DEPENDENT ON OPIOIDS AND WANNA GET A GRIP? YOU HAVE A CHOICE

If you’re thinking about starting on an OTP program, or changing your medication or dose, it seems like there’s a lot of competing information about what to do and what’s available.  

Should you try a private clinic, a public clinic, or dose at a pharmacy? Many people end up trying more than one option because different things work for different people at different times in their lives. What worked when you were single and jobless is not going to work when you have kids and work every day. 

Here is some info alongside peer opinion and advice.  

Why the Opioid Treatment Program (OTP)? 

Sometimes people go on the OTP in a rush, because they are worried about withdrawing from whatever opioid they are using and see it as a way forward. They don’t stop to think about it too much. 

However, there are other options for working through your opioid dependency. You could detox either at home (with or without the support of a Drug and Alcohol Service) or at a detoxification unit. You could do a long or medium term live-in rehab option, such as a therapeutic community; attend a day program to get some skills around controlling your using; see a counsellor and/or drug and alcohol worker; or try peer-based groups based on meetings like SMART Recovery or Narcotics Anonymous (a ‘12-step program’ similar to Alcoholics Anonymous). 

Look into your choices and keep an open mind about different options. User’s News Issue #87 (the treatment edition) gives a run-down of different treatment options, with stories by peers who have tried them. You can find these articles on our website. 

Sally: To be honest, If I’d known when I started methadone that you became stable and didn’t get stoned, I wouldn’t have started it because now I just need it to feel normal.  

Jack: I’ve been on methadone for over 7 years now, with a few short breaks - three months once and a week here or there when I’ve been trying to get off it. I’m really struggling with going to a private clinic and having to pay for it. Initially, I thought that methadone would be easy to get off, but that’s absolutely not the case. To be honest, I think that starting the program was one of the worst decisions I’ve ever made. 

Cindy: I have always worked – usually more than 1 job and sometimes up to 4 – and used from my pay. When I went on the program, I had maxed out all my cards, borrowed from everyone I know and was way behind in rent, looking homelessness in the face. Getting on methadone meant that I didn’t fall over the edge. From that first dose, I felt the freedom of not waking up sick and having to find the money to feel well enough to work, not having to battle through work hanging out, trying to act normal when I was in the toilet half the time. I felt I had control for the first time in a long time. I could even use sometimes without feeling drowned by it all. Yeah, there are rules, but if you tell me you don’t have all that with using, then you haven’t used like I have. Don’t whine to me about cost and not being treated with respect. It’s not like you even have a few dollars for a coffee when you use a few times a day, and you don’t get a lot of respect as a user – sucking up for credit, borrowing money, scamming, arguing with your straight friends and family. My life is out-of-sight better now. 

Pete: They don’t call methadone the “liquid handcuffs” for nothing. I’m sick of jumping through hoops. My life is just about going to the clinic every day and being treated like shit. I thought I would be on it for a couple of years, tops, but it’s been 12 now. I went on it too young; I had only been using a year. I wish I hadn’t rushed into it and had tried a few more other things to get my use under control before going straight to methadone. 

Brian: Methadone took the chaos out of my life. I’ve been on it for years now and it has meant that I can live life on my own terms. Even though there are the obvious restrictions, I am able to be a fully functioning citizen. There aren’t many things I can’t do now. I’m heading overseas in a couple of weeks for work. That wouldn’t have happened for me before the program. 

Jane: I have been on methadone twice and it hasn’t helped either time. The first time I kept using and ended up selling my dose. The second time was after a car accident and I was on oxies for pain. My doctor got this idea that I was too dependent on the oxies and that the ‘done would help me get off them. But it does nothing for the pain. She seems to think it’s all sorted and when I complain about pain that I am drug seeking. It seems to be all about her and nothing about the realities of me living with pain. So now I am back to using and that whole cycle. 

Jim: I really don’t want to use anymore. There’s a lot of reasons why. When I am on Suboxone, I don’t use. When I am off it, I do. It’s that simple for me. I’m not on a high dose and I know that eventually I’ll be off it for good without needing to use any opioids at all. For me, that will be freedom. In the meantime, I use the help I’m offered.  

