Search

Introduction: The introduction of depot buprenorphine for the treatment of opioid dependence allows for reduced dosing frequency compared with conventional treatments, such as oral methadone and sublingual buprenorphine-naloxone. Reduced dosing frequency is perceived to reduce issues such as high out-of-pocket costs, frequent attendance to pharmacies, stigmatisation and the risk of diversion for unsanctioned opioid use. This study aims to explore the experiences of patients receiving depot buprenorphine from an Australian publicly operated drug and alcohol service., Methods: Participants were recruited from the service over a 5-week period in 2021. Twenty-eight participants consented to be involved in a mixed methods quantitative verbal survey and qualitative interview process., Results: The majority of participants reported satisfaction with depot buprenorphine across the domains of efficacy, convenience and global satisfaction. Participants perceived benefits as increased convenience, reduced stigmatisation and the inability to 'skip' daily Medication Assisted Treatment for Opioid Dependence (MATOD) doses. There were mixed experiences with the ability for depot buprenorphine to 'hold' participants throughout the dosing interval. Reduced contact and disconnection from healthcare services were reported as an issue for some participants when initiating depot buprenorphine., Discussion and Conclusions: Patient perceptions of depot buprenorphine appear to be deeply rooted in prior experience with 'conventional' MATOD treatments. Depot buprenorphine is seen to be beneficial socially, personally, and financially by the majority of patients interviewed. The potential for disconnection from services and mixed experiences of efficacy throughout the dosing period may negatively influence patient experience., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

The introduction of long‐acting injectable buprenorphine preparations for opioid use disorder has been widely heralded as a breakthrough treatment, with several studies indicating positive results when using these medications. In many locations, nurse practitioners prescribe, administer, and monitor long‐acting injectable preparations. The objective of this paper is to explore whether a reduction in dispensed needles and syringes is attributable to increased nurse practitioner prescribing of LAIB. We used a retrospective audit of needles dispensed through the health service needle and syringe program vending machine, and individuals treated with long‐acting injectable buprenorphine by the nurse practitioner led model. In addition, we examined potential factors that may influence changes in the number of needles dispensed. Linear regression found that each individual with opioid dependence treated with long‐acting injectable buprenorphine was associated with 90 fewer needles dispensed each month (p < 0.001). The nurse practitioner led model of care for individuals with opioid dependence appears to have influenced the number of needles dispensed at the needle and syringe program. Although all confounding factors could not be discounted entirely, such as substance availability, affordability, and individuals obtaining injecting equipment elsewhere, our research indicates that a nurse practitioner led model of treating individuals with opioid use disorder influenced needle and syringe dispensing in the study setting. [ABSTRACT FROM AUTHOR]

Background: In 2019 daily liquid methadone and sublingual buprenorphine-naloxone were primary opioid agonist treatments for correctional centres in New South Wales, Australia. However, both had significant potential for diversion to other patients, and their daily administration was resource intensive. An alternative treatment in the form of subcutaneous depot buprenorphine became a viable option following a safety trial in 2020 - the UNLOC-T study. Depot preparation demonstrated advantages over current treatments as more difficult to divert and requiring fewer administrations. This paper reports the results of economic modelling of staffing costs in medication administration comparing depot buprenorphine, methadone, and sublingual buprenorphine provision in UNLOC-T trial facilities., Methods: The costing study adopted a micro-costing approach involving the synthesis of cost data from the UNLOC-T clinical trial as well as data collected from Justice Health and Forensic Mental Health Network records. Labour and materials data were collected during site observations and interviews. Costs were calculated from two payer perspectives: a) the New South Wales (state) government which funds custodial and health services; and b) the Australian Commonwealth government, which pays for medications. The analysis compared the monthly-per-patient cost for each of the three medications in trial-site facilities during July 2019. This was followed by simulation of depot buprenorphine implementation across the study population. Costs associated with medical assessment and reviews were excluded., Results: The monthly-per-patient New South Wales government service costs of depot buprenorphine, methadone and sublingual buprenorphine were: $151, $379 and $1,529 respectively while Commonwealth government medication costs were $434, $80 and $525. The implementation simulation found that service costs of depot buprenorphine declined as patients transitioned from weekly to monthly administration. Costs of treatment using the other medications increased as patient numbers decreased alongside fixed costs. At 12 months, monthly-per-patient service costs for depot buprenorphine, methadone and sublingual buprenorphine-which would be completely phased out by month 13-were $92, $530 and $2,162 respectively., Conclusions: Depot buprenorphine was consistently the least costly of the treatment options. Future modelling could allow for dynamic patient populations and downstream impacts for participants and the state health system., Trial Registration: ACTRN12618000942257 . Registered 4 June 2018., (© 2022. The Author(s).)

