Trends in morphine prescriptions, illicit morphine use and associated harms among regular injecting drug users in Australia

Abstract

This paper examines population trends in morphine prescriptions in Australia, and contrasts them with findings from annual surveys with regular injecting drug users (IDU). Data on morphine prescriptions from 1995 to 2003 were obtained from the Drug Monitoring System (DRUMS) run by the Australian Government Department of Health and Ageing. Data collected from regular IDU as part of the Australian Illicit Drug Reporting System (IDRS) were analysed (2001 - 2004). The rate of morphine prescription per person aged 15 - 54 years increased by 89% across Australia between 1995 and 2003 (from 46.3 to 85.9 mg per person). Almost half (46%) of IDU surveyed in 2004 reported illicit morphine use, with the highest rates in jurisdictions where heroin was less available. Recent morphine injectors were significantly more likely to be male, unemployed, out of treatment and homeless in comparison to IDU who had not injected morphine. They were also more likely to have injected other pharmaceutical drugs and to report injection related problems. Among those who had injected morphine recently, the most commonly reported injecting harms were morphine dependence (38%), difficulty finding veins into which to inject (36%) and scarring or bruising (27%). Morphine use and injection is a common practice among regular IDU in Australia. In some cases, morphine may be a substitute for illicit heroin; in others, it may be being used to treat heroin dependence where other pharmacotherapies, such as methadone and buprenorphine, are perceived as being unavailable or undesirable by IDU. Morphine injection appears to be associated with polydrug use, and with it, a range of problems related to drug injection. Further research is required to monitor and reduce morphine diversion and related harms by such polydrug injectors.

The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street‐drug users

“…In Australia, recent morphine injectors were more likely to report morphine dependence (38%), difficulty finding veins into which to inject (36%), as well as scarring and bruising (27%) (8). To our knowledge, our study is the first to examine PO injection in relation to HCV transmission.…”

“…52, 5.45)), whereas the association was not statistically significant for participants who reported using both drugs (HR: In Australia and Vancouver, Canada, a reduction of heroin availability was implicated in significant shifts in drug-use patterns and possibly in increased drug-related harms (8,(27)(28)(29). In Estonia, a shift in use from heroin to POs was observed following heroin shortages in 2001 (30).…”

“…In Australia, 46% of injection drug users (IDUs) reported having used morphine in the previous six months, with significant variations across states and up to a prevalence of 85% in the northern territories (8). In a study conducted in rural Kentucky among non-medical PO users, 35.3% reported having injected POs in their lifetime (9).…”

Alcohol, drugs and Australian young people

“…While the supply of heroin has dropped, there is evidence from both the US and Australia, of an increasing use of prescription opioids by injecting drug users (35), particularly by young people. A report from Victoria studied the prescription and Medicare records of 204 young people (aged 18-24) who had died of opioid overdose.…”

Prevalence and correlates of prescription opioid residue injection

“…Reports of PO injection have risen worldwide, including in the United States (Davis and Johnson, 2008;Young et al, 2010;Surrat et al, 2011;Lankenau et al, 2012;Black et al, 2013;MateuGelabert et al, 2015), Europe (Partanen et al, 2009;Keijzer and Imbert., 2011;Roux et al, 2011), South Asia (Larance et al, 2011) and Australia (Degenhardt et al, 2006). In Canada, over the past decade, PO injection has gained in popularity among drug users across the country (UHRI, 2013; Leclerc et al, 2013;Firestone and Fischer, 2008;Roy et al, 2011;Roy et al, 2013;Bruneau et al, 2012;Fischer et al, 2006;PHAC, 2014).…”