title: The introduction of buprenorphine-naloxone film in opioid substitution therapy in Australia: Uptake and issues arising from changing buprenorphine formulations.
abstract: OBJECTIVE
  Buprenorphine-naloxone (BNX) film for opioid dependence treatment was introduced in Australia in 2011. A key difference in State policy approaches saw transfer from BNX tablets to BNX film mandated in South Australia (SA) with New South Wales (NSW) and Victoria (VIC) having less stringent policies. This study examined (i) how initiations and transfers were implemented, (ii) the profile and predictors of adverse effects as self-reported by BNX film clients, and (iii) dosing issues.
  
  
  METHODS
  Survey of 334 buprenorphine (BPN), BNX tablet and BNX film clients and semi-structured interviews with 39 key experts (KEs) in 2012. Comparisons are made between clients interviewed in SA versus NSW and VIC combined.
  
  
  RESULTS
  Among the 180 current BNX film clients, 23% started treatment on BNX film, 18% requested a transfer to BNX film and 59% (n = 106) reported their clinic/prescriber recommended transfer to BNX film. Among clients who were offered but refused a transfer to BNX film (n = 66), the most common reason was 'I am happy with my current treatment and do not see a reason to change' (53%). Some opioid substitution therapy clients and KE viewed transfers as 'forced' (i.e. no choice of buprenorphine formulation). Multivariable regression showed residing in SA (vs. NSW/VIC) and a shorter length of current treatment episode were associated with more BNX film-attributed adverse effects but clinic/prescriber-recommended transfer was not.
  
  
  CONCLUSIONS
  The introduction of BNX film in Australia varied across States. A perception of restricted choice in medication may have undermined initial acceptance in SA.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.affiliation: Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Dietze
authors.affiliation: School of Medical Sciences, University of Adelaide, Adelaide, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Ali
authors.affiliation: The Langton Centre, Surry Hills, Australia.|Faculty of Medicine, University of Sydney, Sydney, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.affiliation: School of Medical Sciences, University of Adelaide, Adelaide, Australia.
authors.forename: Nancy
authors.identifier: http://orcid.org/0000-0002-2301-8778
authors.initials: N
authors.lastname: White
authors.affiliation: Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jenkinson
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.|Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D001315:Australia; D002047:Buprenorphine / Q000008:administration & dosage* / Q000627:therapeutic use; D000069479:Buprenorphine, Naloxone Drug Combination / Q000008:administration & dosage* / Q000627:therapeutic use; D004338:Drug Combinations; D057915:Drug Substitution / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009270:Naloxone / Q000008:administration & dosage* / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods*; D017060:Patient Satisfaction; D013607:Tablets
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D004338:Drug Combinations; D013607:Tablets; D009270:Naloxone; D002047:Buprenorphine
keywords: buprenorphine; opioid substitution therapy; supervised dosing; transfer