Health service utilization and benzodiazepine use among heroin users: findings from the Australian Treatment Outcome Study (ATOS).
ABSTRACT To determine levels of health service utilization among heroin users, the types of prescription drugs obtained by heroin users and the contribution of benzodiazepine use in health service utilization and prescribed drug use.
A total of 615 current heroin users recruited for the Australian Treatment Outcome Study (ATOS).
Sixty per cent of subjects had consulted a general practitioner (GP) and 7% a specialist in the preceding month. An ambulance had attended 11% of subjects in the preceding month. Forty-eight per cent of subjects had prescriptions dispensed for medication in the preceding month. Thirty-nine per cent of participants had prescriptions dispensed for psychotropic medications, representing 80% of all prescriptions. Twenty per cent of subjects had prescriptions dispensed for non-psychotropic medications (20% of prescriptions). The most commonly prescribed drugs were benzodiazepines (59% of prescriptions), which had been obtained by 30% of subjects. Benzodiazepine users had more GP and psychiatrist visits, were more likely to have had an ambulance attendance and had significantly more dispensed prescriptions.
There were high levels of health utilization among heroin users. Prescription drug use was common, and dominated by psychotropic drugs. Benzodiazepine use was a dominant factor in the use of services and in prescriptions dispensed. Despite increased awareness of the harms associated with benzodiazepines, they continue to be prescribed widely to heroin users.
- SourceAvailable from: Liang-Jen Wang[Show abstract] [Hide abstract]
ABSTRACT: Due to the needs of medical care, the probability of using health care service from heroin users is high. This cross-sectional study investigated the frequency and correlates of health service utilization among heroin users. From June to September 2006, 124 heroin users (110 males and 14 females, mean age: 34.2±8.3years) who entered two psychiatric hospitals (N=83) and a detention center (N=41) in northern Taiwan received a face-to-face interview. Therefore, socio-demographic characteristics, patterns of drug use, psychiatric comorbidities, blood-borne infectious diseases and health service utilization were recorded. The behaviors of health service utilization were classified into the frequency of out-patient department visit and hospitalization, as well as the purchase of over-the-counter drugs. During 12months prior to interview, 79.8% of the participants attended health care service at least once. The rate of having any event in out-patients service visit, hospitalization, and over-the-counter drugs were 66.1%, 29.8% and 25.8% respectively. The frequency of health service utilization was associated with numerous factors. Among these factors, patients who were recruited from hospital and having a mood disorder were conjoint predictors of out-patient department visit, hospitalization and purchase of over-the-counter drugs. According to the results of this study, social education and routine screening for mood disorders can help heroin users to obtain adequate health care service. The findings of this study are useful references for targeting the heroin users for whom a successful intervention represents the greatest cost benefit.Addictive behaviors 07/2013; 38(11):2635-2638. · 2.25 Impact Factor
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ABSTRACT: To describe benzodiazepine and prescription opioid use by clients of drug treatment services and the sources of pharmaceuticals they use. Structured face-to-face interviews on unsanctioned use of benzodiazepines and prescription opioids were conducted between January and July 2008. Convenience sample of treatment entrants who reported regular (an average of ≥ 4 days per week) and unsanctioned use of benzodiazepines and/or prescription opioids over the 4 weeks before treatment entry. Drug treatment services in Victoria, Queensland, Western Australia and Tasmania. Participant demographics, characteristics of recent substance use, substance use trajectories, and sources of pharmaceuticals. Two hundred and four treatment entrants were interviewed. Prescription opioids were predominantly obtained from non-prescribed sources (78%, 84/108). In contrast, medical practitioners were the main source for benzodiazepines (78%, 113/144). Forging of prescriptions was extremely uncommon. A mean duration of 6.3 years (SD, 6.6 years) for benzodiazepines and 4.4 years (SD, 5.7 years) for prescription opioids was reported between first use and problematic use - a substantial window for intervention. Medical practitioners are an important source of misused pharmaceuticals, but they are not the main source of prescription opioids. This has implications for prescription drug monitoring in Australia: current plans (to monitor only Schedule 8 benzodiazepines and prescription opioids) may have limited effects on prescription opioid users who use non-prescribed sources, and the omission of most benzodiazepines from monitoring programs may represent a lost opportunity for reducing unsanctioned use of benzodiazepines and associated harm.The Medical journal of Australia 11/2013; 199(10):696-9. · 2.85 Impact Factor
Technical Report: Methadone-related deaths and prescription drug use[Show abstract] [Hide abstract]
ABSTRACT: Between 2002 and 2007 there were 93 deaths in Victoria in which methadone was implicated as a cause of death. By comparison, 350 deaths were attributed to herion (excluding methadone cases), and 513 cases to drugs other than heroin and methadone and alcohol. Methadone deaths were more common among males than females (2.2:1) with the deceased’s ages ranging from 16 to 57 years (mean = 34 years). Medicare data were found for 82 of the 93 methadone deaths. Only five cases had been prescribed methadone from the Pharmaceutical Benefits Schedule (PBS), presumably for pain relief. The remaining cases are assumed to either be on treatment for heroin addiction (which is administered under the Opiate Dependency Treatment Program, not the PBS) or to have obtained methadone illicitly. Eighty-two heroin, other drug and carbon monoxide deaths from the same time period were matched by age and gender to the methadone cases for comparison. Most methadone deaths were polydrug cases with only three (4%) having only methadone found in their toxicology results. Most methadone deaths also had benzodiazepines (69%) and/or antidepressants present (45%). By comparison, heroin users were most commonly found to have analgesics in addition to heroin (74%—usually codeine) and benzodiazepines (52%). As expected the Other Drugs group had a wide range of drugs present in toxicology, while the Carbon Monoxide group had few other drugs present, other than alcohol (50%). Prescription drug use was substantially higher in the Methadone group (mean = 43.96 prescriptions) in the twelve months before death than in the Heroin group (22.88), Other Drugs group (26.33) or Carbon Monoxide group (9.15). Fifteen percent of the Methadone group obtained prescriptions from ten or more different prescribers, which was higher than that for the Heroin (9%), Other Drugs (6%) or Carbon Monoxide (1%) groups. The Methadone cases were also the most likely to use ten or more different pharmacies to dispense their prescriptions (20%) compared with the Heroin and Other Drugs groups (12% each). No case in the Carbon Monoxide group used more than ten different pharmacies in the twelve months before death. There was an association between the presence of antidepressants and benzodiazepines in toxicology results with the prescription of these drugs in the twelve months before death for the Methadone, Heroin and Other Drugs groups. People who had died from a methadone-related death were significantly more likely to have suffered from chronic disease, particularly cardiovascular disease, than any other group. Chronic illness was listed as contributing to death in 24 Methadone cases, 6 Heroin cases, 14 Other Drugs cases and 1 Carbon Monoxide case. As was also found in our previous study (Martyres et al. 2004), prescription drug use by heroin users increased in the 24 months prior to death. However, this increase was substantially greater for the Other Drugs group, and even larger in the Methadone group. The increase for the Carbon Monoxide group was relatively slight. This finding strengthens the case for investigating proportional increases in prescription drug use as a means of identifying individuals at risk of death from overdose.