Opiate Maintenance in Australia: Difference Between States

[DoctorShop]

Just thought I'd start a thread about this topic. I have been under an opiate maintenance program in two states (I moved from Melbourne to the Gold Coast). And the differences were interesting.

In Melbourne, I was able to go into my appointment with my partner. She would ask us if we were on the right dose and if we needed anything for anxiety, depression or simply so I could sleep at night. After a few weeks I was able to get 5 take-aways a week (subuxone). The only thing I disliked about this doctor and her clinic was that it was always full of people and most of them were quite unsavoury. Carrying on in the waiting room and asking people for smokes all the time. It was quite uncomfortable sometimes.

The Gold Coast was a lot different. I think it's because it's Government run in Queensland. For a start I had to have a separate appointment by myself. They would not offer to prescribe anything. And when I asked if she could fill an anti-depressant prescription for me she said she couldn't. When I told her I'd had five take-aways in Victoria she said I would need to build up trust before I could get that many. After three months I was finally allowed a take-away for Sunday. I don't understand why they are so harsh when 1) My doctor faxed them a letter saying I was very committed to the program, have had no slip ups and never caused any problems at her clinic and 2) They can see from my previous doctor that I was on five take-aways so I had already established 'trust' even if it was at another clinic.

The one thing I liked about the Gold Coast clinic is other patients keep to themselves and do not bother you. I think this is because they are staffed by prison workers and they have a no tolerance rule against harassing other people and the staff either physically or through verbal threads.

What have been your own experiences in your own state? Regardless of whether you are on subuxone, methadone or whatever, I would like to read your stories.

 

[Dr.Genomics]

I am on Suboxone maintenance and spend about half the year in Sydney for university and the other half in Melbourne to visit family and work. The difference between the programs is really significant.

Melbourne: managed to get referred to a great doctor whose rooms are quite pleasant with no hassle from any of the other patients, in fact a few of them are characters that are often worth a bit of a chat. I have been through two pharmacies, one in an upper-class area, and the other in a lower-class area. The former I believe only one other guy on the program apart from myself (I got in on family medical connections), so it was all very smooth, the latter pharmacy I think put through about 200 a day! The owner was a genuinely caring man who I don't think could ever bring himself to say "no" to the calls from he addiction specialists. He would even take the time to see how my study was going and give me encouragement when feelings shit.

As far as takeaways went I was getting 3 a week and there was never any urine scans except for occasionally at the doctors. Doses were $5 each/day.

Sydney: got into a "private" clinic after withdrawing for 4 days as all the public ones were full. All this means is that it costs $50/week which was fine. There is almost a mechanical method up here. It is in this converted terrace half-house and pretty seedy inside with ripped off wall-paper, security cameras, a big window between you and the attendant with drilled holes to speak to & hear each other and they give you each dose through this sliding gadget so they never really have to have any contact with the "filthy junkies". Most of the people who work there are unfriendly, some with the look of the self-righteous Samaritan on their face who make sure you know how much of a piece of filth you are (why do they even take the job with that attitude?), but usually just a scowl. I guess they do have to put up with the constant "ohh I will pay youse tomorrow love, I promise" from every second patient. Having said that there is ONE very friendly lady who talks to me about anthropology books and identifying butterfly species

Anyway, after an accumulated year of time on the Sydney program I am still not allowed any takeaways, no idea why not? I am not even allowed to lower the dose... however they do let me take a "double-dose" so I only have to come in every second day, which has the downside in that it makes you drowsy. There are semi-frequent urine-checks from the in-house doctor (who is very approachable), some of the people are really rough and often smell like urine and garbage. I even saw I guy in the waiting room spit out a Suboxone tablet and fix it up in front of everyone (have no idea if he died but highly likely)

There is one very important advantage to the Sydney system: speed & efficiency, no waiting around 20 minutes after the dose so the pharmacist can make sure you don't OD.

In conclusion they're both shit in their own unique and twisted way, this is the price one pays.

(Sorry if this doesn't read well, I have not slept in 23 hours).

 

[DoctorShop]

Great post! Thanks for talking about your experience. I was especially interested in the information about Sydney.

Hope to read about others experiences soon

 

[boodha]

here is a very good resource for information on the program in W.A

http://www.health.wa.gov.au/cpop/publications/

pretty much everything you would need to know in there,

I would be very interested in actual experiences in the program in W.A specifically though.(some things a "report" will never be able to tell you)

 

[ayjay]

It sucks that in AUstralia they rolled out buprenorphine along much the same lines as methadone. this was done for expediency - to simplify getting a new treatment out there. however - bupe has a much better safety profile than methadone. a takeaway 'done does will kill anyone without a habit, so it makes sense to be careful dispensing it. bupe, on the other hand, is safer than morphine and oxycodone. so it would be heaps better if you could just pick up a box of bupe once a month from the chemist. one day maybe....

