Drug injecting in patients in New Zealand Methadone Maintenance Treatment programs: An anonymous survey

Judson, Graeme; Bird, Rupert; O’Connor, Patrick G.; Bevin, Tim; Loan, Richard; Schröder, Martin; McGrath, Richard; Weatherall, Mark; Robinson, Geoffrey B.

doi:10.1111/j.1465-3362.2009.00080.x

Cited by 16 publications

(16 citation statements)

References 19 publications

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“…The main finding of this study was that, in keeping with previous reports [1,9,11,14,18,19,31,34], nearly one third of patients under OMT reported misuse, this outcome not being influenced by OMT type or dosage in the multivariate model. In accordance with previous studies [35,36], age class was significantly and inversely associated with misuse, suggesting that younger patients under OMT should be more strictly monitored.…”

Section: Discussionsupporting

confidence: 73%

“…Data on the prevalence of MET and BUP injection is inconsistent across studies, with figures ranging from 5.0 to 35.8% for MET and from 9.1 to 46.5% for BUP [1,9,11,12,14,18,19].…”

Section: Introductionmentioning

confidence: 99%

“…According to previous reports, risk factors for OMT misuse include younger age, risky behaviours associated with opioid overdose, needle fixation (i.e., the act of injecting becoming compulsive and rewarding), opioid and benzodiazepine injection, polydrug abuse, self-treatment of withdrawal symptoms, concurrent pain or psychiatric symptoms, desire to obtain rapid onset of drug effect and low OMT dosage [1,7,10,11,14,[18][19][20]23].…”

Section: Introductionmentioning

confidence: 99%

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Intravenous Misuse of Methadone, Buprenorphine and Buprenorphine-Naloxone in Patients Under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study

Lugoboni

Zamboni

Cibin³

et al. 2019

Eur Addict Res

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Background: The act of intravenous misuse is common in patients under opioid maintenance treatment (OMT), but information on associated factors is still limited. Objectives: To explore factors associated with (a) intravenous OMT misuse, (b) repeated misuse, (c) emergency room (ER) admission, (d) misuse of different OMT types and (e) concurrent benzodiazepine misuse. Methods: We recruited 3,620 patients in 27 addiction units in Italy and collected data on the self-reported rate of intravenous injection of methadone (MET), buprenorphine (BUP), BUP-naloxone (NLX), OMT dosage and type, experience of and reason for misuse, concurrent intravenous benzodiazepine misuse, pattern of misuse in relation to admission to the addiction unit and ER admissions because of misuse. According to inclusion/exclusion criteria, 2,585 patients were included. Results: Intravenous misuse of OMT substances was found in 28% of patients with no difference between OMT types and was associated with gender, age, type of previous opioid abuse and intravenous benzodiazepine misuse. Repeated OMT misuse was reported by 20% (i.e., 71% of misusers) of patients and was associated with positive OMT misuse experience and intravenous benzodiazepine misuse. Admission to the ER because of misuse complications was reported by 34% of patients, this outcome being associated with gender, employment, type of previous opioid abuse and intravenous benzodiazepine misuse. OMT dosage was lower than the recommended maintenance dosage. Conclusions: We offered new information on factors associated with intravenous OMT misuse, repeated misuse and ER admission in Italian patients under OMT. Our data indicate that BUP-NLX misuse is not different from that of BUP or MET. Choosing the more expensive BUP-NLX over MET will likely not lead to the expected reduction of the risk of injection misuse of the OMT. Instead of prescribing new and expensive OMT formulations, addiction unit physicians and medical personnel should better focus on patient’s features that are associated with a higher likelihood of misuse. Care should be paid to concurrent benzodiazepine and OMT misuse.

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Section: Discussionsupporting

confidence: 73%

“…Data on the prevalence of MET and BUP injection is inconsistent across studies, with figures ranging from 5.0 to 35.8% for MET and from 9.1 to 46.5% for BUP [1,9,11,12,14,18,19].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intravenous Misuse of Methadone, Buprenorphine and Buprenorphine-Naloxone in Patients Under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study

Lugoboni

Zamboni

Cibin³

et al. 2019

Eur Addict Res

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“…Patients may self-administer OMT by intravenous route because of the shorter time to peak plasma level and the higher reinforcing effect [3]. Several studies reported intravenous OMT misuse with a prevalence of 5-36% for MET and 9-47% for BUP [4][5][6][7][8][9][10][11][12][13]. Sublingual or soluble film BUP-NLX was marketed, assuming that it would reduce the risk of diversion and misuse [14,15], but post-marketing studies showed similar rates of injections for MET, BUP and BUP-NLX [1,16,17].…”

