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The film was not a drama Peter Muhleisen. This study Phase IV study QI project across HNE district Investigators: Adrian Dunlop, Peter Muhleisen, Lyn.

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Presentation on theme: "The film was not a drama Peter Muhleisen. This study Phase IV study QI project across HNE district Investigators: Adrian Dunlop, Peter Muhleisen, Lyn."— Presentation transcript:

1 The film was not a drama Peter Muhleisen

2 This study Phase IV study QI project across HNE district Investigators: Adrian Dunlop, Peter Muhleisen, Lyn Gardner, Julie Carnell, Amanda Brown, Cathy Cochrane Based on Evaluation of suboxone film implementation in drug and alcohol settings – Lintzeris N, Leung S, Paige E Describes change of medication Compares client experience Compares clinic flow data

3 Competing interests This study was investigator-led and funded as a clinical quality improvement project by Hunter New England LHD. Adrian Dunlop and Peter Muhleisen have received honoraria and travel support from Reckitt Benckiser for presenting at professional educational forums and conferences. Reckitt Benckiser had no role in the study design, data collection, analysis, interpretation of data or publication of findings for this study.

4 Was there a problem? The drug buprenorphine (BPN) Has street value and a history of misuse Tablets are easier to divert than methadone. Dose supervision is more time consuming than methadone Relatively few BPN clients can cause a service delay Delays increase incidence of aggression and stress for service users and staff. Much BPN supervision was inadequate The supervision process –is demeaning for patients and –unhelpful in building a therapeutic alliance.

5 BNX SL Film (Suboxone) Introduced 2011 Equivalent to BNX SL tablets Potential benefits: –Reduced supervision time –Reduced potential for diversion –Increased convenience –Increased efficiency for dosing points Potential harms –Clients leaving treatment –Increased harms from injection

6 Hunter New England Local Health District 900 clients in opioid substitution treatment Almost 200 clients are dosed at 3 clinics, –Newcastle >100, –Cessnock and Taree ~30-50 each Total numbers in buprenorphine treatment around 200 in the district >75% clients dose at community pharmacies Reviewed 3 monthly minimum

7 Methods Clients were offered transfer to film at scheduled program reviews from September 2011 to April 2012 Voluntary participation in this study No inducements Questionnaired pre transfer (or refusal) and At next scheduled review in 3 months About 22% participation

8 Transfer for clients dosing at NPS

9 Cessnock (all prescribed BPN clients)

10 Study Participants at entry Newcastle 14 clients in study, all from BNX tablets Cessnock 22 clients, from 17 BNX tablets, 4 BPN tablets, 1 MTD Tamworth 4 clients, from 3 BNX tablet, 1 BPN tab Taree 6 clients all from BNX tablets

11 ATOP drug use at entry (compared to historical control BNX day 84 2009)

12 Client perception of previous treatment Visual analog scale of 100 mm Ease taking dose Av 76.2 (± 23.9) TasteAv 35.3 (± 26.8) SatisfactionAv 75.8 (± 27.1)

13 Clients’ feeling about change Extremely happy1128.2% Somewhat happy13 33.3% Indifferent1025.6% Somewhat unhappy37.7% Extremely unhappy25.1% N=39, 1 did not answer, 6 did not change Reasons given Save time 70% Takeaway access40% Taste65%

14 Reasons to not transfer Won’t hold3/6 Happy now4/6

15 Time at dose point

16 Supervision time

17 Post transfer data 15 of 22 clients at Cessnock PS transferred to film and completed second questionnaire 6 clients transferred from BNX tablets to film at Taree, less happy to change than at Cessnock

18 Drug use before and after change to film n =21

19 Health & Quality of Life n =21

20 Side effects n=21 χ2 analysis No sig differences p > 0.17

21 Client appreciation of drug n=21

22 Client feeling about change (pre and post) n =21

23 Time taken in the clinic and dosing n = 21

24 Treatment outcomes (Sep 2012) n =42 37/42 remain in treatment, 34 at the clinic. Of the 36 who transferred to film voluntarily 30 remained in treatment. 1 transfer to MTD, 1 returned to tablets, 1 to GP still in tx, 1 dropped out, 1 completed withdrawal Of 6 clients that did not wish to change two were incarcerated one involuntary transfer to film and one dropped out of treatment. One client still in BNX tablet treatment, 1 remained in Methadone treatment. Overall 88% remain in tx, 83% of those transferred still in film treatment

25 Newcastle Clinic flow : average 93 doses per day

26 Time taken to dose Calculated from drug register entries * statistically significant MonthBNX tabletsBNX film October 20113m 45 s ( ±2m) January 20124m 16s (±1m 29s)* 3m 40s (±2m 06) April 20123m 06s (±1m 44s)*

27 Time to Dose cumulative % of clients

28 Evidence of harm 2 reports of injecting by clients not currently in treatment (1 with neck abscess) One report of acquisition by a client unable to attend Report by staff member of sachets being seen in public place 3-5 reports of attempted diversion of film* Reports of BPN diversion reduced from 1.8 inc/month in 2011 to 0.6 inc/month, of which over half are still tablets No reports back from other clients of mouth diversion Reports that “quite a process to prepare for injection” 1 report of sublingual blisters ( on 15/11/12) to investigate

29 Conclusions Transfer easily managed as part of regular program reviews Use of film Slightly reduced dosing time, Slight increase in clinic flow Reduced inadequate supervision of BPN dosing Clients reported increased satisfaction with film dosing, film dosing was slightly quicker and 67% were happy with the change none unhappy These clients remained stable in treatment, little evidence of negative consequences. Slight changes likely to be more significant in pooled data

30 The film was not.. A drama A farce A tragedy A horror movie A western ( no cowboys yet) An epic And IT SO COULD HAVE BEEN!

31 Off you go! … –( as we can now say to our BMT patients) Nothing to see here.. Credits Cathy Cochrane Julie Carnell, Amanda Brown, Rose Gray, Lyn Gardner

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