Briony Larance1, Paul Dietze2, Robert Ali3, Nicholas Lintzeris4,5, Nancy White3, Rebecca Jenkinson2, Louisa Degenhardt1,6. 1. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. 2. Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia. 3. School of Medical Sciences, University of Adelaide, Adelaide, Australia. 4. The Langton Centre, Surry Hills, Australia. 5. Faculty of Medicine, University of Sydney, Sydney, Australia. 6. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Abstract
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.
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.
Authors: Briony Larance; Louisa Degenhardt; Jason Grebely; Suzanne Nielsen; Raimondo Bruno; Paul Dietze; Kari Lancaster; Sarah Larney; Thomas Santo; Marian Shanahan; Sonja Memedovic; Robert Ali; Michael Farrell Journal: Addiction Date: 2020-02-05 Impact factor: 6.526