| Project Objectives / Summary:
Prescription drug abuse among injecting drug users is of considerable clinical and public health importance. This project sought to enhance the current evidence base by examining associations between illicit and prescription drug abuse, suicidal behaviour and depressive symptoms in young people who are injecting drug users.
The main aim of the project was to identify risk factors associated with heroin related deaths, for use in general practice.
Project Outcomes:
- A literature review examining risk behaviours in injecting drug users was completed.
- Coroner's reports and matching PBS and MBS records were reviewed for 144 people dieing of heroin related deaths from 1994 - 1999.
- The review highlighted that chemical groups other than heroin were present in 55% of cases. Most common chemical groups were benzodiazepines, cannabis, other opioids and alcohol. Other chemical groups include anti depressants, major tranquilisers, stimulants and methadone. The review also highlighted that access to services increased by 5 to 6 times the average state mean for both males and females. Doctor shoppers accounted for between 22-40% of the sample group seeing more than 15 medical practitioners or 40 MBS services per year. PBS records also indicate that on average the sample group received 14 scripts per person per year and over half of the prescriptions were for drugs known to be subject to abuse and which may be used for illegal drug augmentation in particular benzodiazepines (43%) and opioid analgesics (11%). The number of scripts per person increased in the final year to approximately 22.
- Data was collected from 182 probable injecting drug users aged between 15 -24 years via a self administered questionnaire. Matching PBS data was obtained for 106 of these cases for the period from 1995-2001. The data showed that the average participants were 21 years, living in non permanent accommodation (i.e. squats, emergency or transitional housing) and a quarter to one third of the sample group has a family history of heroin or prescription abuse. 23% of respondents had suffered mental illnesses, but only a quarter of those had seen a mental health professional in the last month. Respondents scored low on the Short Mood & Feeling Questionnaire. PBS rates averaged 13 per person per year with over half of these scripts (56%) for benzodiazepine and (5%) other opioids. Data suggested that those prescribed Temazepam capsules were more likely to report injecting benzodiazepines than those not prescribed capsules.
Recommendations:
Recommended actions arising from this research include:
- A review of the reporting of coroner's data with a view to improving standardisation of records
- A review of systems for accessing PBS and MBS data for research purposes
- Further development of prescription monitoring systems
- Improved liaison between health professionals to facilitate the identification and treatment of high overdose risk patients
Promotion of information highlighting the risks of prescribing Temazepam capsules and encouraging the substitution of alternative treatments.
- Dissemination of information about changes to GP visitation rates and prescription seeking behaviour in patients prior to fatal overdose.
Recognition of "doctor-shopping" as an indicator of high risk behaviour associated with fatal overdose and further research into this behaviour.
- Development of an assessment tool based on personal and psychological information for identifying patients at high risk of overdose.
- A trial, using action based research methodology, of such an assessment tool.
Recommendations identified after project evaluation
- Aims and objectives -working across disciplines made it challenging to achieve all goals and objectives. Project outcomes need to be clearly specified with concise timeframes placed on deliverables and expectations of what a project like this can achieve need to be more realistic. That is, an epidemiological picture of the population of injecting drug users, rather than detailed information.
- Clear assurance of data delivery from the data sources incorporated within the protocol including dates would prevent the project timelines being inflated.
- Smaller working groups assigned to work around clearly defined tasks and issues would assure more optimal use of the multi-disciplinary expertise.
- Projects such as this are fraught with both practical and methodological limitations. Subject participants can be very difficult to engage for a number of reasons; many are suspicious with regards to what the information is going to be used for and data, when collected can be limited in its wider use. Nevertheless, the Division considers this should not be seen as a disincentive to engage in a study such as this one. It is through trial and error, that the innovative methodologies such as those attempted here can be refined to enable successful research of one of the most difficult sub-populations in the community.
Lessons / Assessment:
The project tackled a sensitive area and the Division found from experience that there were a number of obstacles that needed to be overcome.
These included matters such as access to data (eg the HIC), data inconsistency, timeframes and the multi-disciplinary involvement in the project.
A lesson from this project is that project expectations need to be kept realistic. The Division acknowledges that the planned outcomes, while highly commendable, were ambitious, and further complicated by the unforeseen difficulties with data. |
