44 results on '"Suzanne Nielsen"'
Search Results
2. Prescription drug monitoring programs in Australia: A call for a comprehensive evaluation
- Author
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Louisa Picco, Alison Ritter, and Suzanne Nielsen
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Health (social science) ,Medicine (miscellaneous) - Published
- 2023
3. Putting out the welcome mat—A qualitative exploration of service delivery processes and procedures as barriers to treatment‐seeking for people who use alcohol and other drugs
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Leanne Francia, Tina Lam, Amelia Berg, Kirsty Morgan, Michael Savic, Dan I. Lubman, and Suzanne Nielsen
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Health (social science) ,Medicine (miscellaneous) - Abstract
There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery.Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking.Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking.Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.
- Published
- 2022
4. What are the research priorities for optimising the safe and effective use of opioids in Australian general practice?
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Monica Jung, Helena Cangadis‐Douglass, Suzanne Nielsen, Samanta Lalic, Malcolm Dobbin, Grant Russell, Pallavi Prathivadi, Pene Wood, Elizabeth Manias, Cik Y. Lee, Carolyn Arnold, Megan Kuleas, Jennifer L. Schumann, Jenni Ilomäki, and J. Simon Bell
- Subjects
Health (social science) ,Medicine (miscellaneous) - Abstract
Persistent high rates of prescription opioid use and harms remain a concern in Australia, Europe and North America. Research priority setting can inform the research agenda, strategic responses and evidence-based interventions. The objective of this study was to establish research priorities related to the safe and effective use of prescription opioids in general practice.Consumers, clinicians and policy makers were invited to participate in a structured consensus workshop in May 2021. A modified nominal group technique was used to explore research priorities for the safe and effective use of opioids in Australian general practice. Research priorities were identified, consolidated and prioritised using a structured process.Seventeen consumer, medical, pharmacy, nursing, allied health and policy participants generated 26 consolidated priorities across three domains: (i) consumer-focused priorities; (ii) clinician and practice-focused priorities; and (iii) system and policy-focused priorities. The highest ranked research priorities in each of the domains were consumer characteristics that influence opioid prescribing and outcomes, opioid deprescribing strategies, and system-level barriers to prescribing alternatives to opioids, in the consumer, clinician and practice, and system and policy domains, respectively.The priorities reflect opportunities for research priority setting within Australian general practice. The priorities provide a map for future qualitative and quantitative research that will inform safe and effective opioid prescribing.
- Published
- 2022
5. Opioid‐related policy changes: Experiences and perspectives from people who use opioids to manage non‐cancer chronic pain
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Sarah Haines, Michael Savic, Suzanne Nielsen, and Adrian Carter
- Subjects
Health (social science) ,Medicine (miscellaneous) - Published
- 2023
6. Examining the cost and impact of dosing fees among clients in opioid agonist treatment: Results from a cross‐sectional survey of Australian treatment clients
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Emma Zahra, Rory Chen, Suzanne Nielsen, Anh Dam Tran, Thomas Santo, Louisa Degenhardt, Michael Farrell, Jude Byrne, Robert Ali, and Briony Larance
- Subjects
Analgesics, Opioid ,Cross-Sectional Studies ,Health (social science) ,Australia ,Opiate Substitution Treatment ,Humans ,Medicine (miscellaneous) ,Opioid-Related Disorders ,Methadone ,Buprenorphine - Abstract
Opioid agonist treatment (OAT) clients frequently bear costs associated with their treatment, including dosing fees. This study aimed to explore the financial and social impact of dosing fees upon clients.Cross-sectional survey of people who use opioids regularly (N = 402) between December 2017 and March 2018, conducted in Australia. Dosing fees were calculated and expressed as percentage of income, by OAT type. Consequences and strategies for difficulties making payments were examined as proportions.A total of N = 360 participants had ever been in OAT and N = 245 participants currently engaged in OAT reported data on dosing fees, of them 53% (n = 129) reported paying dosing fees. Compared to clients with high levels of dosing supervision, those with moderate or low levels of supervision were more likely to pay dosing fees. The median 28-day dosing fee was AUD$110 (interquartile range AUD$80); median 28-day income was AUD$1520 (interquartile range AUD$700). For those who paid dosing fees, the fee comprised10% of total monthly income for 70% of participants; however, 23% of participants paid fees comprising 10% to 20%, and 7% of participants paid fees comprising 20% or more of monthly income. Among those that had ever been in OAT, 72% experienced difficulties in paying treatment costs; 36% left treatment earlier than intended and 25% had been excluded due to payment difficulties.Negative consequences of treatment costs to clients, particularly dosing fees, are evident. These costs impact treatment access and retention that may negatively impact clients' physical health, mental health and social wellbeing.
- Published
- 2022
7. Feasibility and acceptability of take‐home naloxone for people released from prison in New South Wales, Australia
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Lucy Thi Tran, Suzanne Nielsen, Noora Oikarainen, Sarah Larney, Julia Bowman, Louisa Degenhardt, Jillian Roberts, Banafsheh Moradmand-Badie, and Stephen Ward
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Health (social science) ,Narcotic Antagonists ,media_common.quotation_subject ,Population ,Medicine (miscellaneous) ,Prison ,Pharmacy ,Nursing ,Naloxone ,medicine ,Humans ,Justice (ethics) ,education ,media_common ,education.field_of_study ,business.industry ,Prisoners ,Opioid overdose ,Opioid-Related Disorders ,medicine.disease ,Mental health ,Cross-Sectional Studies ,Opioid ,Feasibility Studies ,Drug Overdose ,New South Wales ,business ,medicine.drug - Abstract
Introduction and aims To assess the feasibility and acceptability of a take-home naloxone program for people with a history of opioid use released from prison in New South Wales, Australia. Design and methods Cross-sectional interviews with people with a history of opioid use who were recently released from prison (n = 105), and semi-structured interviews with key clinical and operational staff of Justice Health and Forensic Mental Health Network and Corrective Services NSW (n = 9). Results Among people with a history of opioid use who had recently left prison, there was very high awareness of the elevated risk of overdose following release from prison (95%) and the potential for naloxone to reverse an opioid overdose (97%). Participants considered that their personal risk of overdose was low, despite ongoing opioid use being common. Participants were largely supportive of take-home naloxone, but the majority (83%) stated that proactively obtaining naloxone would be a low priority for them following release. Key informants were supportive of introducing naloxone training and supply and identified barriers to implementation, including adequate resourcing, identifying the population for training, and developing an appropriate model of training and implementation. Discussion and conclusion There was widespread support for naloxone training in custody and distribution at release among people recently released from prison and key stakeholders in health-care provision and prisons administration. As proactively accessing naloxone is a low priority for patients, naloxone supply at release may be more effective than programs that refer releasees to local pharmacies, but developing a sustainable supply model requires consideration of several barriers.
- Published
- 2020
8. Correlates of indicators of potential extra‐medical opioid use in people prescribed opioids for chronic non‐cancer pain
- Author
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Thomas Santo, Raimondo Bruno, Louisa Degenhardt, Briony Larance, Gabrielle Campbell, Suzanne Nielsen, and Natasa Gisev
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Adult ,Male ,medicine.medical_specialty ,Health (social science) ,media_common.quotation_subject ,Population ,030508 substance abuse ,Medicine (miscellaneous) ,Logistic regression ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Humans ,Medicine ,030212 general & internal medicine ,Prospective cohort study ,education ,Prescription Drug Misuse ,media_common ,education.field_of_study ,business.industry ,Addiction ,Age Factors ,Australia ,Chronic pain ,Odds ratio ,Middle Aged ,Opioid-Related Disorders ,medicine.disease ,Analgesics, Opioid ,Cross-Sectional Studies ,Opioid ,Emergency medicine ,Cohort ,Female ,Chronic Pain ,0305 other medical science ,business ,medicine.drug - Abstract
Introduction and Aims: The opioid-related behaviours in treatment (ORBIT) scale are a measure of recent indicators of potential extra-medical opioid use. Indicators of potential extra-medical opioid use are divergent practices among people prescribed opioids that may place them at risk of harm. This study aimed to examine the correlates of indicators of potential extra-medical opioid use in people prescribed opioids for chronic non-cancer pain (CNCP). Design and Methods: The Pain and Opioids IN Treatment (POINT) study is a prospective cohort study of people prescribed opioids for CNCP in Australia. People prescribed opioids solely for opioid dependence were excluded. This cross-sectional study utilised logistic regression to determine the characteristics associated with reporting any indicators of potential extra-medical opioid use. Results: Of the 1505 participants, 38% reported at least one indicator of potential extra-medical opioid use, most commonly asking for an increase in prescribed opioid dose (21%) and early prescription renewal (12%). Indicators of potential extra-medical opioid use were associated with younger age (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI] = 0.92, 0.99), male sex (AOR = 1.53; 95% CI = 1.15, 2.04), lifetime pharmaceutical opioid use disorder (AOR = 1.87; 95% CI = 1.31, 2.66) and lifetime illicit drug use disorder (AOR = 1.72; 95% CI = 1.18, 2.52). Discussion and Conclusions: Over one-third of the POINT cohort reported one or more indicators of potential extra-medical opioid use. Lifetime substance use disorders were associated these divergent practices, highlighting the importance of clinical monitoring and patient education for this patient group. Longitudinal studies are needed to investigate whether indicators of potential extra-medical opioid use predict opioid use disorders in this population.
