Buprenorphine diversion and injection in Melbourne, Australia: an emerging issue?

Aims To examine indicators of buprenorphine diversion and injection among injecting drug users in Melbourne, Australia and to determine the factors associated with buprenorphine injection. Design Melbourne arm of the 2002 Illicit Drug Reporting System (IDRS) cross-sectional study Setting Five Needle and Syringe Programme sites in Melbourne, Australia. Participants A total of 15 6 current injecting drug users (IDU). Study elibility criteria were at least monthly injection during the previous 6 months, and Melbourne residence for at least the preceding 12 months. Measurements Structured questionnaire covering demographic characteristics, drug use history, the price, purity and availability of drugs, criminal activity, risk-taking behaviours, health-related issues and general drug use trends. Findings Over one-third (37'%) of the study sample reported injecting buprenorphine in their life-time and 33%, reported injecting the drug in the last 6 months. Recent buprenorphine injection was associated with the injection of other drug types (i.e. polydrug injectors), opioid substitution treatment, injection-related health problems and involvement in crime. Almost half (47%) of those who reported recent buprenorphine injection reported obtaining the drug illicitly at least once during that time. Conclusions Given the significant health harms associated with intravenous buprenorphine use (e.g. vein damage, abscesses and infections, precipitated withdrawal, blood-borne virus transmission, hospitalization and death), routine monitoring of the misuse of buprenorphine in Melbourne is warranted. These results suggest the need for development of effective countermeasures to address diversion and injection of buprenorphine in this setting.