Buprenorphine is dispensed primarily in community pharmacies in Victoria, with buprenorphine prescribing expanding nationally. The aim of this paper was to examine issues that affect the delivery of buprenorphine in the community setting. A cross-sectional survey was conducted of 282 pharmacies participating in the methadone and buprenorphine programme across Victoria. Dispensing pharmacists completed the survey, designed to canvass issues around buprenorphine diversion and other issues related to the programme. Themes from the results indicated that there was concern from the majority of pharmacies with the issue of the supervision of buprenorphine and diversion of dispensed doses. The rate of suspected diversion was 1.5 times per 100 doses per month or 33 times per 100 clients per month. Seventy-four per cent of pharmacists indicated that this was a negative aspect of buprenorphine treatment. Frequency of suspected and confirmed diversion was associated with the number of pharmacy clients. Pharmacists' perceptions of issues related to buprenorphine appeared to affect opinions of buprenorphine clients and the buprenorphine programme more generally. Pharmacists believe that a significant level of diversion is occurring. This finding warrants serious attention, particularly in light of the increasing use of buprenorphine nationally and internationally.

Buprenorphine was registered in Australia as a maintenance and detoxification agent for the management of opioid dependence in November, 2000, and became widely available in August, 2001. This paper provides an overview of key developments in the introduction of buprenorphine treatment in Australia, with an emphasis upon the delivery of services in community-based (primary care) settings. A central study in this work was the Buprenorphine Implementation Trial (BIT), a randomized, controlled trial comparing buprenorphine and methadone maintenance treatment delivered under naturalistic conditions by specialist and community-based service providers (general practitioners and community pharmacists) in 139 subjects across nineteen treatment sites. In addition to conventional patient outcome measures (treatment retention, drug use, psychosocial functioning, and cost effectiveness), the BIT study also involved the development and evaluation of clinical guidelines, training programs for clinicians, and client literature, which are described here. Integration of treatment systems (methadone with buprenorphine, specialist and primary-care programs) and factors thought to be important in the uptake of buprenorphine treatment in Australia since registration are discussed.

Issues: Prescription opioid misuse in the USA has increased over threefold since 1990 to epidemic proportions, with substantial increases in prescription opioid use also reported in other countries, such as Australia and New Zealand. The broad availability of prescription pain medications, coupled with public misconceptions about their safety and addictive potential, have contributed to the recent surge in non-medical use of prescription opioids and corresponding increases in treatment admissions for problems related to opioid misuse. Given competing pressures faced by physicians to both diagnose and treat pain syndromes and identify individuals at risk for addictive disorders, the use of opioids in the treatment of pain poses a significant clinical challenge.Approach: This paper reviews the interaction between pain and opioid addiction with a focus on clinical management issues, including risk factors for opioid dependence in patients with chronic pain and the use of assessment tools to identify and monitor at-risk individuals. Treatment options for opioid dependence and pain are reviewed, including the use of the partial µ agonist buprenorphine in the management of concurrent pain and opioid addiction.Implications: Physicians should strive to find a reasonable balance between minimising potential adverse effects of opioid medications without diminishing legitimate access to opioids for analgesia.Conclusions: The article discusses the need to identify methods for minimising risks and negative consequences associated with opioid analgesics and poses research directions, including the development of abuse-deterrent opioid formulations, genetic risk factors for opioid dependence and opioid-induced hyperalgesia as a potential target for medication therapy. [ABSTRACT FROM AUTHOR]

The article focuses on opioid dependence treatment (ODT) in Western Australia, discussing the challenges faced by practitioners and services supporting patients with opioid addiction, highlighting recent developments in ODT, addressing the nationwide shortage of GP prescribers, and discussing the positive changes in ODT with the establishment of a new ODT community pharmacy program aimed at reducing the financial burden on patients.

