title: Lack of reduction in buprenorphine injection after introduction of co-formulated buprenorphine/naloxone to the Malaysian market.
abstract: BACKGROUND
  Diversion of buprenorphine (BPN) has been described in settings where it is legally prescribed and has resulted in increasing concern. To address this concern, co-formulation of buprenorphine/naloxone (BPN/NLX) replaced buprenorphine alone in Malaysia in December 2006.
  
  
  METHODS
  To assess the significance of BPN/NLX introduction, 41 BPN/NLX injectors in Kuala Lumpur, Malaysia were recruited using a modified snowball recruitment technique.
  
  
  RESULTS
  In January 2007, all subjects had previously injected BPN alone. During the transition from injecting BPN alone to co-formulated BPN/NLX, the mean daily BPN injection dose increased from 1.88 mg (range 1.0-4.0 mg) to 2.49 mg/day (p < .001). Overall, 18 (44%) subjects increased their daily amount of injection while 22 (54%) had no change in dose; only one subject reduced the amount of injection. Development of opioid withdrawal symptoms was the primary outcome, however the only symptom that was significantly associated with BPN/NLX dosage was the report of "stomach pains" (p = .01). In logistic regression analysis, the development of opioid withdrawal symptoms was associated with increased benzodiazepine injection and increased syringe sharing.
  
  
  CONCLUSIONS
  These data suggests that the introduction of BPN/NLX did not reduce injection related risk behaviors such as syringe sharing and was associated with increased benzodiazepine use. Evidence-based approaches to treat BPN injection are urgently needed.
authors.affiliation: Yale University AIDS Program, New Haven, Connecticut, USA. Robert.bruce@yale.edu
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Bruce
authors.forename: Sumathi
authors.initials: S
authors.lastname: Govindasamy
authors.forename: Laurie
authors.initials: L
authors.lastname: Sylla
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects*; D000069479:Buprenorphine, Naloxone Drug Combination; D004338:Drug Combinations; D006801:Humans; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage / Q000009:adverse effects*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D016485:Needle Sharing / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000517:prevention & control*; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000517:prevention & control*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D004338:Drug Combinations; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine