Association of benzodiazepine injection with the prescription of temazepam capsules.

Temazepam capsules have become a popular choice for benzodiazepine injection by injecting drug users, and serious vascular and tissue damage leading to ulcers and gangrene can result. We compared the self-reported benzodiazepine injecting behaviour of 91 heroin users with their Pharmaceutical Benefits Schedule (PBS) records for the preceding 5 years. We found that individuals prescribed PBS temazepam capsules were more likely to report injecting benzodiazepines than individuals who had either not been prescribed PBS temazepam capsules or had been prescribed PBS temazepam tablets. These results provide empirical support for the argument to limit the prescription and supply of temazepam capsules in Australia.

Seeking drugs or seeking help? Escalating "doctor shopping" by young heroin users before fatal overdose.

OBJECTIVE: To identify prescription drug-seeking behaviour patterns among young people who subsequently died of heroin-related overdose. DESIGN: Linkage of Medicare and Pharmaceutical Benefits Scheme and Coroner's Court records from Victoria. SUBJECTS: Two hundred and two 15-24-year-olds who died of heroin-related overdose between 6 January 1994 and 6 October 1999. MAIN OUTCOME MEASURES: Patterns of use of medical services and prescription drugs listed on the Pharmaceutical Benefits Scheme in the years before death, and use of all drugs just before death. RESULTS: Polydrug use was reported in 90% of toxicology reports, and prescription drugs were present in 80% of subjects. Subjects accessed medical services six times more frequently than the general population aged 14-24 years, and more than half of all prescribed drugs were those prone to misuse, such as benzodiazepines and opioid analgesics. A pattern of increasing drug-seeking behaviour in the years before death was identified, with doctor-visitation rates, number of different doctors seen and rates of prescriptions peaking in the year before death. CONCLUSIONS: An apparent increase in "doctor shopping" in the years before heroin-related death may reflect the increasing misuse of prescription drugs, but also an increasing need for help. Identification of a pattern of escalating doctor shopping could be an opportunity for intervention, and potentially, reduction in mortality.

Overdose in young people using heroin: associations with mental health, prescription drug use and personal circumstances.

OBJECTIVE: To identify patterns of mental health, prescription drug use and personal circumstances associated with heroin overdose in young people. DESIGN: Linkage of data on use of Pharmaceutical Benefits Scheme (PBS) prescription drugs with data from a self-report questionnaire. SETTING: Inner metropolitan Melbourne, Australia. SUBJECTS: 163 young people, 15-30 years, using heroin. MAIN OUTCOME MEASURES: Personal circumstances, mental health (as measured by various scales), and PBS-listed prescription drug use. RESULTS: Young people using heroin reported high rates of feelings of hopelessness, depression, antisocial behaviour, self-harm and diagnosed mental illness. A prior history of overdose was associated with previous mental illness, which in turn was associated with being female, having poor social support, being dissatisfied with relationships, and living alone or in temporary accommodation. While feelings of hopelessness and antisocial behaviour were strongly associated with overdose history, the number of PBS prescription drugs used had a very strong relationship with overdose, particularly benzodiazepines, other opioids, tricyclic antidepressants and tranquillisers. CONCLUSIONS: Further research to explore causal relationships between prescription drugs and heroin overdose is warranted. Improved data linkage to PBS records for general practitioners may facilitate safer prescribing practices.