Barriers to access
There are identified barriers to accessing opioid pharmacotherapy in Australia, particularly relevant in rural and remote regions.
Some of these barriers can be addressed using LAIB instead of methadone or sublingual buprenorphine.
| Barrier | Why? | Addressed by LAIB? |
|---|---|---|
|
Geographical /lifestyle |
People experiencing opioid dependency may have living situations that make it difficult to visit a pharmacy daily. This might include: · lack of service providers in their area · travel costs, and time spent getting to and from dispensing point · restrictiveness or lack of freedom with regular dose collection · inflexible work conditions that cannot accommodate time away.[17] |
Yes – because LAIB doses only require weekly or monthly injections. The client does not have to attend a clinic or pharmacy daily. |
| Costs |
Like most medications, methadone and buprenorphine are subsided under the Pharmaceutical Benefits Scheme (PBS). However, private dispensing charges are allowed by state and territory governments through pharmacists and doctors. This can cost a patient around $35-$50 a week if they are receiving daily doses. This cost compares with approximately $6.00 per monthly script for someone with a healthcare card who requires ongoing treatment and medication for any other chronic condition. Dispensing fees are a major barrier to people remaining on pharmacotherapy treatment. They present a significant financial burden for clients on fixed income, disability benefits or welfare support.[17,24] |
Yes – patients will still be charged dispensing fees, however, it would be on a weekly or monthly basis, as opposed to daily. This results in a significant cost reduction. |
| Stigma |
Many people accessing pharmacotherapy experience stigma in a number of different ways, which can turn them away from treatment. This includes stigma from: · family and friends · employees in pharmacies or clinics where methadone or buprenorphine is dispensed, as well pharmacotherapy prescribers and GPs · the community – this can be intensified if the person is living in a small town where anonymity is limited.[17] |
Yes – only having to attend a dosing point on a weekly or monthly basis can remove daily interactions at a pharmacy, clinic or with a doctor – where a person may feel stigmatised. This reduces opportunities of ‘being seen’ in the community. |
| Lack of additional support |
People who are opioid dependent may have multiple and complex issues, for example, housing, legal, employment and mental health.[10] It is important that people receiving pharmacotherapy treatment are provided wrap-around support services if they present with complex issues - the lack of such support can result in a barrier to remaining on treatment.[10,17] |
Some people may benefit from the daily interaction associated with attending a pharmacy. The reduction in health care interaction needs to be considered when prescribing monthly LAIB. |
Accessing opioid pharmacotherapy for young people
Although opioid use is less common in younger age groups, there are still young people who will present to community counselling and outreach services, detox clinics, residential rehabilitation and other youth services with opioid use and dependency issues. In most cases, the young person is likely to be using other drugs in combination with opioids.
If a young person wishes to access pharmacotherapy, they will need to be put in contact with a prescribing doctor. Some organisations will have an overdose prevention team, or equivalent, who specialise in being able to locate opioid pharmacotherapy prescribers. Alternatively, individual workers may have to locate prescribers themselves. Workers can call doctors on behalf of the young person and schedule appointments.
There are a number of specific barriers youth AOD workers and their young person might face when trying to access opioid pharmacotherapy, such as:
- Difficulty locating a prescriber: This includes being able to find a close prescriber and also finding one suitable to the young person’s current situation (e.g. one that is close enough to where they live, as a young person may not have transport options).
- Unwillingness to prescribe: Even if a suitable prescriber is located, some doctors may be hesitant to prescribe methadone or buprenorphine to a young person because of their age, and the stigma attached to people who suffer from opioid dependency.
- Dosing: If a prescription is approved, correct dosing can still be a challenge. Again, a doctor may be wary of the young person’s age and unwilling to approve a larger dose – even if it’s required to better stabilise the young person.
Internal stigma can also impact a young person’s personal decision to go on opioid pharmacotherapy, as opioids are largely considered by society as an ‘adult drug’. Therefore, the need for pharmacotherapy can be difficult for a young person to accept.
This page was informed by expert insight from Uniting Vic & Tas and Odyssey House Victoria.