- Published
- 2019
9. Urine drug screening for early detection of unwitting use of fentanyl and its analogues among people who inject heroin in Sydney, Australia
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Julie Latimer, Emma My Tay, Marianne Jauncey, Suzanne Nielsen, and Monica J. Barratt
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medicine.medical_specialty ,Urine drug screening ,Health (social science) ,Strip test ,Urinalysis ,medicine.diagnostic_test ,business.industry ,030508 substance abuse ,Medicine (miscellaneous) ,Early detection ,Urine ,Fentanyl ,Heroin ,03 medical and health sciences ,0302 clinical medicine ,Opioid ,Emergency medicine ,Medicine ,030212 general & internal medicine ,0305 other medical science ,business ,medicine.drug - Abstract
INTRODUCTION AND AIMS North America has witnessed a dramatic rise in fatal opioid overdoses due to the unwitting consumption of non-pharmaceutical fentanyl and its analogues. While some of the drivers of this crisis-including profitability and access to high-potency opioids through internet sources-also apply in Australia, to our knowledge, there have been no ongoing surveillance studies of local populations. Therefore, this pilot study aimed to detect unintentional fentanyl consumption among people who inject heroin through instant urine screening, and determine the feasibility and acceptability of voluntary urinalysis of clients at the Medically Supervised Injecting Centre, Kings Cross, Sydney. DESIGN AND METHODS Brief surveys and urine drug screens were conducted with 67 participants in Wave 1 (October 2017) and 51 participants in Wave 2 (March 2018). Urine samples were tested with BTNX Rapid Response™ fentanyl urine strip test at a detection level of 20 ng/mL norfentanyl. These strips also cross-react to numerous fentanyl analogues. RESULTS There were no cases where positive urine tests suggested unwitting fentanyl use detected in this study. DISCUSSION AND CONCLUSIONS These negative findings contrast sharply with similar Canadian studies. While no cases of fentanyl-laced heroin use have been detected so far, we have demonstrated that this surveillance design is low-cost, feasible and scalable approach to monitoring the considerable public-health threat of undetected fentanyl and its analogues in Australia. Further validation of cross-reactivity of test strips would strengthen this method.
- Published
- 2018
10. Perceived stigma and social support in treatment for pharmaceutical opioid dependence
- Author
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Gabrielle Campbell, Sasha Cooper, Bridin Murnion, Suzanne Nielsen, and Briony Larance
- Subjects
medicine.medical_specialty ,Health (social science) ,Social stigma ,business.industry ,Public health ,Psychological intervention ,Chronic pain ,030508 substance abuse ,Medicine (miscellaneous) ,Stigma (botany) ,medicine.disease ,Mental health ,Heroin ,03 medical and health sciences ,Social support ,0302 clinical medicine ,medicine ,030212 general & internal medicine ,0305 other medical science ,Psychiatry ,business ,medicine.drug ,Clinical psychology - Abstract
Introduction and Aims The dramatic increase in pharmaceutical opioid (PO) use in high-income countries is a growing public health concern. Stigma and social support are important as they may influence treatment uptake and outcomes, yet few studies exist regarding perceived stigma and social support among people with PO dependence. The aims of the study are to: (i) compare characteristics of those with PO dependence from iatrogenic and non-iatrogenic causes; (ii) document perceived stigma and its correlates in people in treatment for PO dependence; and (iii) examine correlates of social support in people in treatment for PO dependence. Design and Methods This prospective cohort study included (n = 108) PO-dependent people referred from treatment services. Telephone interviews were conducted at baseline, 3, 12 and 24 months. Multivariate linear regression was used to examine correlations. Results Mean age was 41 (SD = 10.5). Half (n = 56, 52%) were female. Two in five met the criteria for iatrogenic dependence (n = 41, 38%), with iatrogenic dependence associated with chronic pain, and no history of injection or heroin use. One quarter of study subjects reported past month unsanctioned opioid use (n = 25, 23%). Being married/de facto or female was associated with higher levels of perceived stigma. Unsanctioned opioid use, iatrogenic dependence and mental health conditions were associated with lower social support. Discussion and Conclusions Stigma affects all people in treatment. Those who are married/de facto and female may benefit from interventions to address stigma. The association of low social support with poorer mental health and ongoing substance use indicate that treatment could focus more on this area.
- Published
- 2017
11. Attitudes in Australia on the upscheduling of over-the-counter codeine to a prescription-only medication
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Jacqui McCoy, Suzanne Nielsen, and Raimondo Bruno
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medicine.medical_specialty ,Health (social science) ,business.industry ,Codeine ,Alternative medicine ,Pharmacist ,Medicine (miscellaneous) ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Harm ,Intervention (counseling) ,Family medicine ,Pharmacovigilance ,medicine ,Over-the-counter ,030212 general & internal medicine ,Medical prescription ,business ,medicine.drug - Abstract
Introduction and Aims. In December 2016, the Australian Therapeutic Goods Administration announced that over-the-counter (OTC) codeine would be available by prescription-only in February 2018. Prior to this announcement, the authors aimed to evaluate attitudes among Australian codeine consumers, pharmacists and general medical practitioners (GP) towards the proposed upscheduling of OTC codeine. Design and Methods. Public Therapeutic Goods Administration submissions on codeine upscheduling were assessed, and a brief questionnaire was developed to assess the common issues raised. Participants (354 codeine consumers; 220 pharmacists; 120 GPs) completed a web-based questionnaire. Comparisons of attitudes on specific statements related to codeine upscheduling were made between consumers who were in support and those who opposed the proposal and between pharmacists and GPs. Regression models were conducted to examine correlates of attitudes towards codeine restriction. Results. Most consumer, pharmacist and a third of GP respondents opposed the upscheduling of codeine. Consumers, on average, questioned whether the proposed intervention would address the intended targets of minimising codeine-related side effects and risk of codeine dependence. Like consumers, pharmacists indicated concern around whether codeine restriction would address concerns of associated harm and dependence, as well as the burden regular GP appointments would create in terms of finances for consumers and time for GPs. GPs themselves, did not support these views. Discussion and Conclusions. Consumer responses identify key targets for educational campaigns when codeine is rescheduled, particularly around effective alternatives to OTC codeine. Additionally, contrasting views of pharmacists and GPs reinforce the importance of pharmacovigilance in evaluating the effectiveness of codeine restriction, once implemented. [McCoy J, Bruno R, Nielsen S. Attitudes in Australia on the upscheduling of over-the-counter codeine to a prescription-only medication. Drug Alcohol Rev 2017;00:000-000]
- Published
- 2017
12. Naloxone rescheduling in Australia: Processes, implementation and challenges with supply of naloxone as a ‘pharmacist only’ over-the-counter medicine
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Angelo Pricolo and Suzanne Nielsen
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Health (social science) ,business.industry ,Pharmacist ,030508 substance abuse ,Medicine (miscellaneous) ,Context (language use) ,Opioid overdose ,Pharmacy ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Systematic review ,Intervention (counseling) ,Naloxone ,medicine ,030212 general & internal medicine ,Medical emergency ,Medical prescription ,0305 other medical science ,business ,medicine.drug - Abstract
Issues Numerous studies and systematic reviews have concluded that naloxone for take-home use is an effective intervention to reduce overdose morbidity and mortality, with few side effects and no abuse potential. One barrier to supply is that naloxone has traditionally been a prescription medication. In May 2015, the Therapeutic Goods Administration of Australia announced the intention to down-schedule naloxone when used for the treatment of opioid overdose, enabling sale in pharmacies without a prescription. The aim of this article is to describe process of rescheduling of naloxone and some of the challenges observed. Approach We describe the process of rescheduling from initial proposal development to gaining support and submissions from a range of individuals and professional bodies to support this change. The implications of the change, particularly for pharmacy supply of naloxone, are discussed, including next steps to facilitate implementation of this change in the Australian context. Key findings A submission to reschedule naloxone was successfully instigated by a member of the public. The change may help remove access barriers to naloxone by allowing pharmacist supply. Cost, pharmacist training, existing naloxone formulation, presentation and packaging remain challenges to address. Implications and conclusion Naloxone down-scheduling has opened up an additional way to supply naloxone through community pharmacy. Further expansion of naloxone availability may be achieved through addressing cost as a barrier, and making naloxone more widely accessible through needle syringe programs, and other services that do not have medical staff.
