Comparing jurisdictional approaches to the implementation of buprenorphine-naloxone (Suboxone®) in New South Wales, Victoria, and Western Australia

  • Ms Kristie Mammen, The Langton Centre, South Eastern Sydney and Illawara Area Health Service, Australia
  • A/Prof James Bell, Drug and Alcohol Clinical Program, South Eastern Sydney and Illawara Area Health Service, Australia
  • Dr Allan Quigley, Next Step Specialist Drug & Alcohol Services, Australia
  • A/Prof Nicholas Lintzeris, Drug Health Services, Sydney South West Area Health Service, Australia
  • Ms Amanda Morris, The Langton Centre, South Eastern Sydney and Illawara Area Health Service, Australia
  • Ms Fiona Everette, Next Step Specialist Drug & Alcohol Services, Australia
  • Ms Laura Sciacchitano, Turning Point Alcohol and Drug Centre, Australia
  • Ms Suzanne Robinson, New South Wales Users and AIDS Association (NUAA), Australia

    • This paper examines the differences in the jurisdictional approaches to the implementation of buprenorphine-naloxone (Suboxone®) and their effects on prescribing behaviour, client outcomes and experiences of the opioid treatment system. Buprenorphine-naloxone is a combination pharmacotherapy treatment for opioid dependence, and has been available on the Pharmaceutical Benefits Scheme in Australia since April 2006.

    Australian jurisdictions differ from one another in their approach to the use of opioid pharmacotherapies. Each state has adopted a particular stance on the use of buprenorphine-naloxone, differing on aspects such as who can prescribe the medication, the number of unsupervised doses a patient can be prescribed, and which patient variables (eg. time in treatment, drug use, mental health, social functioning) indicate when and how many unsupervised doses are appropriate.

    Fifty-nine doctors and eighty-five of their patients were recruited into an observational study comparing the effects of treatment paradigms for the use of buprenorphine-naloxone. The three Australian states compared were New South Wales (22 doctors, 29 patients), Victoria (19 doctors, 23 patients), and Western Australia (18 doctors, 33 patients). A mixed methods design (a combination of quantitative and qualitative techniques) was used to ensure both the differing treatment contexts and outcomes of the three approaches were captured. Data collection comprised questionnaires, chart audits, in-depth interviews and focus groups. Findings were triangulated to highlight areas of consistency and inconsistency.

    The relationships between the jurisdictional policies and prescribing behaviour, client outcomes and treatment system experiences, as well as unexpected effects, will be discussed.