Neil: The thing I like about methadone is that it is fantastic for depression. I have never found an anti-depressant that I like. Gear worked of course but it’s a hard life – too expensive, too risky. Being on methadone I can feel relaxed and not stressed. I don’t have the problems that went with using too much – which seems to be the only way I know how to use without methadone. I still use sometimes, but with methadone on board, it’s under control – a couple of times a week instead of a couple of times a day. 

Where can I get it? 

You have a few choices – public clinics, private clinics and prescribers working in the community (GPs or specialists) who can get you dosed at a private clinic or a pharmacy. You may live somewhere with fewer options but call the Opioid Treatment Line to see what is available – they list all the clinics, doctors and pharmacies you can go to in your area. If you can get enough takeaways, it may be work traveling a bit further for a bit more freedom. 

Freda: I don’t have a choice. There are no private prescribers in the whole of the Blue Mountains. Unless I want to travel to Sydney all the time, I’m stuck at a public clinic. I love that it’s free, but I hate having to go every single day. I hate feeling watched. 

Lee: I started at a private clinic because they started me straight away. But it does cost a lot and my prescriber won’t let me dose anywhere else, even though I’ve moved and I’m close to a good chemist. That’s annoying. You get the feeling they’re just about money. You shouldn’t have to commit crimes or give up one of your doses to pay for your methadone! 

San: I have a great chemist. At first, I was worried because I had to get my picture taken and got the talk about “if you shoplift from us, you’re gone” and I felt really pissed off about that. Then we went through the whole thing of me having to wait until everyone else was served first. But I worked out that was them trying to be confidential, not wanting to dose me in front of other people. When I made it clear that didn’t bother me, it changed. I also made sure I came in at the same time, or rang them to let them know, so they would have my dose and takeaways ready for me. It’s turned out really well. 

Jen: I’m at a private clinic and I have had a lot of trouble with them telling me I’m behind with money when I’m not. They don’t EFTPOS so I have to pay in cash and then half the time you can’t read the ink. I also don’t like how often I have to see my doctor every fortnight, or the number of urines they make you do. The queues are brutal too. You feel like everything they do is motivated by money and once you’re there, you’re stuck unless you can find a GP [prescriber] who can fit you in. 

Nik: I’m at a private clinic, basically because they could get me in straight away and it was easy. I was pretty desperate to get on as soon as possible and they got me into a doctor and the paperwork done super fast. I don’t think it’s any better or worse than anywhere else. The nurses are really nice and always ask about my kids, my course, all that sort of stuff. They even gave me a present when my last baby was born.  

Stan: I’m at a public clinic, which I stay at because it’s free. But you never get a takeaway except for really unusual circumstances. There are heaps of people dosing so you always have to wait in line. One day I had had a few drinks the night before and was a bit bleary-eyed, so they got it in their head that I am a drinker and keep breathalysing me. That first day, they only half dosed me. Since then it’s always at 0, so I don’t know why they keep doing it. That week they did it 5 days in a row. Plus the NSP is in the same building, so if you use they know and insist on urines and half-dose you.  

Bill: I have been at a public clinic for 13 years. They’re trying to get all the people who’ve been there a long time to switch to a pharmacy, but I’m resisting. I can’t afford it. The staff are really great and my doctor is fantastic. Takeaways would be good, but it’s an option I can’t afford. 

Emma: Last time I got out of jail I ended up at a private clinic, because I wanted takeaways. Worse decision I ever made. Now I can’t get back to the public clinic where I have been dosed over 10 years. I felt really safe and supported there. It wasn’t worth it to move. 

Pen: I live in a regional area and there aren’t many choices where I am. I wasn’t happy living without takeaways because I work so it was just murder racing around and getting stressed in a queue every day. So I found a doctor and chemist in an outer suburb of Sydney to transfer to. It’s about an hour and a half away but it’s worth it for me. Because I’ve been on a long time and I work and my doctor is happy with my urines, I only have to get dosed once a week and I get takeaways for the other days, then I see my doctor every 3 months. I mean, heaps of people commute every day for work with a much longer trip than I do. And there is no queue at the other end. Sometimes it feels a hassle, but no more than having to do grocery shopping or housework or any of those other boring things in life you have to do. 