Background: This study aims to compare the price difference between the official price for pharmaceutical drugs and the price when sourced from the black market in Australia. Methods: Drug prices recorded on the StreetRx database between 2014 and June 2018 were retrieved and the base pharmacy dispensed price was also retrieved from the Australian Pharmaceutical Benefits Scheme (PBS) website. The difference in Australian dollars between the street and base pharmacy dispensed prices for each mg of drug was calculated and the price mark-up per mg for each drug was compared. Results: 2704 reports were made for Australia between 2014 and 2018 on StreetRx. Buprenorphine accounted for 26% of all reports. After the number of reports for each drug was adjusted to their respective defined daily dose (DDD)/1000 persons/day bromazepam was the most commonly reported drug with 413.2 reports per DDD/1000/day, clonazepam (399.9), lisdexamphetamine (177.1) and oxycodone (138.4), respectively. The mark-up on opioids was the highest. Of the opioids, fentanyl's median price mark-up per mg was the highest (90 AUD). Conclusion: This study has shown that users of prescription medication pay a significant mark-up for those drugs on the street. This is a measure of the perceived value by those misusing drugs. [ABSTRACT FROM AUTHOR]

Background: There has been much research on the efficacy and effectiveness of opioid agonist treatment (OAT), but less on its implementation and sustainability. A challenge internationally has been recruiting and retaining prescribers. This paper aims to characterise the prescribers in terms of OAT prescribing behaviours.Methods: Retrospective cohort study in New South Wales, Australia. Participants were 2199 OAT prescribers between 1 st August 2001-19th September 2018.We examined trends in initiation and cessation of OAT prescribers. Adjusted hazard ratios were calculated to estimate prescriber retention, adjusting for year of initiation, practice type, client load and treatment prescribed.Results: The rate of prescribers ceasing OAT prescribing has been increasing over time: a prescriber who initiated between 2016-2017 had over four times the risk of cessation compared with one who initiated before 2001, AHR: 4.77; [3.67-6.21]. The highest prescriber cessation rate was in prescribers who had prescribed for shorter time periods. The annual percentage of prescribers who ceased prescribing among those who prescribed for ≤5 years increased from 3% in 2001 to 20 % in 2017. By 2017 more prescribers were discontinuing prescribing than new prescribers were starting. Approximately 87 % (n = 25,167) of OAT clients were under the care of 20 % of OAT prescribers (n = 202); half had been prescribing OAT for 17+ years.Conclusions: OAT prescribing is increasingly concentrated in a small group of mature prescribers, and new prescribers are not being retained. There is a need to identify and respond to the reasons that contribute to newer prescribers to cease prescribing and put in place strategies to increase retention and broaden the base of doctors involved in such prescribing. [ABSTRACT FROM AUTHOR]

Background: Insomnia and excessive daytime sleepiness (EDS) are reported to be common in methadone maintenance treatment (MMT) but much less is known about these symptoms in buprenorphine maintenance treatment (BMT) and in women compared with men. Methods: Cross sectional study of recipients of BMT (n = 113, 47 women), MMT (n = 184, 94 women), people using opioids nonmedically (nonopioid agonist treatment, non-OAT: n = 87, 31 women) and a reference group with no opioid use (RG; n = 105, 53 women) in Australia. Measures included Athens Insomnia Scale, Epworth Sleepiness Scale, the Hospital Anxiety and Depression Scale, and other substance use. Results: Insomnia (Athens Insomnia Scale, total ≥10) was highly prevalent among all people who use opioids (BMT 46.0–68.1%; MMT 55.4–69.6%; non-OAT 58.6–80.5%), did not differ significantly among these groups, and was significantly associated with anxiety and depression. EDS (Epworth score >10) was found in 14.2% of BMT, 22.8% of MMT, 35.6% of non-OAT groups, and 11.4% of the RG, and was significantly associated with depression overall. Fewer people had Epworth score >15 indicating more severe EDS (BMT 4.4%, MMT 6.0%; non-OAT 13.8%; RG 1.9%). Insomnia and EDS did not differ by sex or by opioid dose, nor were they significantly associated with other drug use, housing stress or social security status. Conclusions: Insomnia was common in people receiving OAT and using opioids non-medically, and associated with anxiety and depression. Clinicians should consider the possibility of daytime sleepiness in people receiving BMT and MMT, and in people using opioids nonmedically. [ABSTRACT FROM AUTHOR]