Section: Introductionmentioning

confidence: 99%

Association between Adult Attention Deficit/Hyperactivity Disorder and Intravenous Misuse of Opioid and Benzodiazepine in Patients under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study

et al. 2020

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Background: Intravenous misuse and attention-deficit/hyperactivity disorder (ADHD) are common in patients under opioid maintenance treatment (OMT), who often misuse benzodiazepine (BZD). Objectives: To explore the rate of adult ADHD among patients under OMT in Italy and whether screening positive for adult ADHD is associated with OMT and BZD misuse and emergency room (ER) admission because of misuse. Methods: We recruited 1,649 patients from 27 addiction units (AUs) in Italy and collected data on the self-reported rate of OMT intravenous misuse (prevalence, repeated misuse, main reason, temporal pattern in relation to AU access, experience), concurrent intravenous and intra-nasal BZD misuse (prevalence, type of misused BZD), ADHD and ER admissions because of misuse complications. Results: Screening positive for adult ADHD was found in 11.2% patients (ADHD+), with a significant gender difference (women: 15.3%, men: 10.3%). OMT misuse was reported by 24.4 and 18.5% patients during lifetime and in the previous 6 months respectively. BZD misuse was reported by 20.0 and 8.6% patients for intravenous and intranasal route respectively. Misuse was significantly more common in ADHD+ (OMT 27.4-33.1%, BZD 14.5-31.5%) than ADHD-group (OMT 17.4-23.3%, BZD 7.9-18.3%). The multivariate logistic regression model showed positive screening for ADHD to be significantly associated with intravenous OMT misuse in the previous 6 months, and intravenous/intranasal BZD misuse, independently of age, gender and route of previous heroin administration. Conclusions: Screening positive for adult ADHD was associated with OMT and BZD misuse. AU physicians and medical personnel should focus on OMT patient's features that are associated with a higher likelihood of misuse, in particular ADHD.

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“…Some injecting drug users (IDU) in opioid substitution treatment (OST) inject while in treatment (Judson et al, 2010;Li et al, 2012), and consequently, continue to use needle exchange programmes (NEP) services (Gervasoni et al, 2012;Kerr et al, 2005). Continued drug use is cited as evidence of the failure of OST (Gyngell, 2011), and it is one of the reasons why the UK government, since 2010, has moved towards a drug strategy that emphasises rehabilitation with the aim of abstinence rather than OST (UK Government, 2010).…”

Section: Introductionmentioning

confidence: 99%

Is opioid substitution treatment beneficial if injecting behaviour continues?

Gjersing¹,

Bretteville-Jensen²

2013

Drug and Alcohol Dependence

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Title: Is opioid substitution treatment beneficial if injecting behaviour continues? Background Opioid substitution treatment (OST) is recognised as an effective treatment for opioid dependence. Still, a subgroup of OST users continues to inject drugs. This study examines health risks and criminal activity in a population of needle exchange programme (NEP) participants by comparing those identified as current OST users to i) those identified as former OST users and ii) those with no OST experience. MethodsThis was a semi-annual cross-sectional study conducted from 2002 to 2011. NEP participants were interviewed in Oslo, Norway (n=1,760); 341 were identified as current OST users, 356 as former OST users and 1,063 had no OST experience. The associations between OST status and health risk and criminal activity were assessed through univariate and multiple logistic regression analyses. Overall, there was a high level of polysubstance use and no group differences on this measure. Results Among Conclusions 3NEP participants who are currently in OST have substantially reduced health risks and criminal activity than other NEP participants. The high level of polysubstance use nevertheless poses a public health challenge.

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Drug injecting in patients in New Zealand Methadone Maintenance Treatment programs: An anonymous survey

Cited by 16 publications

References 19 publications

Intravenous Misuse of Methadone, Buprenorphine and Buprenorphine-Naloxone in Patients Under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study

Intravenous Misuse of Methadone, Buprenorphine and Buprenorphine-Naloxone in Patients Under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study

Association between Adult Attention Deficit/Hyperactivity Disorder and Intravenous Misuse of Opioid and Benzodiazepine in Patients under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study

Is opioid substitution treatment beneficial if injecting behaviour continues?

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