Desperate people can do desperate things

Public methadone programs in Albury and Wodonga are full, forcing patients seeking treatment for their drug addictions to wait or worse still, self-medicate on other illicit substances. AISHA DOW spoke with one of the few Border doctors involved, an addiction medicine specialist and a drug and alcohol nurse about the shortage of placements in programs that offer some real hope to addicts.

PATIENTS trying to free themselves of their addiction to painkillers are being forced to self-medicate due to a shortage in drug treatment programs.

A well-publicised spate of fatal overdoses from prescription patch fentanyl has failed to galvanise action on long waiting lists for methadone and buprenorphine programs.

It’s still easier to get hold of powerful prescription medication than to be signed up for rehabilitation.

Only a handful of GPs in Albury-Wodonga are registered methadone prescribers, but it’s the norm for every doctor to prescribe addictive painkillers like fentanyl and oxycontin.

The sole public methadone program in Wodonga is stretched beyond capacity, with 61 people filling the 60-place program.

Albury’s program is also full, with 83 people in the pharmacotherapy clinic and six on the waiting list.

Click or flick across the above image for the full statistics.

Drug workers say some patients are “medicating themselves” on illicit drugs such as heroin as they wait for a place.

Addiction medicine specialist Professor Kate Conigrave said these people were at risk of overdosing but the potential for deaths was not taken seriously enough.

“For other conditions that threaten the lives of people in their 20s and early 30s, we would be falling over ourselves to make sure that they had best available care, but because of the stigma associated with drug dependence, people don’t make the same effort,” Professor Conigrave said.

At Wodonga’s public clinic, run by Gateway Community Health, staff will provide phone counselling and support to clients on the waiting list.

But some of those clients invariably fall back into bad habits.

Gateway Community Health drug and alcohol nurse Darren Bate said there was no better time for someone to start a program than when they were first motivated to seek help.

“People say the hardest decision they make is to come in for treatment and we know that their motivation is at their best,” Mr Bate said.

“If there is a wait, what holds them in that period of time?

“We do see people who are lost to the service system for a while because there’s not the capacity to provide the service when they need it.”

Victorian drug agency ANEX recently reported a shortfall in methadone and buprenorphine prescribers on the Border was a “major contributor” to abuse of prescription medication including fentanyl, blamed for nine deaths since August last year.

A drug worker told ANEX they often had to tell people they couldn’t get on a treatment when they need it.

“So to avoid physical and psychological trauma of withdrawal, they may need to keep medicating themselves on an illicit until a place becomes available,” the worker said.

Doctor David Tillett works as the sole prescriber at the public clinics on both sides of the border.

Dr Tillett said the two programs had been at capacity for many years, but more recently they had begun to encounter a new problem — chemists being reluctant to increase the number of clients they dispense methadone to.

“Several of them are saying they’ve got enough people and don’t need any more,” he said.

Dr Tillett said there was also a shortfall of support staff because methadone and buprenorphine programs were not properly resourced by government.

It’s a frustration for a GP who says he’s done more good, and saved more lives, working with methadone patients than any other role in his career.

“There are some absolutely miraculous changes. We see people come and within a couple of weeks it’s like the lights go on,” Dr Tillett said.

And drug-treatment programs are not just about rescuing a few individuals.

Professor Conigrave said methadone or buprenorphine programs could create healthier communities by helping people get jobs and reduce crime, overdoses and other associated health problems.

However, encouraging doctors to become prescribers presented a real challenge, she warned, with many repelled by stories about clients who were aggressive, manipulative and unreliable.

Professor Conigrave called for governments to better pay doctors working in the area as an incentive and do more to train doctors in pharmacotherapy at university.

She also said there was a demand for a live prescription monitoring system and a service to oversee long-term prescription of drugs like Xanax and fentanyl to prevent doctor shopping and stop addictions forming.

Mr Bate said some clients had been prescribed painkillers, perhaps after a workplace accident, but eventually found themselves dependent on the drug.

Zac Nesbitt.

Zac Nesbitt.

“Many people wrongly seem to think that a person is a druggie when really they are the victim of the medical system,” Mr Bate said.