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The sources of pharmaceuticals for problematic users of benzodiazepines and prescription opioids

Suzanne Nielsen, Raimondo Bruno, Louisa Degenhardt, Mark A Stoove, Jane A Fischer, Susan J Carruthers and Nicholas Lintzeris
Med J Aust 2013; 199 (10): 696-699. || doi: 10.5694/mja12.11331

Summary

Objectives: To describe benzodiazepine and prescription opioid use by clients of drug treatment services and the sources of pharmaceuticals they use.

Design: Structured face-to-face interviews on unsanctioned use of benzodiazepines and prescription opioids were conducted between January and July 2008.

Participants: Convenience sample of treatment entrants who reported regular (an average of ≥ 4 days per week) and unsanctioned use of benzodiazepines and/or prescription opioids over the 4 weeks before treatment entry.

Setting: Drug treatment services in Victoria, Queensland, Western Australia and Tasmania.

Main outcome measures: Participant demographics, characteristics of recent substance use, substance use trajectories, and sources of pharmaceuticals.

Results: Two hundred and four treatment entrants were interviewed. Prescription opioids were predominantly obtained from non-prescribed sources (78%, 84/108). In contrast, medical practitioners were the main source for benzodiazepines (78%, 113/144). Forging of prescriptions was extremely uncommon. A mean duration of 6.3 years (SD, 6.6 years) for benzodiazepines and 4.4 years (SD, 5.7 years) for prescription opioids was reported between first use and problematic use — a substantial window for intervention.

Conclusions: Medical practitioners are an important source of misused pharmaceuticals, but they are not the main source of prescription opioids. This has implications for prescription drug monitoring in Australia: current plans (to monitor only Schedule 8 benzodiazepines and prescription opioids) may have limited effects on prescription opioid users who use non-prescribed sources, and the omission of most benzodiazepines from monitoring programs may represent a lost opportunity for reducing unsanctioned use of benzodiazepines and associated harm.

  • Suzanne Nielsen1
  • Raimondo Bruno2
  • Louisa Degenhardt3
  • Mark A Stoove4,5
  • Jane A Fischer6
  • Susan J Carruthers7
  • Nicholas Lintzeris8,9

  • 1 Discipline of Addiction Medicine, University of Sydney, Sydney, NSW.
  • 2 School of Psychology, University of Tasmania, Hobart, TAS.
  • 3 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.
  • 4 HIV Research Program and Justice Health Research Program, Centre for Population Health, Burnet Institute, Melbourne, VIC.
  • 5 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
  • 6 National Centre for Education and Training on Addiction, Flinders University, Adelaide, SA.
  • 7 National Drug Research Institute, Curtin University, Perth, WA.
  • 8 Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW.
  • 9 Faculty of Medicine, University of Sydney, Sydney, NSW.


Acknowledgements: 

Suzanne Nielsen and Louisa Degenhardt are current recipients of NHMRC Fellowships. The larger study that this work was drawn from was commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model with the Victorian Department of Human Services. The funders had no role in the design of the study, analysis of the data or preparation of the manuscript.

Competing interests:

Suzanne Nielsen, Louisa Degenhardt and Nicholas Lintzeris has been investigators on untied education grants, unrelated to this work, from Reckitt Benckiser (who make buprenorphine and a buprenorphine–naloxone combination, which are used in the treatment of opioid dependence). Nicholas Lintzeris has received honoraria to present at professional development courses. Reckitt Benckiser had no role in or knowledge of this study.

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