Introduction: Opioid dependence is a complex health condition often requiring long-term treatment. The main objectives of treatment are to reduce dependence and the associated morbidity and mortality. Opioid replacement therapy (ORT) is an effective pharmacological therapy for opioid dependence. The aims of this research were to explore barriers and enablers to ORT in rural areas of Australia. Design and Methods: A qualitative study design incorporating semi-structured interviews was used to explore views of people in ORT. Interviews were analysed for emergent themes and issues. Results: Barriers to ORT were restrictiveness, stigma, the medication and structure of the program. Enablers were structure of the program, access to takeaway doses, effect on drug use and the medication. Discussion: To improve access and retention in ORT programs action is needed to facilitate programs meeting the needs of rural people, including reducing cost of medication, addressing the restrictiveness of programs and effect on employment opportunities, and stigma associated with drug use and addiction in communities. Conclusions: Barriers and enablers to ORT programs exist in the rural areas studied. Geographical distance, inability to gain and maintain social connections including employment, and lack of community education addressing stigma are significant barriers to ORT in these areas. [ABSTRACT FROM AUTHOR]

Background: Current information on the patterns of medication use in nursing home residents living with dementia is conflicting. Aim: The aim of this study was to investigate medication use and its associations with dementia diagnosis in Australian nursing home residents. Methods: A cross‐sectional study of 541 residents from 17 Australian nursing homes was performed. Results: Over 12 months, nursing home residents were prescribed a mean (±SD) of 14.5 ± 6.8 medications each. Approximately 95% of residents were prescribed medications for the nervous system, and 94% were prescribed medications for the alimentary tract and metabolism. After adjustment for potential confounders, those with dementia were less likely to be prescribed medications for the cardiovascular system (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.27–0.77, p = 0.0032) and respiratory system (OR 0.38, 95% CI: 0.25–0.60, p < 0.0001). Further analysis of specific medications showed that residents with dementia were more likely to be prescribed risperidone (OR: 9.38, 95% CI: 4.01–21.94, p < 0.0001), buprenorphine (OR 3.37, 95% CI: 1.78–6.36, p = 0.0002) and trimethoprim (OR 1.78, 95% CI: 1.06–2.97, p = 0.0282), but less likely to be prescribed glyceryl trinitrate (OR 0.42, 95% CI: 0.19–0.94, p = 0.0340) and salbutamol (OR 0.34, 95% CI: 0.2–0.6, p = 0.0002) in addition to other specific medications. Conclusions: Increased awareness of possible undertreatment of cardiovascular and respiratory conditions, and possible overtreatment of urinary tract infection, in those living with dementia in nursing home settings may improve management of this vulnerable population. [ABSTRACT FROM AUTHOR]

The number of opioid prescriptions has increased significantly over the last few years due to multiple factors, such as physicians' heightened attention to pain management, greater prevalence of chronic pain due to the aging population, and the availability of sustained-release opioid preparations. Correspondingly, this has been associated with a rise in considerable harm due to opioid misuse, which is recognized as a national health priority in Australia. This article outlines the major public health approaches that have been introduced in Australia to address this issue. Opioid misuse can be addressed through establishing a real-time prescription drug monitoring program, ensuring adequate access to affordable and high quality medication-assisted treatment, and promoting physicians' use of the evidence-based guideline on appropriate opioid prescribing. [ABSTRACT FROM PUBLISHER]

