Health service utilization and benzodiazepine use among heroin users: Findings from the Australian Treatment Outcome Study (ATOS)

National Drug and Alcohol Research Centre, University of New South Wales, Australia.
Addiction (Impact Factor: 4.74). 09/2003; 98(8):1129-35. DOI: 10.1046/j.1360-0443.2003.00430.x
Source: PubMed


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.
Cross-sectional survey.
Sydney, Australia.
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.

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    • "Approximately a third of our sample reported accessing a GP for a general health issue in the previous month. While our data are not directly comparable due to the younger age distribution of the study population, it would appear that our sample of Australian PWID frequent GPs more often than the general population [37]. Given that over half of participants reported one or more health conditions, and almost half rated their health and wellbeing poorly, there is clearly a need for non-OST related primary care. "
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    ABSTRACT: Background People who inject drugs (PWID) use healthcare services, including primary care, at a disproportionately high rate. We investigated key correlates of general practitioner (GP) related service utilisation within a cohort of PWID. Methods Using baseline data from a cohort of 645 community-recruited PWID based in Melbourne, Victoria, we conducted a secondary analysis of associations between past month use of GP services unrelated to opioid substitution therapy (OST) and socio-demographic and drug use characteristics and self-reported health using multivariate logistic regression. Results Just under one-third (29%) of PWID had accessed GP services in the month prior to being surveyed. Participants who reported living with children (adjusted odds ratio, AOR 1.97, 95% CI 1.04 - 3.73) or having had contact with a social worker in the past month (AOR 1.92, 95% CI 1.24 - 2.98) were more likely to have seen a GP in the past month. Participants who were injecting daily or more frequently (AOR 0.50, 95% CI 0.30 - 0.83) or had a weekly income of less than $400 (AOR 0.59, 95% CI 0.38 - 0.91) were less likely to report having seen a GP in the past month. Conclusions Our sample frequently attended GP services for health needs unrelated to OST. Findings highlight both the characteristics of PWID accessing GP services and also those potentially missing out on primary care and preventive services.
    Full-text · Article · Jul 2014 · BMC Health Services Research
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    • "In another study, 41% of heroin users reported having used BZDs weekly (or more) within recent months (Ross et al., 1996). In subsequent investigations, they found that 1 in 3 heroin users had obtained a prescription for a BZD drug in the preceding month (Darke et al., 2003), 2 out of 3 heroin users reported nonmedical BZD use within the past year, and 91% reported a lifetime prevalence (Ross and Darke, 2000). In addition to demonstrating how widespread and frequent BZD use is among this population, these types of investigations have shown that opioid-dependent populations show a preference for particular BZD drugs. "
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    ABSTRACT: This paper reviews studies examining the pharmacological interactions and epidemiology of the combined use of opioids and benzodiazepines (BZDs). A search of English language publications from 1970 to 2012 was conducted using PubMed and PsycINFO(®). Our search found approximately 200 articles appropriate for inclusion in this paper. While numerous reports indicate that the co-abuse of opioids and BZDs is ubiquitous around the world, the reasons for the co-abuse of these medications are not entirely clear. Though the possibility remains that opioid abusers are using BZDs therapeutically to self-medicate anxiety, mania or insomnia, the data reviewed in this paper suggest that BZD use is primarily recreational. For example, co-users report seeking BZD prescriptions for the purpose of enhancing opioid intoxication or "high," and use doses that exceed the therapeutic range. Since there are few clinical studies investigating the pharmacological interaction and abuse liability of their combined use, this hypothesis has not been extensively evaluated in clinical settings. As such, our analysis encourages further systematic investigation of BZD abuse among opioid abusers. The co-abuse of BZDs and opioids is substantial and has negative consequences for general health, overdose lethality, and treatment outcome. Physicians should address this important and underappreciated problem with more cautious prescribing practices, and increased vigilance for abusive patterns of use.
    Full-text · Article · Aug 2012 · Drug and alcohol dependence
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    • "Finally, the sample in this study met the inclusion criteria of self-reporting misuse of any pharmaceutical at least once a month in the 6 months prior to treatment entry. While recent pharmaceutical opioid use among treatment-seeking [25] [26] and nontreatment-seeking heroin users [24] is common in Australia , it must be remembered that this criteria may not represent all heroin users, nor any other group entering treatment. As this study was examining recent treatment entrants, it is not possible to make any conclusions about characteristics of POA users that have not entered treatment. "
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    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.
    Full-text · Article · May 2011 · Drug and Alcohol Review
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