Opioid maintenance therapy (OMT), more commonly known as pharmacotherapy, will help more than 48,000 Australians manage their drug addiction this year. Yet for many others, help will remain out of reach due to the high cost of accessing the treatment, which must be taken daily to be effective in suppressing debilitating withdrawal symptoms.
WAIT alumnus and 2016 Pharmacist of the Year Noel Fosbery delivers OMT through both his pharmacies and services around 50 clients, most of whom are recovering heroin addicts. He says it’s long overdue for the program to be fully subsidised by the federal government.
“At the moment, clients pay pharmacists between $5 to $7 a day to obtain their daily dose,” says Fosbery. “This amounts to almost $2,000 per year and I believe this is an unfair impost on the budgets of these people who are commonly on very low incomes.”
Though the drugs used for OMT – methadone and buprenorphine – are funded under Australia’s Pharmaceutical Benefits Scheme (PBS), the cost of dispensing them is not. To cover the administration and recording costs associated with delivering the treatment, pharmacists must charge a dispensing fee, otherwise known as a copayment fee.
John Ryan is the CEO of Penington Institute, a health and welfare foundation dedicated to rethinking how communities tackle unsafe drug use. He agrees that the government should subsidise the delivery of OMT. In an interview with ABC News Radio last year, he spoke out about the unfair placement of burden.
“There’s a lot of administrative burden for pharmacists and they’ve got to get that money somewhere,” says Ryan. ‘[Because] there’s no support from government … patients, who are often trying to recover from extremely difficult circumstances, are expected to find that money – and find it on a daily basis.
“The biggest negative consequence [of the fee] is that people … drop out of treatment and seek illicit drugs, so go back to heroin for example.”
The question of whether the Australian Government should subsidise the costs of dispensing the treatment has been asked at least as far back as the 1990s. Yet the government has so far resisted introducing any subsidy, saying that dispensing fees were a commercial decision for pharmacists. Both Fosbery and Ryan believe, however, that subsidy would actually be in the government’s favour, with the predicted savings far outweighing the cost.
The Penington Institute’s report, Chronic Unfairness: Equal treatment for addiction medicines, proposes a model where clients could obtain a monthly prescription to access OMT – similar to how diabetics access insulin treatment. Under this new model, the client would pay $38.30 a month, or just $6.20 with a Healthcare card. The report suggests the conservative cost to the government would be around $144 million a year, but argues this would be offset by reduced costs in justice and corrections, and healthcare costs such as hospital and mental health admissions. To put this into perspective, illicit drug abuse is estimated to cost Australia more than $8 billion a year.
Ryan sums it up: “It saves the government overall and saves Australia over all because of the reduced costs of crime, reduced hospital admissions … all of the trouble that is associated with addiction is actually reduced by good access to medication and assisted treatment.”
Meanwhile, new technologies can help to reduce the time associated with dispensing OMT, reducing the risk of pharmacists needing to increase the dispensing fee in the future.
“I’m a strong advocate for technology assisting the efficiency and accuracy of the dispensing and customer relationship process,” Fosbery says, who has dispensing robots in both of his pharmacies. “The robots are an amazing piece of technology which even the most technophobic of my employees are comfortable using.”
Fosbery also developed his own software, Easydose, to assist with OMT dispensing.
“There are two main excuses given by pharmacists for not taking on the OMT services. These are the potential for anti-social behaviour in store and the onerous amount of paperwork involved,” he explains. “Easydose was born out of the second issue, and takes care of the recording and reporting side of things beautifully. It is now registered in every state of Australia, a feat which has taken over two years as each state has its own rules and regulations.”
And as for the first issue?
“The anti-social aspect is usually controlled by laying clear behavioural expectations when a client joins us and then being respectful, open and firm but fair. Sometimes this means we must ask some to leave, but mostly we actually develop a really good relationship with them. After all, we see them almost every day,” says Fosbery.
“When all is said and done” he adds, “I’m a big advocate of the OMT scheme. We have to face the reality that drug addiction is a big problem in Australia. And as a pharmacist, I believe it is our role to deliver the best possible health outcomes for our community.”
OMT in Australia
Australia’s OMT program had its beginnings in a small clinic in western Sydney in 1970, where Dr Stella Dalton introduced the treatment as a way of helping people with heroin addictions. It wasn’t until 1985, however, that the program really gained ground. It was then that OMT was recognised as a potential major player in reducing the spread of HIV/AIDS, reducing risky behaviours such as needle sharing. It is now recognised as a successful public health initiative.
On a snapshot day in June 2015, more than 48,000 Australians were on a course of pharmacotherapy treatment for their opioid dependence. Of these, most were on a course of continuing treatment, with only a small percentage treated for readmission or new admission to the program.
Though it is possible to wean patients off OMT, total abstinence from drugs is not generally seen as the objective of the program. Rather, OMT is mostly approached as an ongoing stabilisation therapy, allowing clients to maintain a ‘normal’ life in the face of their addiction.