Suzanne Nielsen | The University of New South Wales (original) (raw)

Papers by Suzanne Nielsen

Drug and Alcohol Review, Jan 1, 2009

Objectives: To examine the detection of alprazolam in Victorian heroin-related deaths (HRD), incl... more Objectives: To examine the detection of alprazolam in Victorian heroin-related deaths (HRD), including the relationship between alprazolam supply and HRD in Victoria from 1990 to 2010.
Design and setting: Population-based study of community alprazolam supply and HRD in Victoria.
Population: Heroin-related deaths reported to the Victorian coroner.
Main outcome measures: Victorian prescription supply and defined daily dose of alprazolam (DDD/1000/day), number and percent of alprazolam detections in post-mortem HRD toxicology.
Results: There was a 1,433% increase in alprazolam supply, from 0.42 DDD/1000/day in 1990, to 6.41 in 2010. A relationship between alprazolam DDD/1000/day and detection in HRD was found; for every 1 unit increase in DDD/1000/day, HRD where alprazolam was detected increased at an incident rate ratio of (IRR) 2.4 (95% CI 2.1- 2.8; p <0.001). Alprazolam was detected in increasing proportions of HRD, from 5.2% of HRD in 2005 to a peak of 35.3% HRD in 2009.
Conclusion: This study described the increasing detection of alprazolam in HRD, particularly since 2005, and a disproportionate increase in prescribing of the high dose 2mg formulation. This suggests a need to examine alprazolam prescribing and to identify inappropriate prescribing and circumstances of diversion from licit to illicit use.

The Medical journal of Australia, Jan 5, 2015

To examine trends in codeine-related mortality rates in Australia, and the clinical and toxicolog... more To examine trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths. Analysis of prospectively collected data from the National Coronial Information System on deaths where codeine toxicity was determined to be an underlying or contributory cause of death. The study period was 2000-2013. Population-adjusted numbers (per million persons) of (1) codeine-related deaths, classified by intent (accidental or intentional); and (2) heroin- and Schedule 8 opioid-related deaths (as a comparator). The overall rate of codeine-related deaths increased from 3.5 per million in 2000 to 8.7 per million in 2009. Deaths attributed to accidental overdoses were more common (48.8%) than intentional deaths (34.7%), and their proportion increased during the study period. High rates of prior comorbid mental health (53.6%), substance use (36.1%) and chronic pain (35.8%) problems were recorded for these deaths. For every two Schedule 8...

The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 2015

Induction is a crucial period of opioid addiction treatment. This study aimed to identify bupreno... more Induction is a crucial period of opioid addiction treatment. This study aimed to identify buprenorphine/naloxone (BUP) induction patterns and examine their association with outcomes (opioid use, retention, and related adverse events [AEs]). The secondary analysis of a study of opioid-dependent adults seeking treatment in eight treatment settings included 740 participants inducted on BUP with flexible dosing. Latent class analysis models detected six distinctive induction trajectories: bup1-started and remained on low; bup2-started low, shifted slowly to moderate; bup3-started low, shifted quickly to moderate; bup4-started high, shifted to low; bup5-started and remained on moderate; bup6-started moderate, shifted to high dose (Fig. 1). Baseline characteristics, including Clinical Opioid Withdrawal Scale (COWS), were important predictors of retention. When controlled for the baseline characteristics, bup6 participants were three times less likely to drop out the first 7 days than bup1...

The Clinical journal of pain, Jan 24, 2015

To examine sleep disturbances in the POINT cohort study consisting of participants prescribed lon... more To examine sleep disturbances in the POINT cohort study consisting of participants prescribed long-term opioids for chronic non-cancer pain (CNCP), and to examine the relationship between sleep and measures of pain, physical and mental health, substance use and medication use at the baseline interview. A convenience sample of 1243 participants with current CNCP and prescription opioid use were recruited from community settings and underwent a structured interview examining subjective sleep symptoms (Medical Outcomes Study (MOS) Sleep Scale and the Sleep Problems Index (SLP-9)), pain severity and interference using the Brief Pain Inventory, mental and physical health symptoms, recent substance and medication use. Linear regression models assessed independent predictors of SLP-9 scores. Median hours of sleep per night was 6 (IQR 5-7.5) with 26% reporting optimal sleep (seven to eight hours), and a mean SLP-9 score of 47.3 (SD 20.9). On multivariate analysis, age, frequent/severe heada...