Background: Naltrexone may provide a suitable alternative to methadone and buprenorphine in the treatment of pregnant opioid-dependent women; however, little is known about its effects on neonatal morbidity and mortality. Objective: The aim was to evaluate the health of neonates exposed to naltrexone in utero, and compare it with outcomes in neonates exposed to methadone or buprenorphine and a non-exposed control group. Methods: Sequential cohorts of Western Australian (WA) opioid-dependent women treated with implant naltrexone, oral methadone or sublingual buprenorphine were identified via records from a drug and alcohol clinic (Subiaco, WA) for naltrexone and state prescribing records for methadone and buprenorphine. A control cohort of non-opioid-dependent women was obtained from the WA electoral roll. Identifying information and treatment records for these women were linked against the Midwife Notification System records to identify exposed offspring born between 2001 and 2011. Birth characteristics, congenital anomalies and perinatal mortality for all neonates were extracted from state records. Results: The birth characteristics of naltrexone-exposed neonates ( n = 68) were superior to methadone-exposed neonates ( n = 199) in terms of birth size (birth weight, head circumference and length), hospital length of stay (5.5 vs. 11.3 days), and rates of neonatal abstinence syndrome (NAS) (7.5 vs. 51.5%). Naltrexone-exposed neonates were generally not significantly different to buprenorphine-exposed neonates ( n = 124), with the exception of significantly lower rates of NAS (7.5 vs. 41.8%) and shorter hospital length of stay (5.5 vs. 8.0 days) in naltrexone-exposed neonates. Compared with the control group of neonates ( n = 569), naltrexone-exposed neonates were not significantly different in terms of overall rates of congenital anomalies, stillbirths and neonatal mortality; however, they were significantly smaller (3137.1 vs. 3378.0 g), spent more time in hospital following birth (5.5 vs. 4.3 days) and had higher rates of NAS (7.5 vs. 0.2%). Exposure of neonates to prenatal methadone was associated with a high incidence of neonatal mortality (2.0 vs. 0.2 per 100 live births) and congenital anomalies (10.6 vs. 4.4 per 100 births) compared with the control group. Rates of neonatal mortality and congenital abnormalities in buprenorphine-exposed neonates were not significantly different to the control group. Conclusions: The use of implant naltrexone during pregnancy was not associated with higher rates of negative birth outcomes compared with methadone- and buprenorphine-exposed neonates. Significantly, naltrexone and buprenorphine were not associated with the high rates of neonatal mortality or congenital anomalies seen in methadone-exposed neonates. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Around 65% of people incarcerated in prisons in Australia, America and Europe have a history of drug dependence, sometimes treated with opioid substitution treatment (OST) medications. Studies report that those in treatment in prison do engage in some level of diversion to others, whether on a voluntary or coerced basis. We aimed to examine the use of prescribed and non-prescribed OST medications by those in prisons, especially buprenorphine-naloxone film (BNX-F); the extent of non-adherence and diversion and reasons for such practices; and the impact of the introduction of BNX-F into the prison system.Design and Methods: Mixed methods study drawing on: (i) structured interviews with current OST clients (n = 60) who reported being incarcerated in the 12 months prior to being interviewed and (ii) qualitative interviews with key experts working in corrections and prison (or justice) health settings.Results: The majority were prescribed OST medications in prison, with 25% removing all or part of their supervised dose on at least one occasion, and 44% reporting use of non-prescribed medications. Some reported intravenous use (14% injected). One-third of OST recipients reported selling/sharing OST medications with others in prison. The introduction of BNX-F into the prison system saw different diversion methods used and removal from dosing within prison.Discussion and Conclusions: Despite prison being a highly regulated and controlled environment, some level of diversion and sharing of psychoactive medication occurs among prisoners. The buprenorphine formulations used in OST present particular challenges with respect to supervised dosing in this setting. [White N, Ali R, Larance B, Zador D, Mattick RP, Degenhardt L. The extramedical use and diversion of opioid substitution medications and other medications in prison settings in Australia following the introduction of buprenorphine-naloxone film. Drug Alcohol Rev 2015;●●:●●-●●]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Buprenorphine-naloxone (BNX) film for opioid dependence treatment was introduced in Australia in 2011. A key difference in State policy approaches saw transfer from BNX tablets to BNX film mandated in South Australia (SA) with New South Wales (NSW) and Victoria (VIC) having less stringent policies. This study examined (i) how initiations and transfers were implemented, (ii) the profile and predictors of adverse effects as self-reported by BNX film clients, and (iii) dosing issues.Design and Methods: Survey of 334 buprenorphine (BPN), BNX tablet and BNX film clients and semi-structured interviews with 39 key experts (KEs) in 2012. Comparisons are made between clients interviewed in SA versus NSW and VIC combined.Results: Among the 180 current BNX film clients, 23% started treatment on BNX film, 18% requested a transfer to BNX film and 59% (n = 106) reported their clinic/prescriber recommended transfer to BNX film. Among clients who were offered but refused a transfer to BNX film (n = 66), the most common reason was 'I am happy with my current treatment and do not see a reason to change' (53%). Some opioid substitution therapy clients and KE viewed transfers as 'forced' (i.e. no choice of buprenorphine formulation). Multivariable regression showed residing in SA (vs. NSW/VIC) and a shorter length of current treatment episode were associated with more BNX film-attributed adverse effects but clinic/prescriber-recommended transfer was not.Discussion and Conclusions: The introduction of BNX film in Australia varied across States. A perception of restricted choice in medication may have undermined initial acceptance in SA. [ABSTRACT FROM AUTHOR]