- Published
- 2017
13. Opioid agonist treatment in the time of fentanyl: What can we learn from emerging evidence?
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Shalini Arunogiri and Suzanne Nielsen
- Subjects
Health (social science) ,Opioid Agonist ,business.industry ,medicine ,Medicine (miscellaneous) ,Pharmacology ,business ,Buprenorphine ,medicine.drug ,Fentanyl - Published
- 2020
14. What factors contributed to the misconduct of health practitioners? An analysis of Australian cases involving the diversion and supply of pharmaceutical drugs for non-medical use between 2010 and 2016
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Suzanne Nielsen, Caitlin Hughes, and Shann Hulme
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Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Prescription Drugs ,Prescription Drug Misuse ,Demographics ,Substance-Related Disorders ,Medicine (miscellaneous) ,Logistic regression ,Pharmacists ,Odds ,Misconduct ,Physicians ,medicine ,Humans ,Hypnotics and Sedatives ,business.industry ,Malpractice ,Australia ,Odds ratio ,Middle Aged ,Confidence interval ,Analgesics, Opioid ,Family medicine ,Female ,business ,Professional Misconduct ,Substance use treatment - Abstract
INTRODUCTION AND AIMS Increasing quantities of pharmaceutical drugs are used non-medically around the world, including in Australia, resulting in rising harms. This study examines the role of health practitioners (HP) in diversion and the circumstances surrounding their misconduct in Australia. DESIGN AND METHODS Tribunal decisions were obtained from the Australasian Legal Information Institute for 117 complaints against HPs for inappropriately prescribing/supplying or misappropriating drugs, representing a comprehensive search of cases from 2010 to 2016. Bivariate and multivariate logistic regressions were used to examine patterns of misconduct by demographics, drug type, scale and contributors. RESULTS Cases involving inappropriate prescribing/supply (73%) had greater odds of involving doctors (adjusted odds ratio [AOR] 48.18, 95% confidence interval [CI] 3.63-640.11) and pharmacists (AOR 85.59, 95% CI 5.08-1443.05) and HPs over 50 years (AOR 16.54, 95% CI 2.80-97.60) and lower odds of being attributed to individual circumstances (AOR 0.06, 95% CI 0.01-0.57). Cases involving misappropriation (31%) had greater odds of involving nurses (AOR 19.86, 95% CI 2.50-157.93), HPs under 40 years (AOR 5.08, 95% CI 1.24-20.90) and being attributed to individual circumstances (AOR 7.96, 95% CI 1.52-41.75). Subgroup analyses indicated that doctors were more likely to inappropriately prescribe pharmaceutical opioids, sedatives and Schedule 8 drugs, and their misconduct was attributed to lacking the skills and temperament to manage complex patient groups, while pharmacists were more often involved in pseudoephedrine supply for financial reasons. DISCUSSION AND CONCLUSIONS Strategies to reduce diversion should be multifaceted and may include better supporting HPs to manage complex patient groups and removing barriers to substance use treatment for HPs.
- Published
- 2018
15. Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series
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Suzanne Nielsen, Apo Demirkol, Nicholas Lintzeris, Raimondo Bruno, and Louisa Degenhardt
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Health (social science) ,Dose ,business.industry ,Medicine (miscellaneous) ,Opiate Substitution Treatment ,Heroin ,03 medical and health sciences ,0302 clinical medicine ,Opioid ,Anesthesia ,medicine ,Morphine ,030212 general & internal medicine ,business ,Oxycodone ,030217 neurology & neurosurgery ,Methadone ,medicine.drug ,Buprenorphine - Abstract
Introduction Use of opioid agonist treatments for prescription opioid (PO) dependence is rapidly increasing. Current guidelines are based on research with heroin users. This study aimed to examine methadone and buprenorphine dose requirements for PO-dependent people. Design and Methods A retrospective case series of PO-dependent patients entering methadone and buprenorphine treatment. Daily oral morphine equivalent (OME) doses at baseline were calculated using standard dose conversion calculations. Dose conversion tables were used to estimate opioid agonist doses, based on starting dose of PO. Baseline methadone and buprenorphine dose at days 7 and 28 were examined. Linear models were fit to the data. Results Participants (n = 44) were 67% male, mean age 41 years (SD 10 years); 69% reported a pain condition. The methadone group (n = 21) had a mean PO dose of 704.5 mg OME (SD 783.5 mg) prior to treatment, and mean methadone dose of 45.3 mg (SD 13.1 mg) at day 7 and 61.6 mg (SD 20.8 mg) at day 28. The buprenorphine group (n = 23) had a mean PO dose of 771.7 mg OME (SD 867.7 mg) prior to treatment, with a mean dose of 14.6 mg (SD 8.3 mg) at day 7 and 18.1 (SD 8.9 mg) at day 28. Linear relationships were not found between OME and opioid agonist dose. Conclusions Opioid agonist dosages varied substantially between individuals, and from predicted dosages based on dose conversion tables. Use of conversion tables to guide selection of opioid agonist dosage may compromise patient safety. [Nielsen S, Bruno R, Degenhardt L, Demirkol A, Lintzeris N. Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series Drug Alcohol Rev 2017;36:311–316]
- Published
- 2016
16. Urine drug screening for early detection of unwitting use of fentanyl and its analogues among people who inject heroin in Sydney, Australia
- Author
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Monica J, Barratt, Julie, Latimer, Marianne, Jauncey, Emma, Tay, and Suzanne, Nielsen
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Adult ,Male ,Pilot Projects ,Middle Aged ,Analgesics, Opioid ,Fentanyl ,Heroin ,Substance Abuse Detection ,Young Adult ,Surveys and Questionnaires ,Humans ,Female ,New South Wales ,Substance Abuse, Intravenous ,Aged - Abstract
North America has witnessed a dramatic rise in fatal opioid overdoses due to the unwitting consumption of non-pharmaceutical fentanyl and its analogues. While some of the drivers of this crisis-including profitability and access to high-potency opioids through internet sources-also apply in Australia, to our knowledge, there have been no ongoing surveillance studies of local populations. Therefore, this pilot study aimed to detect unintentional fentanyl consumption among people who inject heroin through instant urine screening, and determine the feasibility and acceptability of voluntary urinalysis of clients at the Medically Supervised Injecting Centre, Kings Cross, Sydney.Brief surveys and urine drug screens were conducted with 67 participants in Wave 1 (October 2017) and 51 participants in Wave 2 (March 2018). Urine samples were tested with BTNX Rapid Response™ fentanyl urine strip test at a detection level of 20 ng/mL norfentanyl. These strips also cross-react to numerous fentanyl analogues.There were no cases where positive urine tests suggested unwitting fentanyl use detected in this study.These negative findings contrast sharply with similar Canadian studies. While no cases of fentanyl-laced heroin use have been detected so far, we have demonstrated that this surveillance design is low-cost, feasible and scalable approach to monitoring the considerable public-health threat of undetected fentanyl and its analogues in Australia. Further validation of cross-reactivity of test strips would strengthen this method.