 

[Jabberwocky]

^and i hope it's soon.

i'd rather be on buprenorphine for my pain management but it's easiest for me to have oxy prescribed along with muscle relaxants and benzos. i had allergic reactions the the norspan patches available for pain management

i haven't spoken to a doctor yet who's willing to prescribe me either subutex or suboxone for PM; i have to be registered as an addict, otherwise it's put up with the migraines and allergic reaction of the patches if i want bupe.

i'm in qld like doctorshop so he's pretty much explained the government run clinic side of things from my experience. the privatised side sounds very similar, with takehomes easier to earn the longer you're in the program showing proper commitments. it's always going to b e a different experience in different regions and doctors.

it's easier for me to go see my doctor every 10 days for my oxy, etc

 

[DavisK4high247]

From the US here.I used to be prescribed methadone for chronic pain and it was harder to get off of than heroin was.(I was a heroin user before i had my accident which led to the chronic pain). I was prescribe 30mg of methadone and 60mg total of OxyContin a day plus Soma pills (muscle relaxer).Anyway I had an 8 hour surgery after 6 or 7 months on the chronic pain meds,and I finally quit all opiates in about 2 months after the surgery by tapering down off OC's and finally hydrocodones,tapering off them till I had nothing and I kicked cold turkey and the first 2 weeks were physical hell,then there were months og mental cravings etc..I had been using opiates for a total of 6 years daily before the accident I had and the later surgery. Now 4 years removed from opiates I no longer have any desire to use.This is because I severed ties with friends that took opiate pain meds,or heroin,and stayed around only marijuana smokers,drinkers and speed users..

 

[Mr. Squiggle!]

K Dude, me being a Queenslander myself, you NEED to go and see a Sub/Methadone doctor. Not your local GP, I'm talking in the mix in Highgate Hill, South City 7 Day Medical Centre. The doctor there will help you out, even though he prefers Subutexone or whatever that shit is to Methadone, and you have to rock up to your nearest dispensing pharmacy, shouldn't be a problem.

 

[aussiejames]

I live in Sydney and have been on program for about 7 years (this time). I spend about 4 months getting dosed at a private clinic with 1 take away a week after 3 months then 2 a week for the next month.

With 3 months of clean urine (4 random tests over that time) i was able to transfer doctor to a prescribing GP in my local area and community pharmacy. Upon transfer i was then able to get 3 take aways a week for around the next year then upped to the 4 max a week.

My doctor is great (there are one or two out there), he treats me like the intelligent human being that i am. The only area i have had trouble has been with the dosing point. The first 2 years were golden, the old guy who ran the pharmacy was fantastic, polite and generally a great person who cared for his clients. Then came the indian. Ok to deal with but not overly nice. No "how are you" or anything but ok with upto 2 weeks credit. They stopped dosing recently.

Now i am at a chemist run but a devout muslim and have had no end of trouble. Constantly opening late, upto an hour. Stops serving me to serve others and even tried to deny me my take aways because i told him i had reported him to the hccc, he claimed to not have enough and to come back tomorrow. Funnily enough when i got my doctor to call him and remind him that it would be classed as abandonment and he would be being reported for that too he (the chemist) claimed to have just recieved a delivery, not knowing i was outside the shop making these phone calls and didn't see a delivery. I got my take aways with in 25 minutes of him telling me i couldn't have them. The moral here is find a doctor who is on your side and stand up for your rights. Don't swear and get angry it doesn't help and only gives them cause to justify their behaviour.

 

[Verybuffed]

What was the response when you reported the abandonment issue to the relevant authorities?

 

[Jabberwocky]

K Dude, me being a Queenslander myself, you NEED to go and see a Sub/Methadone doctor. Not your local GP, I'm talking in the mix in Highgate Hill, South City 7 Day Medical Centre. The doctor there will help you out, even though he prefers Subutexone or whatever that shit is to Methadone, and you have to rock up to your nearest dispensing pharmacy, shouldn't be a problem.

there are GP's that work out of everyday practices who are licensed to prescribe either, they don't need to be any kind of addiction specialist

 

[MrIbis]

yeah, but they are specialists in some right - they're not your average quack - only so many gps are licensed to dispense these drugs

 

[Flexistentialist]

In Queensland, GPs have to be specially licensed to prescribe methadone or bupe for dependence. Your average GP in Queensland can't prescribe unless they've done the additional training.

 

[Jabberwocky]

^yeah but they're not set aside the rest of other "clinics" are they? they're a GP with grounds to dispense 'done and bupe. really no different to a clinic except practice to practice rules.

qld private gps who have the license to dispense, ime, they're no different to any other GP except the difference being i could choose to stay on my full mu agonists without being put on either after having photographed government consent if my doctor had accepted my plea. i'm a PM patient and prefer bupe (discluding norspan patches) for my relief.

qld ime, outside of brisbane and the gold coast clinics, is fucked for getting any kind of assistance unless fully abiding by their independent rules and you're willing to surrender to the gv't.