The article presents 2013 reports of medication safety issues and strategies to prevent medication errors, featuring information on Australian medication errors and near misses and drug-related incidents and U.S. experiences, including material from "ISMP Medication Safety Alert!", a bulletin published by the U.S. Institute for Safe Medication Practices. Safety briefs on medications which were issued in the U.S. are discussed. Safe practices for medication management in hospitals are examined.

Introduction and Aims. To examine Australian opioid substitution treatment (OST) prescribers' perceptions of (i) diversion and/or injection of methadone, buprenorphine, buprenorphine-naloxone by patients; and (ii) effectiveness of current treatment policies in minimising the associated risks. Design and Methods. 1278 authorised OST prescribers, identified by each jurisdiction's health department records, were sent a postal survey in 2007. Reminder letters and additional copies of the survey were sent to non-responders at weeks four and eight following the initial mail-out. Respondents went into a draw to win one of ten $100 book vouchers. Results. Although the response rate was 26% (N = 291), participating prescribers served half (49%) of all OST patients in Australia. Prescribers perceived more buprenorphine patients removed supervised doses (7%) and diverted unsupervised doses (20%), compared with methadone patients (1% and 4% respectively) and buprenorphine-naloxone patients (3% and 2% respectively). Prescribers reported significantly more buprenorphine and buprenorphine-naloxone patients injected doses (5% respectively), compared with methadone patients (2%). Non-adherence was identified through patient self-report (51%), and the reports of pharmacists (49%) and other staff (34%). More prescribers were confident in assessing the risk of injection (54%) than diversion (37%). Many prescribers responded 'don't know' to quantitative survey items. Qualitative responses highlighted uncertainties in assessing diversion/injection and whether current responses constituted 'best practice'. Discussion and Conclusions. Australian prescribers perceive most patients adhere with OST, although they may underestimate the levels of diversion. Prescribers' beliefs about patients' behaviours are important and influence decisions to prescribe, medication choice and suitability for unsupervised dosing. The uncertainties in assessing and responding to diversion/injection may be a factor deterring prescribers' participation in OST.[Larance B, Degenhardt L, O'Brien S, Lintzeris N, Winstock A, Mattick RP, Bell J, Ali R. Prescribers' perceptions of the diversion and injection of medication by opioid substitution treatment patients. Drug Alcohol Rev 2011;30:613-620] [ABSTRACT FROM AUTHOR]

Aims: There are currently 39,000 people on methadone or buprenorphine treatment in Australia, representing approximately one third of the opioid-dependent population. An educational DVD, entitled Access All Areas, was developed to inform, attract and engage opioid-dependent drug users into treatment, with a view to increasing users' understanding of the benefits and risks of treatment and factors impacting the way treatment is delivered. Methods: A pilot evaluation of the draft DVD was conducted with 99 opioid users recruited from two public opioid treatment clinics and four Needle Syringe Programs (NSP). Participants viewed a 1-hour segment of the DVD and completed a pre- and post-test knowledge questionnaire, and an evaluation questionnaire. Findings: After viewing the DVD, the majority of participants had a 'better understanding of the benefits of treatment' (95%), and were 'more likely to ask about hepatitis C treatment' (69%). Among participants not on opioid treatment, 37% were 'more interested in the idea of treatment' after viewing the DVD. The mean number of correct responses to knowledge questions increased marginally after viewing the DVD (14/28 vs. 15/28; p <.05). However, there were considerable increases in the proportion of participants who responded correctly to questions regarding pregnancy and opioids, the dental effects of methadone, and hepatitis. Conclusions: This study provides preliminary evidence of the benefits of this educational resource to people with opioid dependence. Future research is planned evaluating the DVD in a controlled trial exploring treatment engagement, retention, and other outcomes. [ABSTRACT FROM AUTHOR]