- Published
- 2018
17. Understanding an emerging treatment population: Protocol for and baseline characteristics of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence
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Suzanne, Nielsen, Nicholas, Lintzeris, Bridin, Murnion, Louisa, Degenhardt, Raimondo, Bruno, Paul, Haber, Jennifer, Johnson, Mark, Hardy, Stephen, Ling, Craig, Saddler, Adrian, Dunlop, Apo, Demirkol, Catherine, Silsbury, Nghi, Phung, Jennie, Houseman, and Briony, Larance
- Subjects
Adult ,Analgesics, Opioid ,Cohort Studies ,Male ,Treatment Outcome ,Substance-Related Disorders ,Population Surveillance ,Humans ,Female ,Prospective Studies ,Middle Aged ,Comprehension ,Opioid-Related Disorders - Abstract
Despite large increases in pharmaceutical opioid dependence and related mortality, few studies have focused on the characteristics and treatment experiences of those with pharmaceutical opioid dependence. We describe the formation of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence and describe their baseline characteristics.People who had entered treatment for pharmaceutical opioid dependence (n = 108) were recruited through drug treatment services in New South Wales, Australia. We describe baseline characteristics of those that commenced pharmaceutical opioids for pain or other reasons and conducted a thematic analysis of responses regarding their treatment experience.Mean age was 41 years (SD 11), half were male (48%). Just over half reported lifetime heroin use (57%). Oxycodone (49%) and codeine (29%) were the most common opioids reported. Most (85%) reported past-year problematic pain, 38% reported chronic pain. Half (52%) reported moderate to severe depression symptoms. Most (66%) commenced opioids for pain, and this group were older, less likely to report a previous overdose and less likely to report use of illicit drugs compared to those commencing for other reasons. Five themes related to treatment expectations: (i) stigma; (ii) the restrictive nature of treatment; (iii) knowledge; (iv) pain; and (v) positive experience with buprenorphine.This study describes the complexities in an important emerging treatment population of pharmaceutical opioid-dependent people. Findings highlights that addressing knowledge and perceptions around treatment may be critical to address the rising mortality associated with pharmaceutical opioid dependence.
- Published
- 2017
18. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia
- Author
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Bridin Murnion, Raimondo Bruno, Apo Demirkol, Nicholas Lintzeris, Adrian Dunlop, Louisa Degenhardt, Suzanne Nielsen, and Peter Muhleisen
- Subjects
Health (social science) ,business.industry ,Codeine ,Medicine (miscellaneous) ,medicine.disease ,Confidence interval ,030227 psychiatry ,Heroin ,Substance abuse ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Anesthesia ,medicine ,Over-the-counter ,030212 general & internal medicine ,Medical prescription ,business ,medicine.drug ,Buprenorphine - Abstract
Introduction and Aims Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower potency of codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to codeine. This is the first study to examine buprenorphine treatment for codeine dependence. Design and Methods Retrospective case series of 19 codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment. Results A significant linear relationship was found between initial codeine dose and dose of buprenorphine given at days 7 and 28 for the codeine dose range of 50–960 mg day−1 (mean: 564 mg; 95% confidence interval 431–696 mg). Median buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 4–32 mg) at day 7 and 16.0 mg (interquartile range 13.5 mg, range 4–32 mg) at day 28. Buprenorphine doses received were markedly higher than estimated codeine doses based on standard dose conversion tables. Discussion and Conclusions With increasing presentations relating to codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids. [Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015]
- Published
- 2015
19. Injecting buprenorphine-naloxone film: Findings from an explorative qualitative study
- Author
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Nicholas Lintzeris, Nancy White, Robert Ali, Peter Higgs, Ian Flaherty, Louisa Degenhardt, Suzanne Nielsen, and Briony Larance
- Subjects
Harm reduction ,Health (social science) ,Nursing ,business.industry ,Buprenorphine/naloxone ,medicine ,Medicine (miscellaneous) ,business ,Opioid substitution therapy ,Social psychology ,medicine.drug ,Qualitative research - Abstract
Introduction and Aims Experiences of buprenorphine-naloxone (BNX) sublingual film injection are not well documented or understood. We examined how people who inject BNX film seek and share information about this practice, document the methods used to prepare BNX film for injection, and report participants' experiences of this practice. Design and Methods Interviews were (n = 16) conducted with people who indicated that they had injected BNX film since its introduction onto the Australian market. Semistructured interviews were recorded and transcribed. NVivo10 program (QSR International) was used to analyse the data using qualitative description methodology. Results Participants largely reported similar BNX film preparation techniques, although the texture of BNX film during preparation to inject was reported to be unusual (gluggy), and there were many varied accounts associated with the amount of water used. Physical harms reported as associated with injecting BNX film were described (including local and systemic issues); participants reported injecting the film to enhance its immediate effects, yet generally reported that sublingual administration provided longer-lasting effects. Discussion and Conclusions Understanding knowledge acquisition about injecting new formulations of opioid substitution therapy is crucial in developing more effective harm-reduction strategies. Dissemination by peer networks to those who are currently or planning to inject BNX film regarding the ‘gelatine like’ texture when mixing, using only cold water and double filtering is important to ensure safer injecting practices. Findings from this study highlight the importance of peer networks for the dissemination of harm-reduction information. Introduction of new formulations internationally requires more qualitative studies to inform safer practices. [White N, Flaherty I, Higgs P, Larance B, Nielsen S, Degenhardt L, Ali R, Lintzeris N. Injecting buprenorphine-naloxone film: Findings from an explorative qualitative study. Drug Alcohol Rev 2015;34:623–629]
- Published
- 2015
20. Comparing treatment-seeking codeine users and strong opioid users: Findings from a novel case series
- Author
-
Apo Demirkol, Bridin Murnion, Adrian Dunlop, Louisa Degenhardt, Suzanne Nielsen, Nicholas Lintzeris, and Peter Muhleisen
- Subjects
medicine.medical_specialty ,Health (social science) ,business.industry ,Codeine ,Medicine (miscellaneous) ,Opiate Substitution Treatment ,medicine.disease ,Substance abuse ,Opioid ,Internal medicine ,Anesthesia ,medicine ,Morphine ,business ,Oxycodone ,Methadone ,medicine.drug ,Buprenorphine - Abstract
Introduction and Aims Few studies have described those seeking treatment for codeine dependence. This study aimed to compare patients presenting for treatment where either codeine or a strong pharmaceutical opioid (oxycodone or morphine) was the principal drug of concern to understand if codeine users may have unique treatment needs. Design and Methods Retrospective case review of 135 patients from three geographical areas in New South Wales, Australia. Cases where the principal drug of concern was codeine (n = 53) or a strong pharmaceutical opioid (oxycodone or morphine, n = 82) were compared. Differences in demographic characteristics, pain history, mental health, substance use history and, subsequently, the treatment that was received were examined. Results People whose principal drug of concern was codeine were more likely to be female (66% vs. 37%, P
- Published
- 2014
21. Perceived stigma and social support in treatment for pharmaceutical opioid dependence
- Author
-
Sasha, Cooper, Gabrielle, Campbell, Briony, Larance, Bridin, Murnion, and Suzanne, Nielsen
- Subjects
Adult ,Analgesics, Opioid ,Male ,Prescription Drugs ,Social Stigma ,Humans ,Social Support ,Female ,Prospective Studies ,Chronic Pain ,Middle Aged ,Opioid-Related Disorders - Abstract
The dramatic increase in pharmaceutical opioid (PO) use in high-income countries is a growing public health concern. Stigma and social support are important as they may influence treatment uptake and outcomes, yet few studies exist regarding perceived stigma and social support among people with PO dependence. The aims of the study are to: (i) compare characteristics of those with PO dependence from iatrogenic and non-iatrogenic causes; (ii) document perceived stigma and its correlates in people in treatment for PO dependence; and (iii) examine correlates of social support in people in treatment for PO dependence.This prospective cohort study included (n = 108) PO-dependent people referred from treatment services. Telephone interviews were conducted at baseline, 3, 12 and 24 months. Multivariate linear regression was used to examine correlations.Mean age was 41 (SD = 10.5). Half (n = 56, 52%) were female. Two in five met the criteria for iatrogenic dependence (n = 41, 38%), with iatrogenic dependence associated with chronic pain, and no history of injection or heroin use. One quarter of study subjects reported past month unsanctioned opioid use (n = 25, 23%). Being married/de facto or female was associated with higher levels of perceived stigma. Unsanctioned opioid use, iatrogenic dependence and mental health conditions were associated with lower social support.Stigma affects all people in treatment. Those who are married/de facto and female may benefit from interventions to address stigma. The association of low social support with poorer mental health and ongoing substance use indicate that treatment could focus more on this area.
