Opioid pharmacotherapy treatment (OPT)
This section begins by presenting experiences of accessing treatment. Experiences of treatment with specific opioid pharmacotherapies are discussed next. We begin with accounts of methadone maintenance treatment (MMT), the first opioid pharmacotherapy treatment to be introduced in Australia (in the 1970s). We then present experiences of treatment with buprenorphine (Subutex®), which was introduced in Australia in 2001. Lastly we present experiences of treatment with buprenorphine naloxone (Suboxone®), which was introduced in Australia in 2005 but is now more widely prescribed than buprenorphine.
Australia has a significant demand for OPT and many of our participants, keen to commence treatment and access its benefits, describe difficulty accessing treatment. They often persevere for some time and travel long distances to secure access to treatment. In Australia, pharmacotherapy is delivered through dedicated, government-funded clinics, private clinics, community pharmacies and GP prescribers. Most states and territories have a combination of government-funded clinics, community pharmacies and GP prescribers. A few of our participants say they find it especially hard to access OPT outside major cities. Having to queue for a long time to get their dose from a prescribing clinic or chemist was a concern for several people. It was suggested that clinics employ more clinical staff to cope with the demand and reduce waiting times. In most states in Australia, doctors must apply for approval to prescribe OPT before they can prescribe, but some states (e.g. Victoria, South Australia, New South Wales) are granting exemptions to increase the number of buprenorphine-prescribing doctors to facilitate access to treatment.
Affording OPT on top of other regular expenses was also an issue in some cases. In Australia OPT consumers have to pay a ‘program’ or ‘dispensing’ fee to the prescribing chemist or clinic – this can be an additional $15 to $90 per week and is not subsidised by Medicare. Research has found that dispensing fees can be a significant financial burden for pharmacotherapy clients on fixed incomes or welfare support and contribute to people prematurely dropping out of treatment due to financial stress. Experiences of stigma and discrimination when accessing OPT at chemists or clinics were also described and in some cases, this discouraged people from seeking or continuing treatment.
Despite these issues, many stress the value of OPT and describe the difference it makes in their lives. As Nick (M, 50, not working due to illness, heroin) puts it:
I’m on methadone as well, which is, you know, to get off heroin. But I am not on a very large dose. If you haven’t got methadone to back you up, where it takes away the withdrawals, there is no other choice but to use the drug to feel normal, which is a shame […] The best way to stop using heroin […] is methadone and Suboxone and Subutex and all those things that they have got available now […They’re very helpful in] managing withdrawal symptoms.
Josie (F, 38, not working due to illness, heroin) makes a similar point:
The methadone does make a difference […] Now I only use [heroin] once a week or whatever, but I’m not chasing and trying to do anything I can to get on […The methadone] doesn’t take [the withdrawals] away but it does make a difference. It’s bearable, you know. It sort of gives you that calm feeling […] I need to either have my methadone or my gear [heroin] to get me going for the day.
Grace (F, 58, works in manufacturing, heroin) and her partner find it hard to access OPT in their local town so they travel to the nearest major city for it. (Played by an actor)