Drug and Alcohol Review, 2015

Codeine dependence is an emerging public health concern, yet no studies have specifically examine... more Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower potency of codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to codeine. This is the first study to examine buprenorphine treatment for codeine dependence. Retrospective case series of 19 codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment. A significant linear relationship was found between initial codeine dose and dose of buprenorphine given at days 7 and 28 for the codeine dose range of 50-960 mg day(-1) (mean: 564 mg; 95% confidence interval 431-696 mg). Median buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 4-32 mg) at day 7 and 16.0 mg (interquartile range 13.5 mg, range 4-32 mg) at day 28. Buprenorphine doses received were markedly higher than estimated codeine doses based on standard dose conversion tables. With increasing presentations relating to codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids. [Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015].

Drug and alcohol review, Jan 14, 2015

Experiences of buprenorphine-naloxone (BNX) sublingual film injection are not well documented or ... more Experiences of buprenorphine-naloxone (BNX) sublingual film injection are not well documented or understood. We examined how people who inject BNX film seek and share information about this practice, document the methods used to prepare BNX film for injection, and report participants' experiences of this practice. Interviews were (n = 16) conducted with people who indicated that they had injected BNX film since its introduction onto the Australian market. Semistructured interviews were recorded and transcribed. NVivo10 program (QSR International) was used to analyse the data using qualitative description methodology. Participants largely reported similar BNX film preparation techniques, although the texture of BNX film during preparation to inject was reported to be unusual (gluggy), and there were many varied accounts associated with the amount of water used. Physical harms reported as associated with injecting BNX film were described (including local and systemic issues); part...

Journal of Addiction Medicine

OBJECTIVES:: Dependence on prescription opioids (PO) is a growing problem. Although most research... more OBJECTIVES:: Dependence on prescription opioids (PO) is a growing problem. Although most research with buprenorphine has focused on heroin-dependent populations, we hypothesize that individuals dependent on PO display characteristics that may predict different outcomes in treatment, particularly in short-term taper procedures in which comorbidities such as pain conditions may complicate taper. METHODS:: This secondary data analysis examined differences in outcomes between PO users (n = 90) and heroin users (n = 426) after a buprenorphine taper. Data were collected in a multisite randomized clinical trial conducted by the National Drug Abuse Treatment Clinical Trials Network at 11 study sites across the United States. After a 4-week buprenorphine induction/stabilization phase, 516 opioid-dependent individuals were randomized into 1 of 2 taper lengths (7 vs 28 days) to assess the association between taper length and outcome. The primary outcome was measured by urine drug test for opio...

The Lancet Psychiatry, 2015

Classification of patients with pharmaceutical opioid use disorder and dependence varies dependin... more Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used. We compared how WHO&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ICD-10 and proposed ICD-11 and the American Psychiatric Association&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s DSM-IV and DSM-5 classified individuals in a community-based sample of Australians with chronic non-cancer pain for which opioids have been prescribed. We studied participants in the Pain and Opioid IN Treatment (POINT) cohort, a 2 year prospective cohort study of 1514 people prescribed pharmaceutical opioids for their chronic pain who were recruited in 2012-13 from community-based pharmacies across Australia. After giving patients the Composite International Diagnostic Interview about their opioid use, we assessed which patients would be categorised as having disorders of pharmaceutical opioid use by ICD-10, the draft ICD-11, DSM-IV, and DSM-5. We examined agreement between classification systems, and tested the unidimensionality of the syndrome with confirmatory factor analysis. We included 1422 participants (median time of pain disorder 10 years [IQR 5-20]; median length of strong opioid prescription 4 years [IQR 1·5-10·0]; mean age 58 years). Similar proportions of individuals met lifetime criteria for dependence with DSM-IV (127; 8·9%), ICD-10 (121; 8·5%), and ICD-11 (141; 9·9%). Criteria in DSM-5 classified 127 (8·9%) participants with moderate or severe use disorder. There was excellent agreement between ICD-10, ICD-11 and DSM-IV dependence (κ&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0·90). However, there was only fair to moderate agreement between ICD-10 and DSM-IV dependence diagnoses, and DSM-5 use disorder (mild, moderate, or severe). There was only good agreement between moderate to severe use disorder in DSM-5 and the other definitions. Criteria for all definitions loaded well on a single factor; the best model fit was for the definition for dependence in the draft ICD-11, the worst was in DSM-5. Classification of problematic pharmaceutical opioid use varies across editions of ICD and DSM. The much lower levels of agreement between DSM-5 and other definitions than between other definitions might be attributed to DSM-5 containing an increased number of criteria and treating dependence and problematic use as a continuum. The more parsimonious ICD-11 dependence definition showed excellent model fit and excellent agreement with previous classificatory systems. Australian National Health and Medical Research Council.

