Exploring patient experience and satisfaction with depot buprenorphine formulations: A mixed-methods study.

INTRODUCTION: The introduction of depot buprenorphine for the treatment of opioid dependence allows for reduced dosing frequency compared with conventional treatments, such as oral methadone and sublingual buprenorphine-naloxone. Reduced dosing frequency is perceived to reduce issues such as high out-of-pocket costs, frequent attendance to pharmacies, stigmatisation and the risk of diversion for unsanctioned opioid use. This study aims to explore the experiences of patients receiving depot buprenorphine from an Australian publicly operated drug and alcohol service. METHODS: Participants were recruited from the service over a 5-week period in 2021. Twenty-eight participants consented to be involved in a mixed methods quantitative verbal survey and qualitative interview process. RESULTS: The majority of participants reported satisfaction with depot buprenorphine across the domains of efficacy, convenience and global satisfaction. Participants perceived benefits as increased convenience, reduced stigmatisation and the inability to 'skip' daily Medication Assisted Treatment for Opioid Dependence (MATOD) doses. There were mixed experiences with the ability for depot buprenorphine to 'hold' participants throughout the dosing interval. Reduced contact and disconnection from healthcare services were reported as an issue for some participants when initiating depot buprenorphine. DISCUSSION AND CONCLUSIONS: Patient perceptions of depot buprenorphine appear to be deeply rooted in prior experience with 'conventional' MATOD treatments. Depot buprenorphine is seen to be beneficial socially, personally, and financially by the majority of patients interviewed. The potential for disconnection from services and mixed experiences of efficacy throughout the dosing period may negatively influence patient experience.

Substance use patterns in newly admitted male and female South Australian prisoners using the WHO-ASSIST (Alcohol, Smoking and Substance Involvement Screening Test).

OBJECTIVE: To report on the patterns of substance use in newly admitted male and female South Australian prisoners using the WHO-ASSIST screening tool (Alcohol, Smoking and Substance Involvement Screening Test) and observe the feasibility of using the ASSIST and associated Brief Intervention in this population. DATA SOURCES: Results of the first 518 prisoners screened using ASSIST in South Australian reception prisons. RESULTS: In the first 10 months of the implementation of the WHO ASSIST, 518 clients were assessed in the 3 metropolitan intake prisons in Adelaide, Australia. This represents 31% of all male and 35% of all female prisoners admitted over this period. Injecting drug use was reported in the previous 3 months by 55% of men and 51% of women. The six most common substances used at high and moderate risk levels, in order of prevalence (from high to low) in males were tobacco, cannabis, amphetamines, opiates, alcohol, and sedatives. In women the order was tobacco, amphetamines, cannabis, opiates and sedatives equal, and alcohol. Fifty percent of men and 33% of women were using four or more substances. Overall rates of substance use related risk amongst men coming into prison are slightly greater than for women. Accessing prisoners for screening within the first few days is difficult with 55% already being released or at court or other external appointments.

Could recidivism in prisoners be linked to traumatic grief? A review of the evidence.

Traumatic grief arises as a result of interpersonal trauma experienced as a betrayal of attachment. The distinct set of symptoms associated with it were first recognized in the 1990s. Losses associated with traumatic grief can be either death or non-death related. A variety of studies have demonstrated that many prisoners have suffered from losses and trauma throughout their lives, and in many instances they have never received any support or interventions to address resultant problems. This paper examines whether there could be a relationship between many of the maladaptive behaviours demonstrated by the prisoners (including substance use), mental illness and traumatic grief. Of particular importance is the exploration of whether the high rates of recidivism seen in many developed countries (and which in Australia have been reported as high as 77%) may be related to traumatic grief. This paper explores new concepts that may be relevant to the development of strategies to reduce recidivism.

Prison health. A different place for GPs.

BACKGROUND: Imprisonment rates in Australia have been steadily increasing over the past decade. Prisoners have high rates of substance use and dependence, mental illness, self harming behaviours and infectious disease. OBJECTIVE: This article discusses health issues of prisoners and the role of general practitioners in prison health. DISCUSSION: The standard of health care provided for prisoners should be equivalent to that available in the general community. Medical officers working within prisons need to be competent GPs with particular skills in managing the unique patterns of morbidity encountered. In addition, public health advocacy, an ability to examine the frequent ethical issues at stake, and close links with colleagues both within prisons and in the community are needed.

Allied health professionals providing psychological treatments in general practice settings. What options are there?

BACKGROUND: This article is based on a literature review and discussion document developed for the Commonwealth Department of Health and Aging to assist in its deliberations on the structure of the Better Outcomes in Mental Health Program (BOMH). OBJECTIVE: This article examines issues regarding the engagement of allied health professionals in the delivery of specific time limited and evidence based counselling interventions in the general practice setting. DISCUSSION: Specific issues examined include employment and administrative arrangements, citing of these services, communication between general practitioners and counsellors, as well as clinical supervision and support.