title: Diversion and injection of buprenorphine-naloxone film two years post-introduction in Australia.
abstract: OBJECTIVE
  We report 2 years of post-marketing surveillance of the diversion and injection of buprenorphine-naloxone (BNX) film following its introduction in 2011.
  
  
  METHODS
  Interviews were conducted with people who inject drugs regularly (PWID) (2004-2013), opioid substitution therapy clients (2013, n = 492) and key experts (n = 44). Key outcomes were unsanctioned removal of supervised doses, diversion, injection and street price. Prevalence of past 6-month injection among PWID was adjusted for background availability of opioid substitution therapy medications using sales data.
  
  
  RESULTS
  Among out-of-treatment PWID, the levels of regular (weekly+) BNX film injection were comparable to methadone and BNX tablets, and lower than mono-buprenorphine, adjusting for background availability. Fewer BNX film clients [3%; 95% (CI) 1-5] regularly injected their medication than mono-buprenorphine clients (25%; 95% CI 11-39), but at levels equivalent to those among methadone (3%; 95% CI 1-6) and BNX tablet clients (2%; 95% CI 0-6). Key experts perceived BNX film needed less supervised dosing time as it dissolved rapidly and was harder to remove from the mouth than sublingual tablets; however, removal of supervised doses was higher among BNX film clients (15%; 95% CI: 10-20) than methadone clients (3%; 95% CI 1-6), and not significantly different from BNX tablet (11%; 95% CI 2-21) and mono-buprenorphine clients (31%; 95% CI 16-46).
  
  
  CONCLUSIONS
  Two years post-introduction, levels of BNX film diversion and injection remained comparable with those for methadone and BNX tablets, and lower than mono-buprenorphine. We found no evidence that BNX film has lower non-adherence and diversion than the tablet formulation. [Larance B, Mattick R, Ali R, Lintzeris N, Jenkinson R, White N, Kihas I, Cassidy R, Degenhardt L. Diversion and injection of buprenorphine-naloxone film two years post-introduction in Australia. Drug Alcohol Rev 2015].
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: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Mattick
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, South East Sydney Local Health District, Sydney, Australia.|Faculty of Medicine, University of Sydney, Sydney, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.affiliation: Center for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jenkinson
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: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kihas
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Cassidy
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
keywords: opiate substitution treatment; opioid-related disorders; patient compliance; post-marketing product surveillance