- Published
- 2017
22. Attitudes in Australia on the upscheduling of over-the-counter codeine to a prescription-only medication
- Author
-
Jacqui, McCoy, Raimondo, Bruno, and Suzanne, Nielsen
- Subjects
Adult ,Male ,Prescription Drugs ,Attitude of Health Personnel ,Codeine ,Australia ,Middle Aged ,Pharmacists ,Drug Prescriptions ,Analgesics, Opioid ,General Practitioners ,Humans ,Female ,Attitude to Health - Abstract
In December 2016, the Australian Therapeutic Goods Administration announced that over-the-counter (OTC) codeine would be available by prescription-only in February 2018. Prior to this announcement, the authors aimed to evaluate attitudes among Australian codeine consumers, pharmacists and general medical practitioners (GP) towards the proposed upscheduling of OTC codeine.Public Therapeutic Goods Administration submissions on codeine upscheduling were assessed, and a brief questionnaire was developed to assess the common issues raised. Participants (354 codeine consumers; 220 pharmacists; 120 GPs) completed a web-based questionnaire. Comparisons of attitudes on specific statements related to codeine upscheduling were made between consumers who were in support and those who opposed the proposal and between pharmacists and GPs. Regression models were conducted to examine correlates of attitudes towards codeine restriction.Most consumer, pharmacist and a third of GP respondents opposed the upscheduling of codeine. Consumers, on average, questioned whether the proposed intervention would address the intended targets of minimising codeine-related side effects and risk of codeine dependence. Like consumers, pharmacists indicated concern around whether codeine restriction would address concerns of associated harm and dependence, as well as the burden regular GP appointments would create in terms of finances for consumers and time for GPs. GPs themselves, did not support these views.Consumer responses identify key targets for educational campaigns when codeine is rescheduled, particularly around effective alternatives to OTC codeine. Additionally, contrasting views of pharmacists and GPs reinforce the importance of pharmacovigilance in evaluating the effectiveness of codeine restriction, once implemented. [McCoy J, Bruno R, Nielsen S. Attitudes in Australia on the upscheduling of over-the-counter codeine to a prescription-only medication. Drug Alcohol Rev 2017;00:000-000].
- Published
- 2016
23. Diversion of prescribed opioids by people living with chronic pain: Results from an Australian community sample
- Author
-
Louisa Degenhardt, Nicholas Lintzeris, Briony Larance, Bianca Hoban, Suzanne Nielsen, Jessica Belcher, Gabrielle Campbell, and Raimondo Bruno
- Subjects
medicine.medical_specialty ,Health (social science) ,business.industry ,Chronic pain ,Medicine (miscellaneous) ,Pharmacy ,Odds ratio ,medicine.disease ,Opioid ,Telephone interview ,medicine ,Medical prescription ,business ,Psychiatry ,Oxycodone ,Rheumatism ,medicine.drug - Abstract
Introduction and Aims There has been an increase in prescription of opioids for chronic non-cancer pain, and concern exists over possible diversion of prescription opioids to the illicit marketplace. Recent media coverage suggests that elderly patients sell their prescribed opioids for additional income. This study investigated the extent to which an Australian community sample of chronic pain patients prescribed opioids reported supplying their prescribed opioids to others. Design and Methods Participants living with chronic non-cancer pain and prescribed opioids for their pain (n = 952) were recruited across Australia via advertisements at pharmacies. A telephone interview included questions about their pain condition and opioid medication. Results Participants had been living with pain for a mean of 14.2 years; most common conditions included chronic back/neck problems and arthritis/rheumatism. Around half (43%) were currently prescribed one opioid, and 55% had been prescribed 2–5 opioids; the most common was oxycodone. Forty-two participants (4%) reported ever supplying prescribed opioids to another person; one participant reported receiving payment. Participants who supplied opioids to others were younger (odds ratio 0.97, 95% confidence interval 0.95–0.99) and engaged in a greater number of aberrant behaviours relating to their opioid medication (odds ratio 1.77, 95% confidence interval 1.45–2.17), including tampering with doses, taking opioids by alternative routes, seeing doctors to obtain extra opioids and refilling prescriptions early. Discussion and Conclusion Few people with chronic non-cancer pain divert their opioids to others. Media reports of elderly patients selling their opioids to supplement their income may be reflective of exceptional cases. Future studies may investigate the extent to which other patient groups divert prescription opioids to the illicit marketplace. [Belcher J, Nielsen S, Campbell G, Bruno R, Hoban B, Larance B, Lintzeris N, Degenhardt L. Diversion of prescribed opioids by people living with chronic pain: Results from an Australian community sample. Drug Alcohol Rev 2013]
- Published
- 2013
24. A cross-sectional analysis of over-the-counter codeine use among an Australian sample of people who regularly inject drugs
- Author
-
Raimondo Bruno, Amanda Roxburgh, Sheena Arora, Lucy Burns, and Suzanne Nielsen
- Subjects
medicine.medical_specialty ,education.field_of_study ,Health (social science) ,business.industry ,Cross-sectional study ,Analgesic ,Population ,Codeine ,Pharmacist ,Medicine (miscellaneous) ,Poison control ,medicine.disease ,Substance abuse ,Family medicine ,Forensic engineering ,Medicine ,Over-the-counter ,business ,education ,medicine.drug - Abstract
INTRODUCTION AND AIMS: The study aims to examine the medical and non-medical use of over-the-counter (OTC) codeine combination drugs in a sample of people who inject drugs; and to examine risk factors associated with exceeding the recommended dose of OTC codeine, including the experience of pain. DESIGN AND METHODS: This study analysed annual survey data from a convenience sample of people who inject drugs in Australia who are interviewed for the Illicit Drug Reporting System. People who have injected drugs (n = 902) on at least a monthly basis in the preceding six months across Australia were interviewed. Participants were asked about their use of OTC codeine and their experience of pain. RESULTS: One third (35%) of participants had used OTC codeine in the preceding six months and 52% (95% confidence interval 48.7-55.3) of this group had exceeded the recommended dose on their last occasion of use. This clearly places them at increased risk of harms associated with toxicity from the accompanying analgesic found in combination codeine products. Multivariate analyses demonstrated that those exceeding the recommended codeine dose of OTC codeine were more likely to be experiencing moderate to very severe pain. DISCUSSION AND CONCLUSION: There is a need to evaluate the approach to pain management in this population. Greater pharmacist involvement, real-time monitoring of sales, the development of screening tools to identify those at risk of harm and further education of primary care practitioners could be beneficial in reducing the risk of harm associated with these medications for all users of OTC codeine, including people who inject drugs. [Arora S, Roxburgh A, Bruno R, Nielsen S, Burns L. A cross-sectional analysis of over-the-counter codeine use among an Australian sample of people who regularly inject drugs. Drug Alcohol Rev 2013]. Language: en
- Published
- 2013
25. Naloxone rescheduling in Australia: Processes, implementation and challenges with supply of naloxone as a 'pharmacist only' over-the-counter medicine
- Author
-
Angelo, Pricolo and Suzanne, Nielsen
- Subjects
Naloxone ,Narcotic Antagonists ,Australia ,Humans ,Nonprescription Drugs ,Community Pharmacy Services ,Drug Overdose ,Pharmacists - Abstract
Numerous studies and systematic reviews have concluded that naloxone for take-home use is an effective intervention to reduce overdose morbidity and mortality, with few side effects and no abuse potential. One barrier to supply is that naloxone has traditionally been a prescription medication. In May 2015, the Therapeutic Goods Administration of Australia announced the intention to down-schedule naloxone when used for the treatment of opioid overdose, enabling sale in pharmacies without a prescription. The aim of this article is to describe process of rescheduling of naloxone and some of the challenges observed.We describe the process of rescheduling from initial proposal development to gaining support and submissions from a range of individuals and professional bodies to support this change. The implications of the change, particularly for pharmacy supply of naloxone, are discussed, including next steps to facilitate implementation of this change in the Australian context.A submission to reschedule naloxone was successfully instigated by a member of the public. The change may help remove access barriers to naloxone by allowing pharmacist supply. Cost, pharmacist training, existing naloxone formulation, presentation and packaging remain challenges to address.Naloxone down-scheduling has opened up an additional way to supply naloxone through community pharmacy. Further expansion of naloxone availability may be achieved through addressing cost as a barrier, and making naloxone more widely accessible through needle syringe programs, and other services that do not have medical staff.
