any suggestions or comments?
Two issues:
1 - There needs to be a great deal more flexibility with take away (TA) doses. There need to be more of them, and they need to be given out earlier and at more regular intervals. What's the point of a program which is supposed to help people stabilize their life when in return it just ties them to their pharmacy/clinic? This causes an endless list of problems with work, study, social life, travel, etc. Even after you reach the maximum of 22 TA's a month after
18 months on the program, you still have to pick up your dose twice a week. They could easily increase it to 24 or 25 and allow the patients to only have to go once a week. This might not seem like a big deal, but after 18 months, let alone longer, you grow very, very tired of having to constantly pick up your dose (and this is speaking as someone with only a short travel time and a polite pharmacy which doesn't make me wait, I can only imagine how bad it is for those who travel an hour or even more, or deal with rude and discriminative pharmacists).
There should also be a much more even curve, instead of leaving massive 6 or 9 month gaps between increases, the extra TA's should be gained more gradually, every month or two. This provides a constant incentive to continue with the program, instead of knowing your TA doses won't be increased for half a year or more. Staring at a 6 month wait until you can at least not worry about having to go to the pharmacy at all on the weekends isn't much fun.
The current system is, iirc:
Months 1 - 2: 0 TA's
Months 3 - 9: 6 TA's
Months 9 - 18: 12 TA's
Months 18+: 22 TA's
A far more reasonable and effective system would be (for example) to give 6 TA's after one month, then an extra TA every month until the patient reaches 18 months. This provides a constant incentive - every time the patient renews their script, they know they're getting more freedom and earning more trust, instead of leaving massive plateaued gaps of months between large increases. It would also cap out a little higher, allowing patients to pick up once a week instead of twice (that might not seem like a big difference, but it is, even for someone like myself who only has a 10 minute walk to pick up their dose).
Alternatively, they could just prescribe the way they do any other medication, and give people a months supply at a time, either immediately, or after a certain amount of time on the program. I know this is unlikely (although they do it for suboxone in America and it works just fine there - and the US is hardly a bastion of progressive addiction treatment), but I believe the risk of extensive diversion would much lower than it's made out to be, especially for suboxone.
2 - The cost is exorbitant. It's well known that a large portion of the people on ORT survive on centrelink. The reasons for this are varied - some are unable to work while they seek treatment to address the issues which lead to their addiction in the first place, some are studying at TAFE or University or doing some kind of trade training program to get their life and long term career and income back on track. Regardless of the reason, paying between $5 and $10 a day results in a huge drop in income for people on benefits, or indeed, even for people working lower income jobs. Full time students, for example, get $380 a fortnight from centrelink, so the cost adds up to between 1/4 to over 1/3 of their income - on top of which they have to pay for transport, food, communication, and potentially rent. Even if they work part time on top of their student allowance, it's still a very tight squeeze, and only adds to the stress of study. I imagine it would be even worse for those who have children and are trying to put their family back together, or those who ended up with a criminal record as a result of their addiction and are unable to find work because of it. No matter where the patient is in life, it's almost certain that someone newly arrived on ORT is losing a big chunk of their income to the daily fee.
And for all that, what exactly is the $280 - $560 a month paying for? It can't be the medication itself - after all, a box of oxycontin or another strong opioid costs between $5 and $15 for a month's supply. If pain patients can be treated for that much, I don't see the justification for people on ORT therapy (many of whom have been pain patients in the past, or suffer from pain issues which lead to their addiction) paying a price so many times higher for their own medication. And it can't be the customer service at the pharmacy patients pay for, otherwise they would only have to pay for the days on which they attend the pharmacy, and not for days for which they are given a TA dose. There's no logic behind the absurd prices, and they're only counterproductive in the goal of keeping patients on ORT and off street opioids.
