Prevalence of hepatitis C among injecting drug users attending drug clinics.

BACKGROUND: Chronic hepatitis C (HCV) infection is an important public health issue in New Zealand, and an increasing cause of advanced liver disease. METHOD: This study examined the 2015 data on hepatitis C serology in patients on opiate substitution at four Alcohol and Drug Services, as well as rates of referral and responses to treatment for HCV. RESULTS: Among 579 patients tested, 439 (76 %) were positive for HCV antibody. For a subgroup of patients, those who reported their first use of injecting since 2010, the prevalence of HCV antibody was 48%. Among 405 patients with PCR/viral load test on file, 206 had a positive result when most recently tested. In all, 191 patients were referred for treatment, and of the 91 treated, 68 achieved viral clearance. Overall, it was found that 131 (32%) patients with a PCR/viral load test on file had cleared the HCV without treatment, as indicated by at least one negative PCR. CONCLUSIONS: HCV remains highly prevalent in injecting drug users attending these clinics, with no important reduction in infection rates from past studies. There appears to be considerable rates of spontaneous viral clearance. Nevertheless, it remains important, from individual and public health perspectives, to refer patients for treatment, which is becoming increasingly effective and safe.

Patterns of prescription drug misuse presenting to provincial drug clinics.

AIM: To survey new patients, presenting to three drug clinics, on the patterns, usage and costs of prescription pharmaceuticals. METHOD: Consecutive patients seen by the medical staff for assessment had a 7-day history recorded for prescription drug (PD) usage, and the associated costs of these from street sources. RESULTS: There were 37 patients (26 males) with a mean age of 34 years (21-51). Ten reported using only intravenous (IV) morphine, at a median dose of 105 mg/day (40-600), at a mean cost of 56 cents/mg. Another 12 reported methadone as their sole opioid at a median dose of 50 mg/day (27-70), at a mean cost of 81 cents/mg. A further 11 used a mixture of opioids, predominantly morphine and methadone but also dihydrocodeine (3), oxycodone (1), tramadol (1) and codeine (2). Seventeen reported also using hypnosedatives, but did not report high doses of these. The overall weekly expenditure on PDs was $367/week (0-2100). CONCLUSIONS: Morphine and methadone remain the predominant street opioid PDs in this region. Street prices have reduced, perhaps reflecting greater drug availability in accordance with increased national prescribing of opioids. There is continuing diversion of PDs to the street which is an ongoing Public Health issue requiring coordinated responses, including improved prescribing training, pain guidelines, drug clinic policy and actions by Medsafe, Police and regulatory bodies to contain this problem.

Drug injecting in patients in New Zealand Methadone Maintenance Treatment programs: an anonymous survey.

INTRODUCTION AND AIMS: To investigate the prevalence and nature of injecting behaviour among patients on Methadone Maintenance Treatment (MMT) programs. DESIGN AND METHODS: A self-reported questionnaire was handed to 423 patients enrolled in MMT across six clinics in the lower North Island of New Zealand. RESULTS: A total of 151 patients responded, giving a 35.6% response rate. One hundred and twenty (79.5%) respondents reported they had injected methadone while enrolled in MMT, 84 (55.6%) had injected methadone in the last year and of those 43 (35.8%) had injected methadone in the last week. Reasons given for injecting of methadone included: rapid onset of effect, needle fixation and euphoria. Time on the methadone programme was negatively associated with ever injecting methadone [odds ratio (95% CI) 0.92 (0.85-0.99), P = 0.029] and injecting other substances [odds ratio (95% CI) 0.93(0.87-1.0), P = 0.046]. More frequent pharmacy-observed consumption was associated with increased injecting of other substances [odds ratio (95% CI) 1.32 (1.09-1.59), P = 0.005] but not methadone. The time a person had been enrolled on the methadone programme was associated with decreased use of other substances [odds ratio (95% CI) 0.93 (0.87-1.0), P = 0.046]. DISCUSSION AND CONCLUSIONS: Many individuals on MMT continue to inject their methadone. In this sample, the frequency of injection of methadone did not correlate with prescribed dose or takeaway arrangements. The beneficial impact of time on the programme emphasises the importance of retention in treatment. It is suggested that these results also indicate a need for routine education concerning safe injecting.