Drug and alcohol dependence, 2015

There has been a well-documented increase in the non-medical use of pharmaceutical opioids (PO) w... more There has been a well-documented increase in the non-medical use of pharmaceutical opioids (PO) worldwide. However, there has been little detailed examination of treatment demand, or the characteristics of those presenting for treatment, particularly for treatments other than opioid substitution. Data from closed drug and alcohol treatment episodes from the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS, representing non-opioid substitution treatment) in Australia for 2002-2003 to 2010-2011 were examined. In the four jurisdictions where detailed data were available, episodes where heroin was the principal drug of concern were compared to episodes for the four most frequently reported pharmaceutical opioids (morphine, codeine, fentanyl and oxycodone). In 2002-2003, most (93%) opioid treatment was related to heroin with seven percent of all opioid treatment episodes reporting a PO as the principal drug of concern. In 2010-2011, 20% of all opioid treatm...

Drug and alcohol review, 2013

Clinical Medicine Reviews in Therapeutics, 2015

Drug and Alcohol Dependence, 2014

Advances in Dual Diagnosis, 2013

ABSTRACT Purpose ‐ The purpose of this paper is to examine test-retest reliability of the PsyChec... more ABSTRACT Purpose ‐ The purpose of this paper is to examine test-retest reliability of the PsyCheck screening tool. Design/methodology/approach ‐ In all, 50 drug users in their first three months of treatment were given the Self Reporting Questionnaire (SRQ; PsyCheck version) at two time points between five and nine days apart to examine reliability of the screen over time. Findings ‐ Results suggest that the SRQ (PsyCheck version) has good test-retest reliability. ICC=0.841 (p=0.000) showed strong agreement between time 1 and time 2. Practical implications ‐ The study confirms that the SRQ (PsyCheck) is a stable and reliable instrument for use within drug treatment settings. The implications of the use of screening tools not validated within alcohol and drug treatment setting are discussed. Originality/value ‐ Mental health problems, particularly anxiety and mood disorders, are common among clients of alcohol and drug treatment services and alcohol and drug workers often undertake symptom management of high prevalence disorders. The originality of this study is that the PsyCheck screening tool was designed for use by non-mental health specialists to detect common mental health problems.

Drug and Alcohol Dependence, 2015

BMC Pharmacology and Toxicology, 2014

Background: Internationally, there is concern about the increased prescribing of pharmaceutical o... more Background: Internationally, there is concern about the increased prescribing of pharmaceutical opioids for chronic non-cancer pain (CNCP). In part, this is related to limited knowledge about the long-term benefits and outcomes of opioid use for CNCP. There has also been increased injection of some pharmaceutical opioids by people who inject drugs, and for some patients, the development of problematic and/or dependent use. To date, much of the research on the use of pharmaceutical opioids among people with CNCP, have been clinical trials that have excluded patients with complex needs, and have been of limited duration (i.e. fewer than 12 weeks). The Pain and Opioids In Treatment (POINT) study is unique study that aims to: 1) examine patterns of opioid use in a cohort of patients prescribed opioids for CNCP; 2) examine demographic and clinical predictors of adverse events, including opioid abuse or dependence, medication diversion, other drug use, and overdose; and 3) identify factors predicting poor pain relief and other outcomes. Methods/Design: The POINT cohort comprises around 1,500 people across Australia prescribed pharmaceutical opioids for CNCP. Participants will be followed-up at four time points over a two year period. POINT will collect information on demographics, physical and medication use history, pain, mental health, drug and alcohol use, non-adherence, medication diversion, sleep, and quality of life. Data linkage will provide information on medications and services from Medicare (Australia's national health care scheme). Data on those who receive opioid substitution therapy, and on mortality, will be linked.