- Published
- 2016
26. Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series
- Author
-
Suzanne, Nielsen, Raimondo, Bruno, Louisa, Degenhardt, Apo, Demirkol, and Nicholas, Lintzeris
- Subjects
Adult ,Male ,Dose-Response Relationship, Drug ,Middle Aged ,Opioid-Related Disorders ,Buprenorphine ,Analgesics, Opioid ,Opiate Substitution Treatment ,Humans ,Female ,Morphine Dependence ,Methadone ,Oxycodone ,Retrospective Studies - Abstract
Use of opioid agonist treatments for prescription opioid (PO) dependence is rapidly increasing. Current guidelines are based on research with heroin users. This study aimed to examine methadone and buprenorphine dose requirements for PO-dependent people.A retrospective case series of PO-dependent patients entering methadone and buprenorphine treatment. Daily oral morphine equivalent (OME) doses at baseline were calculated using standard dose conversion calculations. Dose conversion tables were used to estimate opioid agonist doses, based on starting dose of PO. Baseline methadone and buprenorphine dose at days 7 and 28 were examined. Linear models were fit to the data.Participants (n = 44) were 67% male, mean age 41 years (SD 10 years); 69% reported a pain condition. The methadone group (n = 21) had a mean PO dose of 704.5 mg OME (SD 783.5 mg) prior to treatment, and mean methadone dose of 45.3 mg (SD 13.1 mg) at day 7 and 61.6 mg (SD 20.8 mg) at day 28. The buprenorphine group (n = 23) had a mean PO dose of 771.7 mg OME (SD 867.7 mg) prior to treatment, with a mean dose of 14.6 mg (SD 8.3 mg) at day 7 and 18.1 (SD 8.9 mg) at day 28. Linear relationships were not found between OME and opioid agonist dose.Opioid agonist dosages varied substantially between individuals, and from predicted dosages based on dose conversion tables. Use of conversion tables to guide selection of opioid agonist dosage may compromise patient safety. [Nielsen S, Bruno R, Degenhardt L, Demirkol A, Lintzeris N. Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series Drug Alcohol Rev 2017;36:311-316].
- Published
- 2015
27. Pharmaceutical opioid analgesic and heroin dependence: How do treatment-seeking clients differ in Australia?
- Author
-
Susan Carruthers, Suzanne Nielsen, Jane Fischer, Nicholas Lintzeris, Mark Stoove, and Raimondo Bruno
- Subjects
endocrine system ,education.field_of_study ,medicine.medical_specialty ,Health (social science) ,Multivariate analysis ,business.industry ,Addiction ,media_common.quotation_subject ,Population ,Medicine (miscellaneous) ,Odds ratio ,Mental health ,Confidence interval ,Heroin ,Structured interview ,medicine ,education ,business ,Psychiatry ,medicine.drug ,media_common - Abstract
Introduction and aims Non-prescribed use of pharmaceutical opioid analgesics (POA) has been escalating internationally. In Australia, few studies have examined if POA users have similar characteristics and treatment needs to heroin users. The aim of this study was to compare those presenting for treatment where heroin versus POA were the primary drugs of concern. Design and methods A convenience sample of 192 treatment entrants were recruited from alcohol and drug treatment services in four Australian jurisdictions. A structured interview collected data on demographic characteristics, substance use, self-perceived mental and physical health, crime and harms resulting from drug use. Multivariate analyses were performed to identify characteristics which may differentiate those seeking treatment for heroin compared with POA. Results Most treatment entrants sampled reported a history of injection drug use and use of both heroin and POA. However, those with primary POA problems were less likely to report an overdose history (adjusted odds ratio 0.90, 95% confidence interval 0.81-0.99) and more likely to initiate opioid use for pain (adjusted odds ratio 2.52, 95% confidence interval 1.04-6.12) than those with primary heroin problems. Latent Class Analysis found that, while most of the POA group were similar to heroin users in demographics, health and injecting drug use, there was a small, distinct group of primary POA problem users that did not typically inject and who commonly initiated opioid use for pain and also experienced elevated physical and mental health disability. Discussion and conclusions While some differences existed, this study of Australian treatment seekers found many similar characteristics between those with primary problems with heroin and POA. Few non-injecting POA were recruited in this sample. This finding contrasts with reports of a growing population of opioid-dependent people with characteristics that are distinct from traditional opioid-dependent populations, which may reflect the orientation of current treatment systems in Australia towards injection drug users.
- Published
- 2011
28. Implementing real-time prescription drug monitoring: Are we ready?
- Author
-
Suzanne Nielsen and Raimondo Bruno
- Subjects
medicine.medical_specialty ,Prescription Drugs ,Health (social science) ,Prescription drug ,Controlled Substances ,Prescription Drug Misuse ,business.industry ,Australia ,Medicine (miscellaneous) ,medicine.disease ,United States ,Emergency medicine ,Humans ,Medicine ,Medical emergency ,Medical prescription ,business ,Prescription monitoring - Published
- 2014
29. Prescription drug misuse: Is technology friend or foe?
- Author
-
Monica J. Barratt and Suzanne Nielsen
- Subjects
Drug ,medicine.medical_specialty ,Health (social science) ,Prescription drug ,Prescription Drug Misuse ,Vendor ,business.industry ,media_common.quotation_subject ,Online pharmacies ,Internet privacy ,Alternative medicine ,Medicine (miscellaneous) ,medicine ,The Internet ,Medical prescription ,business ,media_common - Abstract
Introduction and Aims. Prescription drug misuse and related harms have been increasing considerably over the past decade. At the same time, there has also been rapid growth in the use of online and Internet technologies. Thus, it is important that we understand the role online and Internet technologies play in prescription drug misuse. Design and Methods. Published work addressing the role of technology in prescription drug misuse is explored. Topics include: Internet supply, online monitoring of prescription drug use trends and electronic prescription monitoring. Results. Little is known about the prevalence of acquiring prescription drugs from online pharmacies. Prescription drugs are easily accessible through vendor websites, and ‘rogue’ no-prescription websites have proven difficult to control. There has so far been limited application of real-time monitoring to prevent overuse of prescription medications. Online monitoring of drug use trends may also prove to be a useful and timely source of information about new methods of ‘off-label’ prescription drug use. Discussion and Conclusions. Technology has the potential to play a more prominent role in facilitating drug acquisition, while also enhancing the monitoring and prevention of prescription drug misuse. As technology becomes more ubiquitous in everyday life, the continued investigation of its relationship with prescription drug misuse becomes even more important.[Nielsen S, Barratt MJ. Prescription drug misuse: Is technology friend or foe? Drug Alcohol Rev 2009;28:81–86]
- Published
- 2009
30. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia
- Author
-
Suzanne, Nielsen, Raimondo, Bruno, Bridin, Murnion, Adrian, Dunlop, Louisa, Degenhardt, Apo, Demirkol, Peter, Muhleisen, and Nicholas, Lintzeris
- Abstract
Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower potency of codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to codeine. This is the first study to examine buprenorphine treatment for codeine dependence.Retrospective case series of 19 codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment.A significant linear relationship was found between initial codeine dose and dose of buprenorphine given at days 7 and 28 for the codeine dose range of 50-960 mg dayWith increasing presentations relating to codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids. [Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015].
