The sources of pharmaceuticals for problematic users of benzodiazepines and prescription opioids.

OBJECTIVES To describe benzodiazepine and prescription opioid use by clients of drug treatment services and the sources of pharmaceuticals they use. DESIGN Structured face-to-face interviews on unsanctioned use of benzodiazepines and prescription opioids were conducted between January and July 2008. PARTICIPANTS Convenience sample of treatment entrants who reported regular (an average of ≥ 4 days per week) and unsanctioned use of benzodiazepines and/or prescription opioids over the 4 weeks before treatment entry. SETTING Drug treatment services in Victoria, Queensland, Western Australia and Tasmania. MAIN OUTCOME MEASURES Participant demographics, characteristics of recent substance use, substance use trajectories, and sources of pharmaceuticals. RESULTS Two hundred and four treatment entrants were interviewed. Prescription opioids were predominantly obtained from non-prescribed sources (78%, 84/108). In contrast, medical practitioners were the main source for benzodiazepines (78%, 113/144). Forging of prescriptions was extremely uncommon. A mean duration of 6.3 years (SD, 6.6 years) for benzodiazepines and 4.4 years (SD, 5.7 years) for prescription opioids was reported between first use and problematic use--a substantial window for intervention. CONCLUSIONS Medical practitioners are an important source of misused pharmaceuticals, but they are not the main source of prescription opioids. This has implications for prescription drug monitoring in Australia: current plans (to monitor only Schedule 8 benzodiazepines and prescription opioids) may have limited effects on prescription opioid users who use non-prescribed sources, and the omission of most benzodiazepines from monitoring programs may represent a lost opportunity for reducing unsanctioned use of benzodiazepines and associated harm.