NDARC Technical Report No. 158 (2003)
The Commonwealth Department of Health and Ageing (CDHA) commissioned the National Drug and Alcohol Research Centre (NDARC) to coordinate research investigating benzodiazepine use among injecting drug users (IDU) and assess the impact of the prescription restriction of 10mg temazepam capsules, introduced on May 1st 2002.
Data was collected in five jurisdictions – New South Wales (NSW), the Northern Territory (NT), Queensland (QLD), Tasmania (TAS) and Victoria (VIC) as findings from 2001 indicated concerning levels of benzodiazepine injection in those jurisdictions (Topp et al 2002). The study was conducted as part of the annual Illicit Drug Reporting System (IDRS) using the existing IDRS methodology. Data on benzodiazepine use was collected by; a quantitative survey conducted with IDU in June 2002 and December 2002, a semi structured survey with pharmacists and doctors that have contact with benzodiazepine users, and the examination of benzodiazepine prescription data, both PBS and non PBS data.
This final report contains data from a sample of IDU interviewed in June 2002 that had used benzodiazepines between January and April 2002 prior to the restriction of 10mg temazepam capsules and from a sample of IDU interviewed in December 2002 that had used benzodiazepines in the month prior to interview, six months after the change in policy.
As expected, the prescription data indicates that there has been an increase in the number of temazepam tablet prescriptions and a corresponding decrease in the number of 10mg temazepam capsule prescriptions.
Although the data available is limited, general practitioners and pharmacists that provided feedback regarding the impact of the policy restriction reported that the change in subsidisation of temazepam capsules did not have negative clinical implications and little administrative impact. Other key informants interviewed between June and August reported it was too early to tell the full impact of the policy change. Generally there was support for the policy restriction although there were comments that it was overdue and would not solve the problem of benzodiazepine misuse. There were suggestions that there should be further restrictions on benzodiazepines generally and temazepam capsules specifically. As supported by the prescription data in some states, some key informants thought the change in prescribing practices had been initiated before the May 1st 2002 policy restriction.
The IDU samples interviewed in June and December had similar demographic characteristics and patterns of drug use. They were all regular injectors. They are not representative of all IDU that use benzodiazepines. Information on IDU that may have ceased benzodiazepine use as a result of the restriction was not collected for this study and therefore the data presented from IDU surveyed in December may represent patterns of use by more dedicated benzodiazepine users. Further research is needed here.
The majority of the IDU surveyed in June and December reported oral use of benzodiazepines. Substantial proportions of benzodiazepine users reported oral and injecting use and injecting only was not as common. Examination of temazepam users specifically suggest that a greater proportion of them ‘inject only’ compared to benzodiazepine users overall, suggesting that capsule preparations are more amenable to injection, and have desirable effects over and above oral routes of administration.
Despite a suggested decrease in the reporting of injecting in the June survey in the month after the policy change, the data from the December survey suggest that among injecting drug users who continue to use benzodiazepines, there is continued injection of benzodiazepines and temazepam gel capsules specifically. Similar proportions continue to inject capsules and tablet preparations. The frequency of the injection of capsules remained similar after May 2002, with a slight increase in the frequency of injection of tablets.
The majority of IDU surveyed reported obtaining their benzodiazepines from doctors, presenting with genuine symptoms. Although the majority reported only visiting one or two doctors to obtain their benzodiazepines, small numbers had visited numerous doctors. There appears to be a substantial black market for benzodiazepines with about half of IDU reporting purchasing benzodiazepines on the street. IDU were able to continue to obtain capsules on the street after the policy restriction.
The negative health effects of the misuse, and particularly the injection of benzodiazepines remains a concern. Although limiting the supply of the temazepam capsules may have reduced the injection of temazepam capsules for some IDU, others continue to inject them and therefore additional strategies are needed to further reduce the misuse of benzodiazepines. Further monitoring is desirable, specifically addressing the health impacts of the use and injection of benzodiazepines, the sourcing of benzodiazepines and levels of criminal activity among benzodiazepine users.
Citation: Breen, C., Degenhardt, L., Roxburgh, A., Bruno, R., Fry, C., Duquemin, A., Fischer, J., Gray, B. and Jenkinson, R. (2003) The impact of changes in the availability of publicly subsidised 10mg temazepam gel caps in Australia, Sydney: National Drug and Alcohol Research Centre.