B Vicknasingam1, M N M Dazali2, D Singh3, R S Schottenfeld4, M C Chawarski5. 1. Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia. Electronic address: vickna@usm.my. 2. Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia. Electronic address: nazridazali@gmail.com. 3. Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia. Electronic address: darshan@usm.my. 4. Yale School of Medicine, New Haven, CT 06519, USA. Electronic address: richard.schottenfeld@yale.edu. 5. Yale School of Medicine, New Haven, CT 06519, USA. Electronic address: marek.chawarski@yale.edu.
Abstract
OBJECTIVE: Medication assisted treatment with buprenorphine/naloxone (Bup/Nx), including prescribing and dispensing practices of general practitioners (GPs) in Malaysia and their patients' experiences with this treatment have not been systematically examined. The current study surveyed GPs providing Bup/Nx treatment and patients receiving office-based Bup/Nx treatment in Malaysia. METHODS: Two cross-sectional surveys of GPs (N=115) providing outpatient Bup/Nx maintenance treatment and of patients (N=253) currently receiving Bup/Nx treatment throughout peninsular Malaysia. RESULTS: Physicians prescribed Bup/Nx dosages in the range of 2-4mg daily for 70% of patients and conducted urine testing in the past month on approximately 16% of their patients. In the patient survey, 79% reported taking daily Bup/Nx doses of 2mg or less; 82% reported that no urine toxicology testing had been conducted on them in the past month, 36% had an opiate positive urine test at the time of the survey, 43% reported illicit opiate use, 15% reported injection of heroin and 22% reported injection of Bup/Nx in the past month. CONCLUSION: Low daily Bup/Nx doses, lack of behavioral monitoring or counseling, and high rates of continued drug use, including injection of drugs and medications during Bup/Nx treatment in Malaysia, indicate continuing problems with implementation and less than optimal treatment effectiveness. High cost of Bup/Nx in Malaysia may deter patients from seeking treatment and contribute to taking low Bup/Nx dosages. Improved training of physicians and establishing standards for Bup/Nx dosing, routine toxicology testing, and counseling may be needed to improve care and treatment response.
OBJECTIVE: Medication assisted treatment with buprenorphine/naloxone (Bup/Nx), including prescribing and dispensing practices of general practitioners (GPs) in Malaysia and their patients' experiences with this treatment have not been systematically examined. The current study surveyed GPs providing Bup/Nx treatment and patients receiving office-based Bup/Nx treatment in Malaysia. METHODS: Two cross-sectional surveys of GPs (N=115) providing outpatientBup/Nx maintenance treatment and of patients (N=253) currently receiving Bup/Nx treatment throughout peninsular Malaysia. RESULTS: Physicians prescribed Bup/Nx dosages in the range of 2-4mg daily for 70% of patients and conducted urine testing in the past month on approximately 16% of their patients. In the patient survey, 79% reported taking daily Bup/Nx doses of 2mg or less; 82% reported that no urine toxicology testing had been conducted on them in the past month, 36% had an opiate positive urine test at the time of the survey, 43% reported illicit opiate use, 15% reported injection of heroin and 22% reported injection of Bup/Nx in the past month. CONCLUSION: Low daily Bup/Nx doses, lack of behavioral monitoring or counseling, and high rates of continued drug use, including injection of drugs and medications during Bup/Nx treatment in Malaysia, indicate continuing problems with implementation and less than optimal treatment effectiveness. High cost of Bup/Nx in Malaysia may deterpatients from seeking treatment and contribute to taking low Bup/Nx dosages. Improved training of physicians and establishing standards for Bup/Nx dosing, routine toxicology testing, and counseling may be needed to improve care and treatment response.
Authors: Richard S Schottenfeld; Marek C Chawarski; Mehmet Sofuoglu; Weng-Tink Chooi; Norzarina M Zaharim; M Azhar M Yasin; Imran Ahmad; Sharifah Zubaidiah Syed Jaapar; B Kasinather Vicknasingam Journal: Drug Alcohol Depend Date: 2018-03-10 Impact factor: 4.492
Authors: Balasingam Vicknasingam; N A Mohd Salleh; Ravi Ramadah; Darshan Singh; Adeeba Kamarulzaman; Marek C Chawarski Journal: Int J Drug Policy Date: 2021-06-07