Pharmacotherapies is the name given to drug such as methadone, buprenorphine and Naltrexone that are used to treat opioid dependency. Pharmacotherapies can be used in two ways: to help with detox over a short term and for longer term maintenance.
How do I get on methadone or buprenorphine in NSW?
Methadone syrup and Biodone are the two formulations of methadone which are prescribed in Australia. The Biodone Forte available in Australia is the same strength as methadone syrup but has less additives than methadone syrup. They are both fully subsidized by the Australian government.
What is methadone?
Methadone is a synthetic opioid drug which is long acting. It is taken orally and absorbed slowly and in most cases only needs to be administered once every 24 hours.
Are there any side effects?
Not everyone gets side few effects from methadone but some of the more common side effects include:
What are some of the pros of methadone?
Methadone has been shown to be a very effective treatment in the sense that once you are stabilized on methadone, you can start getting on with your life. It stops you feeling withdrawals and if you are on an adequate dose you shouldn’t crave heroin as much.
What are some of the cons?
The methadone program is quite restrictive. In NSW, takeaways are limited and it is often difficult to arrange your life around picking up your dose. Spontaneous travel is pretty well out of the question, and traveling overseas can be very difficult.
Methadone can also be very difficult to come off. The withdrawal period can be much longer than heroin — often lasting weeks rather than days — and some prescribers are reluctant to reduce your dose, even when you want to. For these reasons methadone is often referred to as ‘liquid handcuffs’.
Buprenorphine (sometimes known as Subutex, its trade name) is also used for the treatment of opioid dependence and has been available in Australia since 2001. It is available in .4mg, 2mg and 8mg tablets and is dissolved sub-lingually (under the tongue).
What are the pros of buprenorphine?
Perhaps the biggest advantage of buprenorphine (or bupe, as many people call it) is that it is generally thought to be easier than methadone to withdraw from. Another advantage is that, although everyone starts on daily dosing, many find that by increasing their dose they only need to be dosed each second or third day (although this doesn’t work for everyone).
What are the cons?
If you are using as well as being on a pharmacotherapy, being on bupe can become a bit complicated and probably not the best option.
Suboxone is essentially designed to stop people selling and injecting their doses. It is a version of buprenorphine and is currently being trialed in NSW. The advantage to users in NSW is that more take-aways should be allowed, although the program is yet to be fully rolled out.
Suboxone is bupe combined with naloxone (otherwise known by its trade name, Narcan). If you take Suboxone under the tongue then the naloxone won’t affect you but if you try to inject it, whatever opioid effect the bupe would have will be instantly overridden by the naloxone, which will also knock out any other opioids in your system!
The advantage of Suboxone is that unsupervised dosing may be allowed because of the limited appeal of injecting and therefore of diversion (sale and supply of prescribed stuff to people it’s not prescribed to).
Suboxone has caused a lot of confusion and fear amongst users. A lot of this confusion is because Suboxone is closely related, to but different, from buprenorphine (Subutex). A lot of the fear is borne from the fact that Suboxone contains naloxone — an opioid antagonist that can put people into withdrawal.
The User’s News article, Suboxone: bupe with a built in cop [Adobe Acrobat PDF - 227.56 KB], explains the difference between Subutex and Suboxone.
To find out what clinics prescribe and dispense Suboxone, call the Methadone Advice & Conciliation Service (MACS) on 1800 642 428.
Ring ADIS on 1800 422 599 or 9361 8000 (Sydney) to find a prescribing doctor. Prescribing doctors will either be based in the community or at public or private clinics.
The doctor will assess you and in most cases refer you to a clinic for dosing. After three months you may be eligible to be dosed at a community pharmacy.
In NSW approximately 43% of people on methadone or buprenorphine are dosed at pharmacies, 35% at public clinics and about 22% at private clinics.
This is not a pharmacotherapy treatment and it is not easily accessed in NSW. It is a controversial treatment for alcohol and opioid dependence.
Naltrexone is a full opioid antagonist. That means that it reverses the effect of opioids and prevents them from attaching to our brain’s receptors and making us high. It is a longer acting drug than naloxone (Narcan) and so it is not as effective for treating overdoses.
Taking naltrexone means that there is no point taking opioids, as they won’t work. This can be a good thing for some people as it may take the temptation to use away. But some people have found that it is just really frustrating and stop taking it. This is a dangerous time to use as one’s tolerance has gone and so people sometimes overdo the gear and drop.
If you are going to use after stopping naltrexone please be extra careful!
Naltrexone is usually administered after an Ultra Rapid Detox. A controversial aspect of some naltrexone treatments is that many people have been encouraged to get naltrexone implants. The idea is that these implants break down over time and give a long lasting effect. While they have worked for some people, there have been many problems for others. This ranges form infection of the implant site to people becoming so frustrated that they have attempted to cut them out.
Before agreeing to naltrexone implants, assess carefully whether you are truly ready and willing to stop using completely.
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