Buprenorphine/naloxone treatment practices in Malaysia: Results of national surveys of physicians and patients.
OBJECTIVE
Medication assisted treatment with buprenorphine/naloxone (Bup/Nx), including prescribing and dispensing practices of general practitioners (GPs) in Malaysia and their patients' experiences with this treatment have not been systematically examined. The current study surveyed GPs providing Bup/Nx treatment and patients receiving office-based Bup/Nx treatment in Malaysia.


METHODS
Two cross-sectional surveys of GPs (N=115) providing outpatient Bup/Nx maintenance treatment and of patients (N=253) currently receiving Bup/Nx treatment throughout peninsular Malaysia.


RESULTS
Physicians prescribed Bup/Nx dosages in the range of 2-4mg daily for 70% of patients and conducted urine testing in the past month on approximately 16% of their patients. In the patient survey, 79% reported taking daily Bup/Nx doses of 2mg or less; 82% reported that no urine toxicology testing had been conducted on them in the past month, 36% had an opiate positive urine test at the time of the survey, 43% reported illicit opiate use, 15% reported injection of heroin and 22% reported injection of Bup/Nx in the past month.


CONCLUSIONS
Low daily Bup/Nx doses, lack of behavioral monitoring or counseling, and high rates of continued drug use, including injection of drugs and medications during Bup/Nx treatment in Malaysia, indicate continuing problems with implementation and less than optimal treatment effectiveness. High cost of Bup/Nx in Malaysia may deter patients from seeking treatment and contribute to taking low Bup/Nx dosages. Improved training of physicians and establishing standards for Bup/Nx dosing, routine toxicology testing, and counseling may be needed to improve care and treatment response.
Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia. Electronic address: vickna@usm.my.
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Vicknasingam
Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia. Electronic address: nazridazali@gmail.com.
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Dazali
Centre for Drug Research, Universiti Sains Malaysia, 11800 Penang, Malaysia. Electronic address: darshan@usm.my.
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Singh
Yale School of Medicine, New Haven, CT 06519, USA. Electronic address: richard.schottenfeld@yale.edu.
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Schottenfeld
Yale School of Medicine, New Haven, CT 06519, USA. Electronic address: marek.chawarski@yale.edu.
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Chawarski
D000328:Adult; D001291:Attitude of Health Personnel; D000069479:Buprenorphine, Naloxone Drug Combination / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008296:Malaysia; D008297:Male; D009292:Narcotic Antagonists / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists
Buprenorphine/naloxone treatment; Drug counseling; Drug treatment; Heroin; Malaysia; Opiates