- Published
- 2015
31. Pharmaceutical drugs: The delicate balance between reducing pain and reducing harm
- Author
-
Raimondo Bruno and Suzanne Nielsen
- Subjects
medicine.medical_specialty ,Health (social science) ,Harm ,Balance (accounting) ,business.industry ,medicine ,Medicine (miscellaneous) ,Intensive care medicine ,Psychiatry ,business - Published
- 2011
32. Injecting buprenorphine-naloxone film: Findings from an explorative qualitative study
- Author
-
Nancy, White, Ian, Flaherty, Peter, Higgs, Briony, Larance, Suzanne, Nielsen, Louisa, Degenhardt, Robert, Ali, and Nicholas, Lintzeris
- Subjects
Adult ,Male ,Administration, Sublingual ,Australia ,Middle Aged ,Opioid-Related Disorders ,Interviews as Topic ,Young Adult ,Humans ,Female ,Buprenorphine, Naloxone Drug Combination ,Substance Abuse, Intravenous ,Prescription Drug Misuse ,Qualitative Research - Abstract
Experiences of buprenorphine-naloxone (BNX) sublingual film injection are not well documented or understood. We examined how people who inject BNX film seek and share information about this practice, document the methods used to prepare BNX film for injection, and report participants' experiences of this practice.Interviews were (n = 16) conducted with people who indicated that they had injected BNX film since its introduction onto the Australian market. Semistructured interviews were recorded and transcribed. NVivo10 program (QSR International) was used to analyse the data using qualitative description methodology.Participants largely reported similar BNX film preparation techniques, although the texture of BNX film during preparation to inject was reported to be unusual (gluggy), and there were many varied accounts associated with the amount of water used. Physical harms reported as associated with injecting BNX film were described (including local and systemic issues); participants reported injecting the film to enhance its immediate effects, yet generally reported that sublingual administration provided longer-lasting effects.Understanding knowledge acquisition about injecting new formulations of opioid substitution therapy is crucial in developing more effective harm-reduction strategies. Dissemination by peer networks to those who are currently or planning to inject BNX film regarding the 'gelatine like' texture when mixing, using only cold water and double filtering is important to ensure safer injecting practices. Findings from this study highlight the importance of peer networks for the dissemination of harm-reduction information. Introduction of new formulations internationally requires more qualitative studies to inform safer practices.
- Published
- 2014
33. Comparing treatment-seeking codeine users and strong opioid users: Findings from a novel case series
- Author
-
Suzanne, Nielsen, Bridin, Murnion, Adrian, Dunlop, Louisa, Degenhardt, Apo, Demirkol, Peter, Muhleisen, and Nicholas, Lintzeris
- Subjects
Adult ,Male ,Morphine ,Codeine ,Opiate Substitution Treatment ,Humans ,Female ,Middle Aged ,Patient Acceptance of Health Care ,Opioid-Related Disorders ,Methadone ,Oxycodone ,Retrospective Studies - Abstract
Few studies have described those seeking treatment for codeine dependence. This study aimed to compare patients presenting for treatment where either codeine or a strong pharmaceutical opioid (oxycodone or morphine) was the principal drug of concern to understand if codeine users may have unique treatment needs.Retrospective case review of 135 patients from three geographical areas in New South Wales, Australia. Cases where the principal drug of concern was codeine (n = 53) or a strong pharmaceutical opioid (oxycodone or morphine, n = 82) were compared. Differences in demographic characteristics, pain history, mental health, substance use history and, subsequently, the treatment that was received were examined.People whose principal drug of concern was codeine were more likely to be female (66% vs. 37%, P0.001), employed (43% vs. 22%, P0.01) and use only one pharmaceutical opioid (91% vs. 49%, P0.001). There was no difference in age between the codeine group (mean 38.6 years) and the strong opioid group (39.3 years). Opioid substitution therapy was the most common treatment received by both groups although codeine patients were more likely to be treated with buprenorphine than methadone (odds ratio = 7.7, 95% confidence interval 2.2-27.2, P0.001) and more likely to attempt withdrawal (odds ratio = 2.6, 95% confidence interval 1.2-5.3, P = 0.010).There are important differences between codeine-dependent patients and strong prescription opioid-dependent patients. Further work should explore the outcomes of withdrawal versus maintenance treatment for codeine users.
- Published
- 2014
34. Online open access: we all want it, but can we afford it?
- Author
-
Rebecca, McKetin and Suzanne, Nielsen
- Subjects
Access to Information ,Internet ,Humans ,Periodicals as Topic - Published
- 2013
35. Diversion of prescribed opioids by people living with chronic pain: results from an Australian community sample
- Author
-
Jessica, Belcher, Suzanne, Nielsen, Gabrielle, Campbell, Raimondo, Bruno, Bianca, Hoban, Briony, Larance, Nicholas, Lintzeris, and Louisa, Degenhardt
- Subjects
Analgesics, Opioid ,Male ,Prescription Drug Diversion ,Data Collection ,Australia ,Humans ,Female ,Chronic Pain ,Middle Aged ,Drug Prescriptions - Abstract
There has been an increase in prescription of opioids for chronic non-cancer pain, and concern exists over possible diversion of prescription opioids to the illicit marketplace. Recent media coverage suggests that elderly patients sell their prescribed opioids for additional income. This study investigated the extent to which an Australian community sample of chronic pain patients prescribed opioids reported supplying their prescribed opioids to others.Participants living with chronic non-cancer pain and prescribed opioids for their pain (n=952) were recruited across Australia via advertisements at pharmacies. A telephone interview included questions about their pain condition and opioid medication.Participants had been living with pain for a mean of 14.2 years; most common conditions included chronic back/neck problems and arthritis/rheumatism. Around half (43%) were currently prescribed one opioid, and 55% had been prescribed 2-5 opioids; the most common was oxycodone. Forty-two participants (4%) reported ever supplying prescribed opioids to another person; one participant reported receiving payment. Participants who supplied opioids to others were younger (odds ratio 0.97, 95% confidence interval 0.95-0.99) and engaged in a greater number of aberrant behaviours relating to their opioid medication (odds ratio 1.77, 95% confidence interval 1.45-2.17), including tampering with doses, taking opioids by alternative routes, seeing doctors to obtain extra opioids and refilling prescriptions early.Few people with chronic non-cancer pain divert their opioids to others. Media reports of elderly patients selling their opioids to supplement their income may be reflective of exceptional cases. Future studies may investigate the extent to which other patient groups divert prescription opioids to the illicit marketplace.
- Published
- 2013
36. Correlates of pain in an in-treatment sample of opioid-dependent people
- Author
-
Nicholas Lintzeris, Adrian Dunlop, Suzanne Nielsen, Bridin Murnion, Briony Larance, Emma Black, Raimondo Bruno, and Louisa Degenhardt
- Subjects
medicine.medical_specialty ,Health (social science) ,business.industry ,Medicine (miscellaneous) ,Odds ratio ,Opioid ,Quality of life ,medicine ,Anxiety ,Pain catastrophizing ,Brief Pain Inventory ,medicine.symptom ,Psychiatry ,business ,Clinical psychology ,Buprenorphine ,medicine.drug ,Methadone - Abstract
Introduction and Aims: The limited literature on pain in opioid-treatment samples indicates that it is highly prevalent. Understanding the implications of pain on treatment outcomes is important, particularly in light of ageing opioid-treatment cohorts. This study explores correlates of pain, including aberrant behaviours related to prescribed opioids. Our hypothesis is that pain may increase aberrant opioid-related behaviours, including illicit substance use, among opioid-dependent people. Design and Methods: We examined pain in methadone or buprenorphine patients (n = 141) from three treatment services. Measures included basic demographics, Brief Pain Inventory, general mental health, physical health and quality of life measures, pain history and treatments, and an aberrant opioid-related behaviour scale. Univariate and multivariate analyses were used to examine correlates of pain. Results: Forty percent reported current pain, measured with the first question of the Brief Pain Inventory. Correlates of pain were depression ratings [adjusted odds ratio (OR) 2.24, 95% confidence interval (CI) 1.04, 4.83], anxiety ratings (adjusted OR 4.29, 95% CI 1.88, 9.80) and self-reported health ratings (adjusted OR 0.35, 95% CI 0.16, 0.76). Contrary to our hypothesis, pain was not associated with greater use of illicit opioids, nor any aberrant opioid-related behaviours. Pain was comparable among methadone and buprenorphine patients. Discussion and Conclusions: The lack of association with pain and aberrant behaviours suggest that it should not be assumed that those in opioid treatment misuse medications in response to pain. The high prevalence of depression/anxiety symptoms indicates a need for further work with larger samples to explore pain and co-morbidity among opioid-dependent people.
