywords :

• buprenorphine/naloxone
• diversion liability
• needle syringe program
• unsupervised dosing
• Australia
• harm reduction
• harm minimization
• methadone
• buprenorphine
• misuse

THE AUTHORS

Andrew Smirnov has been a public health researcher with the Drug Harm Reduction Branch of Queensland Health since 2001. Prior to this he worked at the National Drug and Alcohol Research Centre on the development of data from drug treatment services. His research interests have included the public health aspects of amphetamine use, harm reduction (especially regarding injecting drug use) and health program development. He currently divides his time between Queensland Health and the Queensland Alcohol and Drug Research and Education Centre (University of Queensland) where he lectures in alcohol, tobacco and other drug studies and coordinates research concerned with illicit drug use. He is a PhD candidate with the University of Queensland's School of Population Health; his thesis is concerned with amphetamine-type stimulant use during early adulthood.

Robert Kemp has been Manager of the Needle and Syringe Program Management Unit (NSPMU), Queensland Health, since September 2000. The NSPMU has particular responsibility for enhancing public health services for injecting drug users (IDU). As NSPMU Manager, Robert has been involved in the development of a network of primary needle and syringe programmes across the state, the implementation of a state NSP policy, and many facets of programme enhancement. Over the past three years Robert has supervised the development and roll-out of the Queensland Minimum Data Set for Needle and Syringe Programs as well as initiating exploratory research regarding the nature and patterns of Injection Related Injury and Disease (IRID) among IDU. Throughout these various projects Robert has continued to pursue his interest in natural histories of illicit drug use and social determinants of health and the relationship of these to contemporary public policy.