Does Restricting Publicly Subsidised Temazepam Capsules Limit Benzodiazepine Use Among Injecting Drug Users?
Reducing access to temazepam capsules may have reduced their injection by some intravenous drug users (IDUs), but more needs to be done, according to a research paper published in the current issue of The Medical Journal of Australia.
Co-author of the research, Courtney Breen, from the National Drug and Alcohol Centre at the University of New South Wales, said the misuse of benzodiazepines among injecting drug users has been associated with serious harms, such as benzodiazepine dependence, increased risk of heroin overdose, increased risky injection behaviour and injecting-related health problems, including gangrene.
Researchers set out to assess the effect of restricting publicly subsidised temazepam 10mg capsules on the injection of benzodiazepines by IDUs through a cross-sectional study of regular IDUs, targeting periods before and after the policy change.
Researchers also analysed prescription data.
"Because of concerns about the rising incidence of injection-related harm associated with temazepam gel-filled capsules, the Australian Pharmaceutical Advisory Council recommended the capsules be restricted under the Pharmaceutical Benefits Scheme (PBS)," Ms Breen said.
"Before 1 May 2002, temazepam 10mg tablets and 10mg capsules were subsidised on the PBS or could be obtained on private prescription. From 1 May 2002, temazepam 10mg capsules required an Authority Prescription (ie, prior approval from the Health Insurance Commission) to allow subsidy on the PBS.
"Temazepam 10mg tablets remained on the PBS and no authority was required. The temazepam 10mg capsules, 20mg tablets and 20mg capsules continued to be available on private prescription (ie, they could still be prescribed by any doctor and purchased without PBS subsidy).
"The restriction was not designed to reduce benzodiazepine use per se, but to reduce the injection of temazepam capsules.
"The research showed a decrease in temazepam 10mg capsule prescriptions and a corresponding increase in temazepam 10mg tablet prescriptions after the policy change.
"IDU survey data suggested that IDUs continued to inject benzodiazepines and temazepam capsules. The frequency of the injection of capsules after the restriction appeared similar to that before the policy change.
"There was no change in the frequency of injection of tablets. Most IDUs reported obtaining their benzodiazepines from doctors, with substantial proportions obtaining capsules even after the restriction. About half the IDUs reported purchasing benzodiazepines on the street.
"Most IDUs who injected benzodiazepines reported injection-related problems.
"Limiting the prescribing of temazepam capsules may have reduced their injection by some IDUs, but additional strategies such as further restriction of capsule preparations, continued education of doctors and IDUs, and the examination of prescribing practices of individual doctors are needed to reduce the misuse among this group."
Stop press: In March this year Sigma withdrew its brands of temazepam capsules and destroyed remaining stock, following the receipt of information from concerned doctors, pharmacists and researchers on the effects of their product.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT Ms Courtney BREEN 0431 539 056
Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471