A note on prescribers: 

In order to be a prescriber, doctors do a course to learn about the OTP (called the Opioid Treatment Accreditation Course or OTAC) followed by an exam. The course includes a talk from a NUAA member on the program.  

All doctors, no matter where they prescribe, have a quota on how many patients they can prescribe for (usually 50 or 100). They can apply to have that increased as they get more experienced (usually up to 200 if there is a special need such as a doctor practicing in a rural or remote area).  

Any doctor – including your local family GP – can prescribe for up to 20 buprenorphine patients (including starting them) or 10 methadone patients (taking over stabilised patients) without doing the OTAC or other special training. They can get support from current prescribers if they want it. Ask NUAA for more info if you would like to approach someone like this. 

A word on stigma and discrimination: 

We’ve spoken to lots of people on OTP who have experienced different (and sometimes all) available services. There is no sense that one type of service discriminates more than others. People have had both great and dreadful experiences at both private and public OTP clinics, general practice clinics and pharmacies.  

In general, we are treated differently. What other patient groups would be discriminated against like we are? Imagine if all pregnant women were given a lecture about shop-lifting when they started going to a new pharmacy. Or a doctor refused to prescribe to anyone with a heart condition. Or diabetics had to go in every day to get their insulin injected by a nurse. But people seeking treatment for opioid use are regularly treated as if we are bad people, looking for a free hit.  

People who are employed in OTP are from the general community. Some discriminate, some don’t. Some have experience with harm reduction, some don’t. It can feel like the luck of the draw, but everyone has the right to be cared for with respect and knowledge every time they engage with a health professional. There is no excuse for a health professional to be poorly trained or treat people badly. 

If you are discriminated against, make a complaint. NUAA does anti-stigma and discrimination training that might benefit all staff. And if you are choosing a service to attend and you know anyone on the program, ask what they think of their clinic/pharmacy to help you make an informed decision. 

OTP Vox Pops – Advice 

Sandy: To be honest, If I’d known when I started methadone that you became stable and didn’t get stoned, I wouldn’t have started it because now I just need it to feel normal. I think methadone is better to help detox. If you can buy takeaways, get 200mg worth and have 40mg over 5 days to get off heroin, then you won’t be hanging out for it. But you also won’t be saturated by methadone, so you won’t get sick from that either.  

Marcus: If you wanna start on methadone, don’t go too high. The higher your dose, the harder it is to go down. And don’t try using on your dose, it’ll just make your life harder and is a waste. If you’re thinking about getting on the methadone program, just try to get on it as soon as possible. You don’t wanna get locked up, cos jail is not very fun. 

Pete: My advice to people thinking about starting the program? Just do it. Give it a try at least because it does work. It’s better than using, then waking up feeling like shit every day. Just give it a shot – no pun intended. 

Aaron: If I had advice for newbies, it would be to have a good and honest chat with your doctor. Think about the end result of going on it, and where you want to go with it. And for heaven’s sake, don’t inject. It’ll just make you end up using more. 

David: If you’re going to go on the program, do it and stick to it. Don’t get swayed by trying to get abstinent. Get stable before you try to do anything else – mentally, emotionally and financially stable. Being on the program isn’t the end of the world – it’s the beginning of something good.  

James: Think about your decision very carefully – it should only be a last resort. I got on methadone not knowing that a lot of people stay on it for the rest of their lives. To be honest, I think that starting the program was one of the worst decisions I’ve ever made, especially seeing I’d only been on heroin for 6 months before then. 

Frank: My advice to people thinking about going on the program is to try do a detox program first. You can do a bupe detox program, which only goes for five days, instead of going straight into maintenance. If you’ve only been using a little while, a bupe detox could be enough to help you kick it. 

Ace: When I was on bupe, the tablet (Subutex) was alright, but as soon as I hit the film (Suboxone) it was no good. If I could I would go back on Subutex for sure. Make sure you do your research to find out what’s right for you, because everyone’s different. 

Kelsy: My advice to people thinking of starting on the program is to really think about it. It’s a long-term decision. Consider your options. Five days detox and then stopping cold turkey with the support of those around you? Or a long-term commitment to pharmaceuticals that you might not be able to break.