- Published
- 2013
37. A cross-sectional analysis of over-the-counter codeine use among an Australian sample of people who regularly inject drugs
- Author
-
Sheena, Arora, Amanda, Roxburgh, Raimondo, Bruno, Suzanne, Nielsen, and Lucy, Burns
- Subjects
Adult ,Male ,Adolescent ,Dose-Response Relationship, Drug ,Codeine ,Data Collection ,Australia ,Pain ,Nonprescription Drugs ,Middle Aged ,Pharmacists ,Severity of Illness Index ,Analgesics, Opioid ,Drug Combinations ,Young Adult ,Cross-Sectional Studies ,Professional Role ,Risk Factors ,Pharmaceutical Services ,Multivariate Analysis ,Humans ,Female ,Substance Abuse, Intravenous - Abstract
The study aims to examine the medical and non-medical use of over-the-counter (OTC) codeine combination drugs in a sample of people who inject drugs; and to examine risk factors associated with exceeding the recommended dose of OTC codeine, including the experience of pain.This study analysed annual survey data from a convenience sample of people who inject drugs in Australia who are interviewed for the Illicit Drug Reporting System. People who have injected drugs (n = 902) on at least a monthly basis in the preceding six months across Australia were interviewed. Participants were asked about their use of OTC codeine and their experience of pain.One third (35%) of participants had used OTC codeine in the preceding six months and 52% (95% confidence interval 48.7-55.3) of this group had exceeded the recommended dose on their last occasion of use. This clearly places them at increased risk of harms associated with toxicity from the accompanying analgesic found in combination codeine products. Multivariate analyses demonstrated that those exceeding the recommended codeine dose of OTC codeine were more likely to be experiencing moderate to very severe pain.There is a need to evaluate the approach to pain management in this population. Greater pharmacist involvement, real-time monitoring of sales, the development of screening tools to identify those at risk of harm and further education of primary care practitioners could be beneficial in reducing the risk of harm associated with these medications for all users of OTC codeine, including people who inject drugs.
- Published
- 2012
38. Correlates of pain in an in-treatment sample of opioid-dependent people
- Author
-
Suzanne, Nielsen, Briony, Larance, Nicholas, Lintzeris, Emma, Black, Raimondo, Bruno, Bridin, Murnion, Adrian, Dunlop, and Louisa, Degenhardt
- Subjects
Adult ,Analgesics, Opioid ,Male ,Depression ,Humans ,Pain ,Female ,Substance Abuse Treatment Centers ,Anxiety ,Middle Aged ,Opioid-Related Disorders ,Pain Measurement - Abstract
The limited literature on pain in opioid-treatment samples indicates that it is highly prevalent. Understanding the implications of pain on treatment outcomes is important, particularly in light of ageing opioid-treatment cohorts. This study explores correlates of pain, including aberrant behaviours related to prescribed opioids. Our hypothesis is that pain may increase aberrant opioid-related behaviours, including illicit substance use, among opioid-dependent people.We examined pain in methadone or buprenorphine patients (n = 141) from three treatment services. Measures included basic demographics, Brief Pain Inventory, general mental health, physical health and quality of life measures, pain history and treatments, and an aberrant opioid-related behaviour scale. Univariate and multivariate analyses were used to examine correlates of pain.Forty percent reported current pain, measured with the first question of the Brief Pain Inventory. Correlates of pain were depression ratings [adjusted odds ratio (OR) 2.24, 95% confidence interval (CI) 1.04, 4.83], anxiety ratings (adjusted OR 4.29, 95% CI 1.88, 9.80) and self-reported health ratings (adjusted OR 0.35, 95% CI 0.16, 0.76). Contrary to our hypothesis, pain was not associated with greater use of illicit opioids, nor any aberrant opioid-related behaviours. Pain was comparable among methadone and buprenorphine patients.The lack of association with pain and aberrant behaviours suggest that it should not be assumed that those in opioid treatment misuse medications in response to pain. The high prevalence of depression/anxiety symptoms indicates a need for further work with larger samples to explore pain and co-morbidity among opioid-dependent people.
- Published
- 2012
39. Pharmaceutical opioid analgesic and heroin dependence: how do treatment-seeking clients differ in Australia?
- Author
-
Suzanne, Nielsen, Raimondo, Bruno, Nicholas, Lintzeris, Jane, Fischer, Susan, Carruthers, and Mark, Stoové
- Subjects
Adult ,Male ,Adolescent ,Heroin Dependence ,Australia ,Middle Aged ,Patient Acceptance of Health Care ,Opioid-Related Disorders ,Analgesics, Opioid ,Heroin ,Young Adult ,Humans ,Female ,Self Report - Abstract
Non-prescribed use of pharmaceutical opioid analgesics (POA) has been escalating internationally. In Australia, few studies have examined if POA users have similar characteristics and treatment needs to heroin users. The aim of this study was to compare those presenting for treatment where heroin versus POA were the primary drugs of concern.A convenience sample of 192 treatment entrants were recruited from alcohol and drug treatment services in four Australian jurisdictions. A structured interview collected data on demographic characteristics, substance use, self-perceived mental and physical health, crime and harms resulting from drug use. Multivariate analyses were performed to identify characteristics which may differentiate those seeking treatment for heroin compared with POA.Most treatment entrants sampled reported a history of injection drug use and use of both heroin and POA. However, those with primary POA problems were less likely to report an overdose history (adjusted odds ratio 0.90, 95% confidence interval 0.81-0.99) and more likely to initiate opioid use for pain (adjusted odds ratio 2.52, 95% confidence interval 1.04-6.12) than those with primary heroin problems. Latent Class Analysis found that, while most of the POA group were similar to heroin users in demographics, health and injecting drug use, there was a small, distinct group of primary POA problem users that did not typically inject and who commonly initiated opioid use for pain and also experienced elevated physical and mental health disability.While some differences existed, this study of Australian treatment seekers found many similar characteristics between those with primary problems with heroin and POA. Few non-injecting POA were recruited in this sample. This finding contrasts with reports of a growing population of opioid-dependent people with characteristics that are distinct from traditional opioid-dependent populations, which may reflect the orientation of current treatment systems in Australia towards injection drug users.
- Published
- 2011
40. Pharmaceutical drugs: the delicate balance between reducing pain and reducing harm
- Author
-
Suzanne, Nielsen and Raimondo, Bruno
- Subjects
Analgesics, Opioid ,Analgesics ,Prescription Drugs ,Harm Reduction ,Humans ,Pain - Published
- 2011
41. Prescription drug misuse: is technology friend or foe?
- Author
-
Suzanne, Nielsen and Monica Jane, Barratt
- Subjects
Internet ,Prescription Drugs ,Substance-Related Disorders ,Pharmaceutical Services ,Humans ,Drug Prescriptions ,Drug Labeling - Abstract
Prescription drug misuse and related harms have been increasing considerably over the past decade. At the same time, there has also been rapid growth in the use of online and Internet technologies. Thus, it is important that we understand the role online and Internet technologies play in prescription drug misuse.Published work addressing the role of technology in prescription drug misuse is explored. Topics include: Internet supply, online monitoring of prescription drug use trends and electronic prescription monitoring.Little is known about the prevalence of acquiring prescription drugs from online pharmacies. Prescription drugs are easily accessible through vendor websites, and 'rogue' no-prescription websites have proven difficult to control. There has so far been limited application of real-time monitoring to prevent overuse of prescription medications. Online monitoring of drug use trends may also prove to be a useful and timely source of information about new methods of 'off-label' prescription drug use.Technology has the potential to play a more prominent role in facilitating drug acquisition, while also enhancing the monitoring and prevention of prescription drug misuse. As technology becomes more ubiquitous in everyday life, the continued investigation of its relationship with prescription drug misuse becomes even more important.
- Published
- 2009
42. Buprenorphine supply by community pharmacists in Victoria, Australia: perceptions, experiences and key issues identified
- Author
-
Paul Dietze, Suzanne Nielsen, Peter Muhleisen, Adrian Dunlop, Nicole K. Lee, and David Taylor
- Subjects
Health (social science) ,Attitude of Health Personnel ,Narcotic Antagonists ,Medicine (miscellaneous) ,Pharmacy ,Community Pharmacy Services ,Key issues ,Health Services Misuse ,Pharmacists ,Nursing ,Catchment Area, Health ,Prevalence ,Medicine ,Humans ,Demography ,Community pharmacies ,business.industry ,Heroin Dependence ,Drug Administration Routes ,Australia ,Buprenorphine ,Cross-Sectional Studies ,Community pharmacy ,Health Care Surveys ,Community setting ,business ,human activities ,Methadone ,medicine.drug - Abstract
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.
- Published
- 2007
43. Online open access: We all want it, but can we afford it?
- Author
-
Rebecca McKetin and Suzanne Nielsen
- Subjects
World Wide Web ,Health (social science) ,Text mining ,business.industry ,Political science ,Medicine (miscellaneous) ,business - Published
- 2013
44. Pain and Chemical Dependency
- Author
-
Suzanne Nielsen
- Subjects
Health (social science) ,Dependency (UML) ,Econometrics ,Medicine (miscellaneous) ,Psychology - Published
- 2009
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