The diversion and injection of a buprenorphine-naloxone soluble film formulation.
BACKGROUND
We compared the diversion and injection of a new formulation of buprenorphine, a buprenorphine-naloxone film product (BNX film), with buprenorphine-naloxone tablets (BNX tablets), mono-buprenorphine (BPN) and methadone (MET) in Australia.


METHODS
Surveys were conducted with people who inject drugs regularly (PWID) (2004-2012) and opioid substitution treatment (OST) clients (2012, N=543). Key outcome measures: the unsanctioned removal of supervised doses, diversion, injection, motivations, drug liking and street price. Levels of injection among PWID were adjusted for background availability of medication using sales data. Doses not taken as directed by OST clients were adjusted by total number of daily doses dispensed.


RESULTS
Among out-of-treatment PWID, levels of injection for BNX film were comparable to those for MET and BNX tablet formulations, adjusting for background availability; BPN injecting levels were higher. Among OST clients, recent injecting of one's medication was similar among clients in all OST types; weekly or more frequent injection of prescribed doses was reported by fewer BNX film clients (3%; 95% CI: 1-6) than BPN clients (11%; 95% CI: 3-17), but at levels similar to those observed among MET and BNX tablet clients. The proportion of BNX film doses injected was lower than that for BPN and BNX tablets, and equivalent to that for MET. The majority of BNX film doses injected by OST clients were unsupervised doses, although some injection of supervised doses of BNX film did occur. The median price of all buprenorphine forms on the illicit market was the same.


CONCLUSIONS
Non-adherence and diversion of the BNX film formulation was similar to MET and BNX tablet formulations; BPN had higher levels of all indicators of non-adherence and diversion.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: b.larance@unsw.edu.au.
Briony
B
Larance
The Langton Centre, South East Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW 2050, Australia; Mental Health and Drug and Alcohol Office, NSW Department of Health, 73 Miller Street, North Sydney, NSW 2060, Australia.
Nicholas
N
Lintzeris
School of Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia.
Robert
R
Ali
Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia.
Paul
P
Dietze
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
Richard
R
Mattick
Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia.
Rebecca
R
Jenkinson
School of Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia.
Nancy
N
White
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3000, Australia.
Louisa
L
Degenhardt
D000286:Administration, Sublingual; D000328:Adult; D001315:Australia / Q000453:epidemiology; D002047:Buprenorphine / Q000008:administration & dosage* / Q000191:economics; D002626:Chemistry, Pharmaceutical; D016527:Drug Costs; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D009042:Motivation; D009270:Naloxone / Q000008:administration & dosage* / Q000191:economics; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000191:economics; D058850:Opiate Substitution Treatment; D064226:Prescription Drug Diversion / Q000191:economics / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000453:epidemiology*; D013607:Tablets; D016896:Treatment Outcome
D009292:Narcotic Antagonists; D013607:Tablets; D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone
Abuse liability; Compliance; Methadone; Opioid substitution therapy; Post-marketing surveillance