Journal of Substance Abuse Treatment, 2012

Prescription opioid (PO)-dependent treatment presentations are becoming increasingly common; howe... more Prescription opioid (PO)-dependent treatment presentations are becoming increasingly common; however, most research on the treatment of opioid-dependent populations has been conducted in heroin users. The aim of this secondary data analysis was to compare the buprenorphine induction experience of 167 heroin and 61 PO users. Results demonstrate that although the groups differed on some baseline characteristics, many of the key induction experience variables were comparable between the groups. Heroin users were found to have significantly higher preinduction Clinical Opiate Withdrawal Scale (COWS) scores (p = .014) and postinduction COWS score (p = .008) compared with the PO users. No differences between groups were found for self-reported craving and withdrawal scores, mean buprenorphine dose on Day 1, or retention at the end of the first week. The findings of this study suggest that existing buprenorphine induction practices developed for heroin users appear to be equally effective with PO users.

Drug and Alcohol Dependence, 2005

Methadone and buprenorphine are the two main opioid substitution treatments for heroin dependence... more Methadone and buprenorphine are the two main opioid substitution treatments for heroin dependence currently offered in Australia. A number of publications have implicated buprenorphine as being potentially dangerous in combination with benzodiazepines but no comparison has been made to the relative dangers of benzodiazepines combined with buprenorphine or methadone. The effect of i.v. methadone and buprenorphine on respiration was investigated by evaluating arterial blood pCO2, pO2 and pH, and measuring respiratory rate in rats. Measurements were taken at 0, 15, 30, 60, 120, 180 and 240 min after i.v. administration of methadone or buprenorphine. Effects on respiration were greatest 15 min after i.v. drug administration. The effect of methadone and buprenorphine on respiration was compared with and without diazepam pretreatment (20 mg/kg). Buprenorphine alone exhibited a bell shaped dose response inhibition of respiration; however the plateau of the dose response inhibition on respiration was lost when administered in combination with diazepam. Methadone showed a dose-dependent inhibitory effect on respiration, which was potentiated with diazepam pretreatment. While the effect of diazepam pretreatment was the abolishment of the protective bell shaped dose response effect on respiration, the effect of buprenorphine and diazepam was not greater than methadone and diazepam.

Contemporary Clinical Trials, 2013

Effective medications to treat cocaine dependence have not been identified. Recent pharmacotherap... more Effective medications to treat cocaine dependence have not been identified. Recent pharmacotherapy trials demonstrate the potential efficacy of buprenorphine (BUP) (alone or with naltrexone) for reducing cocaine use. The National Institute on Drug Abuse Clinical Trials Network (CTN) launched the Cocaine Use Reduction with Buprenorphine (CURB) investigation to examine the safety and efficacy of sublingual BUP (as Suboxone®) in the presence of extended-release injectable naltrexone (XR-NTX, as Vivitrol®) for the treatment of cocaine dependence. This paper describes the design and rationale for this study. This multi-site, double-blind, placebo-controlled study will randomize 300 participants across 11 sites. Participants must meet the DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. Participants are inducted onto XR-NTX after self-reporting at least 7 days of abstinence from opioids and tolerating a naloxone challenge followed by oral naltrexone and are then randomly assigned to one of three medication conditions (4 mg BUP, 16 mg BUP, or placebo) for 8 weeks. Participants receive a second injection of XR-NTX 4 weeks after the initial injection, and follow-up visits are scheduled at 1 and 3 months post-treatment. Participants receive weekly cognitive behavioral therapy (CBT). Recruitment commenced in September, 2011. Enrollment, active medication, and follow-up phases are ongoing, and recruitment is exceeding targeted enrollment rates. This research using 2 medications will demonstrate whether BUP, administered in the presence of XR-NTX, reduces cocaine use in adults with cocaine dependence and opioid use disorders and will demonstrate if XR-NTX prevents development of physiologic dependence on BUP.