 

[Methadonia2010]

In SA its 25-30 per week, I think the whole payment thing stinks, same for working people and those on CL. The feds should fun the dispense fee, seriously 30 bucks a week out of a pension is rotten , esp if your on it 9years or so...the average script is 5bucks, we all need to push this more with the feds!!!! ..... I get 6 takhomes week, go to private GP for script last 3months. Repeat in another 3 months... so i only go to the pharm once a week. nobody is ever there , unsavory characters which is good, go into booth go home. 50 a week is highway robbery , I hear they pay huge fee's in NSW?, funny when the Gov give it for free PBS! how do u justify that???. More people will go to illegal means to support a program that is supposed to do the opposite keep them clean and healthy. Any other South AUssies here, gets a bit lonley , love talking to others.

 

[DoctorShop]

I don't really have a problem with the cost. I'm still upset about the fact I still only get one take away a week. I don't see why I have to build 'trust' all over again just because I changed state.

 

[Mr. Squiggle!]

Dude, fuck em all.

 

[Boku_]

Sorry to bump a rather old thread and go slightly off topic but i have a serious Question!

If you are on methadone treatment daily to control heroin craving and you only use the prescribed amount of methadone are you able to maintain an erection and have sexual intercourse to point of orgasm? Or just like using Heroin Methadone will null your sex drive and you simply will not feel horny enough to have sex until point of orgasm.

i am not a heroin addict in withdrawal but the times i snort around 200 mg of China white smack i can't function sexually for around 48 hours after using the heroin. For example if i use heroin at lunch time on a Monday i am unable to cum for the whole day and night after and even on the Tuesday once i've slept and got up again i am still unable to function sexually to the point of ejaculation due to my sex drive being nulled and finding it impossible to get a rock hard erection from the heroin in my system. Once Wednesday comes around i can shoot a load out but sometimes it can still be a struggle get rock hard.

So is it a case of being physically dependant on opiates makes most men impotent?

 

[mostly-human]

You can definitely maintain an erection and have sex. But it DOES have a serious (negative) impact on your libido (sex-drive).

EDIT: Also - I will add two more things to this (I'm married by the way, so these issues are quite relevant to my life)

1 ) If you use heroin on top of your regular methadone dose, then even if you don't feel the heroin at all, it will still have a detrimental impact on your ability to get / maintain an erection - and will be near-impossible to orgasm. Also - this is probably pretty obvious - but the higher your regular methadone dose is, then the more damage it will do to your overall virility (eg; over 100mg/day and you can expect a seriously negative impact on your sex drive, erections, quality of orgasm, etc).

2 ) I'm also on an anti-depressant. I wasn't always, this is the first time I have been in my whole life, only started a few months ago (Long after I started methadone and 15 years after I started opiates). Anyway, I'm on an SNRI and it is also known to have a very negative impact on libido. The combination of semi-regular heroin use, daily methadone and daily SNRI - have all but killed my sex drive. It's a serious issue.


Finally: YMMV





EDIT 2: I just wanted to stress as well (before anyone tries to correct me). I am being very honest here and have not lied about any of this. HOWEVER - this is MY experience. Everyone is different. I need to stress the statement "YMMV" is incredibly important. Some people may maintain a PERFECTLY healthy and happy sex life, on a high dose of methadone. Others may struggle to even get an erection on a relatively small dose.

As always - if affected and if it is a problem. Obviously talk to your doctor!

 

[Lilyeye]

This happened to me, but it's 100% worse in Tasmania.

NEVER transfer your done to Tasmania, I'd suggest getting off if you're moving.
I could rant for hours, but basically some of the worst bits are:

You MUST be dosed thru government clinic for first 9mnths, Max 2 earned NON CONSECUTIVE takeaways per week after 9mo. You are piss tested and track mark checked every month and you have to see a counsellor as well as the Dr.

You are not allowed any S8 or S4 eg Valium. You are put on a register to prevent this. Even if you arrive from interstate with Valium it is confiscated. Benzos in your monthly piss test is a breach, removal of take aways, back to fortnightly Dr appointments.

You are put on a register under the Poisons Act as a Drug Addict for LIFE, restricting your access to scheduled drugs. When you get off the done it will still come up on records when you go to get friggen antibiotics. God forbid you get cancer and need morphine. Apparently for your own protection so no doctor prescribes you any scheduled drugs cos it could cause a relapse / addiction.

I am off the done and about to give birth and the hospital is wary about giving me any epidural, pain relief, etc due to my "status". If I am given any I am told it will be a very minimal amount.