Report From Tasmania August 1998

Dr Dolophine

Often when I read patients' reports in MA newsletter (a fantastic publication, by the way), I count my blessings that I live in Australia. There are varying degrees of quality throughout Oz as far as Methadone Maintenance Treatment goes, but generally it seems to be much much cheaper and far less institutionalized and entangled in red tape than the USA. While I have only had 1st hand experience of the program in Melbourne (Victoria) and Hobart (Tasmania), I have heard a lot of anecdotal evidence about other States. Currently I am on the program in Hobart, probably the best set-up MMTP in Australia. In Tasmania the MMTP is privatized, that is to say it works like this: each month or two I visit my GP, who is a licenced methadone prescriber, to talk about how the treatment is going for me and to renew my script for another couple of months. Each day I visit my pharmacy (drugstore) and have my dose, sometimes collecting take home doses. And that's all there is to it!!

Counselling is available should I feel a need for it, but definitely not compulsory. I can choose any licenced methadone prescriber as my GP and pick my dose up from any of a large number of dispensing pharmacies. I have to go to the same one each day, but can change to another pharmacy any time I wish. My dose costs me $3.50 a day, and I have a credit account with the pharmacy which I pay monthly. The chemist and staff there are friendly and discreet. During the 3 and a bit years I have been on the program in Hobart I have never had to provide a urine sample, and certainly I would not be penalized for having taken an illicit substance. In fact, right from the start I have been honest with my GP, telling him straight out if I had used at all since my last visit, and far from expelling me from MMT, he would be more likely to increase the dose - If I felt this would help and he agreed. Both the doctor and the chemist have been very flexible with my treatment. I have a fast metabolism, and now split my dose of 120 mg per day into 2 doses - one I have at the pharmacy and one I take home for later that day, including 2 whole day take home doses for the weekend. Splitting the dose has really worked for me, before that I was just increasing and increasing the dose, because it just wouldn't last the 24 hrs. Since I split the dose I haven't had to increase once in nearly a year.Thanks to Methadone, I have a stable family life with my wife and child, a job that I enjoy and time on my hands to really enjoy life.

Anyway, what prompted me to put finger to keyboard was A.M. Black's letter "Wrong Dose" in the September issue. On a few occasions this has happened to me, but with entirely different and satisfactory outcomes. Once, I walked into the back room of the pharmacy to receive my dose (no windows or shutters!), The chemist handed it to me in the usual plastic cup. I glanced at it, and it did look less than usual, but I wasn't sure. When I got it in my mouth I was certain it was not correct. I said to the pharmacist, "uh Terry was that two squirts in that cup or only one?... only, it didn't feel like the right volume in my mouth. "He stopped and thought and said " Hmm... actually, I'm not sure I did put two in", then measured out the remainder of what the dose should have been and gave it to me.Another time, I took my take home portion of my dose out into my car, and unscrewed the lid just to see if it looked right. (Take homes are mixed with water -about 50/50). It didn't look right- seemed too light a color. I took the bottle back inside the pharmacy and asked the chemist if he'd mind measuring me a new dose, as I thought this one wasn't right."No worries", he said "I'm sure its right, but better safe than sorry". He measured a new dose out. I compared the bottles and realized the dose had been correct.
"Sorry Greg", I said " It just didn't look right. Save the other one for me for tomorrow."
At no time was I put-down or made to feel embarrassed.This demonstrates the trust that can develop when MMT patients are treated as equals, as the same as any other customer purchasing necessary medication and on a level of one human to another.
There are of course down-sides to Australia's drugs policy in general. While harm minimisation is the cornerstone, there are still elements of the people with political power who consistently push for a Nancy R. styled "just say no" - zero tolerance drug policy. Thus a promising Heroin trial in Canberra -the nation's capital- was scrapped, and subsidies for treatment programs were withdrawn to fund a "war-on drugs" approach to combat increasing Heroin Use and Heroin related deaths.

[Update: The New South Wales state government have recently set up "safe injecting rooms" in Sydney as a trial. To date I have no information on progress]

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