Introduction and Aims. A consumer satisfaction survey was conducted among clients receiving methadone or buprenorphine treatment for opioid dependence. The survey aimed to assess client perceptions across a number of treatment domains, including the clinic environment, service provision, clinical relationships, medication and treatment outcomes. Design and Methods. Participants were 432 clients receiving treatment at nine public clinics in New South Wales, Australia. An interviewer-administered questionnaire was utilised, designed by the researchers. Participation was voluntary and anonymous. All participants received $10 remuneration. Results. Seventy-eight per cent of participants were on methadone treatment. Overall satisfaction with treatment was high (mean: 3.8; very satisfied = 5). Participants were mainly satisfied with service provided by the clinic, although had concerns over the inflexibility associated with the clinic atmosphere, frequency of clinic attendance, dosing hours and lack of takeaway doses. While relationships with prescribers and case managers were rated positively, 16% and 21% of participants wanted to see their prescriber and case manager more often, respectively; 53% reported that they did not have input into their care plan. Regarding the helpfulness of case managers in assisting clients with problems experienced in identified domains of case management (e.g. drug use, physical and mental health, psychosocial supports), the mean rating was 5.2 (excellent = 10). Discussion and Conclusions. While participants reported being mainly satisfied with their treatment, results must be viewed within the context of what a consumer reasonably expects to receive from a service. The concept of 'expectation' and 'relative experience' is crucial in measuring consumer satisfaction among pharmacotherapy consumers. [ABSTRACT FROM AUTHOR]

The introduction of buprenorphine - naloxone in Australia in April 2006 has permitted the revision of takeaway policies in many states and has introduced the possibility of unsupervised treatment. This study explored the implications of the introduction of buprenorphine - naloxone in terms of cost to patients through a survey of pharmacists' intended pricing practices. The aim of the research was to examine the intentions of pharmacists in relation to fees for buprenorphine - naloxone and study the potential implications to patients when compared with the existing fee structure for methadone and for buprenorphine alone. A self-complete questionnaire was mailed to every community pharmacy in New South Wales (NSW) (n = 593) dispensing methadone or buprenorphine to people with opioid dependence. A response rate of 68.6% (n = 407) was achieved after three mailouts. The majority of pharmacies charged a flat weekly fee for methadone (92.2%; mean = $31.90) and buprenorphine (74.8%; mean = $31.00). The mean intended fees for buprenorphine - naloxone according to different dosing and takeaway regimens ranged from $19.19 per week for no supervised doses and fortnightly takeaways to a $30.88 per week flat fee. There appeared to be little variation in fee structure irrespective of the takeaway regimen, until reaching the 2 weeks' unsupervised dose regimen. This study highlights the importance of the early dissemination of unambiguous information regarding the introduction of a new medication, especially where supervised dispensing through community pharmacies is essential to the provision of treatment. The potential impact upon the successful rollout of a new treatment paradigm that was developed to benefit stable patients in the community may be jeopardised when such processes are not followed. [Winstock AR, Lea T, Ritter A. The impact of community pharmacy dispensing fees on the introduction of buprenorphine - naloxone in Australia. Drug Alcohol Rev 2007;26:411-416] [ABSTRACT FROM AUTHOR]

Since 2001, the Langton Centre has used supervised administration of buprenorphine in treating heroin dependence, without distinguishing between detoxification and maintenance; most people commencing treatment may remain on buprenorphine indefinitely. The aim of this study was to describe retention in treatment, reasons for leaving, re-entry and pattern of attendance, and compare retention in practice with results from research trials, using a file review of sequential presentations for buprenorphine treatment. Retention in treatment was 37% at 6 months, the same as in Australian research trials of buprenorphine maintenance (37%); most people dropped-out without consultation or dose tapering. Repeated episodes of treatment constituted 45% of all episodes; missed scheduled doses were common. Participation in buprenorphine treatment often involves repeated, short episodes and erratic attendance. Measures to improve retention in treatment could improve treatment efficacy. [Bell J, Burrell T. Retention and attendance with supervised buprenorphine treatment: a case-note review . Drug Alcohol Rev 2006;25:161 – 165] [ABSTRACT FROM AUTHOR]

Editorial. Comments on usage of buprenorphine in treatment of heroin dependence in Australia. Effectiveness of buprenorphine; Characteristics of the substance; Information regarding other drugs used for therapy.