Accessing opioid pharmacotherapy in Australia

Every day, hundreds of Australians are impacted by opioid-related harms.¹

If you, or someone you know, is dependent on opioids, you may be wondering what treatment options are available.

One of the more common and successful treatment options is pharmacotherapy - where health conditions are treated with prescribed medications.²

What is opioid pharmacotherapy?

Opioid pharmacotherapy is the use of medications to treat opioid dependence.

It involves replacing opioids that are short acting (such as heroin or oxycodone) with a longer-acting, medically prescribed substitute (such as methadone or buprenorphine).³

The person is still dependent on opioids - but the longer-acting medication helps them stop or reduce their use of shorter-acting opioids, reducing the risk of related harms.³

The goal for some people who are dependent is to stop using opioids entirely.³ But for many, completely stopping use is very challenging, and long-term pharmacotherapy can provide the best outcomes.³

There are many different names for opioid pharmacotherapy, and no national agreement on which term to use. Here, we use the term ‘opioid pharmacotherapy program’.

Other names include:

• Medication Assisted Treatment for Opioid Dependence (MATOD)
• Opioid Substitution Treatment (OST)
• Opioid Maintenance Program (OMP)
• Opioid Replacement Therapy (ORT)
• Opioid Dependence Treatment (ODT)
• Opioid Agonist Medication (OAM)
• Opioid Agonist Treatment (OAT).

What opioid pharmacotherapy medicines are available in Australia?

Methadone and buprenorphine (also known as bupe) formulations are the most common medications prescribed for opioid dependence in Australia.⁴

Both are usually taken daily, by mouth, under supervision at a clinic or pharmacy. Sometimes take-home doses are also allowed.

Buprenorphine also comes in a long-acting injectable form (LAIB), where those prescribed receive a slow release injection weekly or monthly.⁵

These medications are safe and effective for treating opioid dependence, and are listed as essential medicines by the World Health Organization.⁶

People may start on one medication and later switch to another - for example moving from methadone to buprenorphine.³

Which medication is best for someone should be a shared decision made by the individual and their prescriber, and informed by a person’s preferences and treatment goals.³

Naloxone

Naloxone temporarily reverses an opioid overdose.⁶

It should be carried by anyone who is currently taking opioids (including pharmacotherapy), and their friends and family. It is available for free over the counter from most local pharmacies, and can be administered by anyone.⁷

How can I access pharmacotherapy?

The following steps can help guide someone who wants to access opioid pharmacotherapy.

1. Learn more about it. Read articles, talk to people who have tried or are currently on opioid pharmacotherapy, and get information and resources online or from state/territory-based Drug User Organisations.
2. Make notes to bring to the prescribing appointment. Include any questions and which treatment you believe is right for you and why. This should be informed by the information gathered in Step 1.
3. Make an appointment to see a pharmacotherapy prescriber. 
   If you want to start/re-start on methadone or buprenorphine taken by mouth, before seeing the prescriber you will need to identify a daily dosing point that is willing and able to service you.
   If you want to start/re-start on LAIB, you’ll need to know the prescriber’s system for administering (e.g. can they provide the injection on-site or do you need to attend a different location to receive the injection). It can be helpful to ask this when making the appointment with the prescriber.

Most Australian states and territories have services specifically funded to help people access pharmacotherapy prescribers and dosing points.

Call the National AOD Hotline or visit AIVL’s website for a table of services and their contact details.

What are some of the barriers to accessing and maintaining pharmacotherapy?

Opioid pharmacotherapy has been available in Australia for over 50 years.

Over time, things like additional medications becoming available and cost reductions have improved access - but there are still significant barriers.

• Access
  Especially in rural and remote regions, access can be impacted by:
  • travel time and costs due to lack of prescribers and dosing points
  • different prescribing regulations across jurisdictions, making interstate and international movements or travel challenging
  • limited opening hours at dosing points
  • inflexible workplace conditions that prevent someone from being able to attend dosing
  • fewer health professionals prescribing pharmacotherapy.

Access to pharmacotherapy also varies widely in custodial (e.g. prison, police cells) and residential treatment settings.^{8, 9}

• Knowledge and awareness
  Most people who use opioids are aware of pharmacotherapy, but some:
  • don’t know how or where to access it
  • have stereotypes and misconceptions about it
  • don’t receive information from healthcare workers, as some workers also have misconceptions or a lack of knowledge.⁹
    
• Other supports
  A lack of support for a person’s multiple and complex needs can also be a barrier to access.
  Opioid pharmacotherapy works best when combined with other supports that meet a person’s wants and needs, including:
  • housing
  • food
  • financial
  • legal
  • employment
  • mental health
  • support groups
  • counselling
  • behavioural therapies.^3,8

How can barriers be reduced to improve access to opioid pharmacotherapy?

LAIB can reduce some access barriers as daily dosing isn’t needed. It reduces the number of visits to the pharmacy, clinic or doctor and can make short term travel (up to 4 weeks), securing employment or attending other appointments easier.⁹

But addressing knowledge and awareness barriers is more challenging, and requires clear messaging that:

• Opioid pharmacotherapy is an effective treatment for opioid dependence.
• Opioid pharmacotherapy should be accessible for those who want it.
• There are organisations and resources available to support people looking to access opioid pharmacotherapy.

More information on pharmacotherapy

For more information, read our guide on opioid pharmacotherapy. And, check out some further resources below:

• Consumers’ Guide to the OTP: From the NSW Users and Aids Association (NUAA), written by and for people who use drugs, that tells you what to expect on the OTP and what is expected of you.
• Changing Lanes: A series of four videos by Harm Reduction Victoria to assist with the decision-making process.
• Lives of Substance: Experiences of people who use or have previously used heroin, including their experiences accessing pharmacotherapy and other treatments.
• Drug Overdose Peer Education (D.O.P.E): https://www.hrvic.org.au/pharmacotherapy-video-projectDelivers peer-based overdose education to people who use illicit drugs. Overdose training sessions are available for staff and clients.

This article is based on our opioid pharmacotherapy guide, which was developed in collaboration with Pharmacotherapy Advocacy Mediation Support (PAMS).