Several key developments in the world of pharmacotherapy have affected the PAMS Service over the past reporting year. These include of course the COVID-19 pandemic, but there have also been significant challenges related to the system in Victoria and a completely new medication delivery system.
Throughout it all PAMS kept its focus on our community and our clients as our priority.
70.1% People retained in pharmacotherapy due to PAMS’ intervention: 2020-2021 (n=596)
15.8% People who re-started pharmacotherapy with assistance from PAMS (n=134)
5.3% People who started program for the first time with assistance from PAMS (n=45)
98% PAMS cases completely or partly resolved (n=831)
This year we have had some staff changes. Daniel Ward has joined us and is a fantastic addition to the team. We were also lucky to have some surge funding from the Department of Health to employ Dellie McKenzie for a few months. On the other hand, Leora Robertson has retired and moved on from HRVic and PAMs.
Above: Daniel, PAMS Officer
Leora was a valued staff member at PAMS for 10 years. Her significant contribution should never be overlooked, and her capacity has enabled PAMS to grow and develop to the service it is today. Leora's reliability and commitment is already missed, but we are all hopeful she is enjoying her well-deserved retirement. Thank you for everything Leora.
COVID
Throughout the COVID-19 period the demand for PAMS service delivery seemed to ebb and flow. For example, when the price of illicit opioids increased dramatically PAMS has an influx of consumers wanting to start/re-start treatment. Interestingly, many consumers in this situation had been out of treatment for more than 5 years.
PAMS was actively involved in the development of the Victorian COVID-19 specific policy, which has by and large involved an increased number of MATOD take-away doses, increased script length and the availability of 3rd party pick-up, especially for consumers in isolation due to exposure or to contracting COVID-19. PAMS also participated as a key expert in the formal review of these policies.
The availability of telehealth due to the pandemic was a positive thing for many consumers, as MATOD prescriptions could be renewed over the phone. This saved time and also reduced COVID-19 risks of course. It also meant consumers could move or stay for short periods in other parts of the state (lockdown permitting) without having to source and change to a new prescriber.
Long-Acting Injectable Buprenorphine (LAIB)
LAIB as a treatment option for opioid dependence became available across Victoria this year.
PAMS experienced a period of roughly 2-4 weeks when we had an influx of people “wanting the injection” (LAIB), despite having little knowledge of it.
As is often the case when a new treatment becomes available, some were convinced it would solve all their issues.
However, while LAIB is proving to be a beneficial treatment option for some, there are also unintended consequences e.g., the cost to the consumer (up to $75 per month) and the pain associated with an injection of this type.
Equitable choice of medication type is reducing as well. It is often easier to access the abstinence-oriented treatments such as LAIB or buprenorphine-naloxone film compared to methadone. This in turn indicates a slow erosion of the harm reduction element of MATOD, which was a key reason for its expansion in the 1980’s.
System Strains
The Victorian MATOD system is increasingly strained as prescribers retire or stop prescribing MATOD. When this, combined with the fact there are not enough new prescribers coming through it is not dramatic to say it on the verge of collapse in some areas
Although there continue to be prescribers undertaking the MATOD specific prescriber training, few actively take on opioid dependent patients once trained. If prescribers had to opt out of prescribing MATOD rather than opt-in this might help increase the number of prescribers in Victoria.
Stigma and discrimination continue to be a key concern for consumers and one of the likely reasons it is so difficult to attract prescribers to this area of medicine. For example, during COVD-19, any GP could prescribe buprenorphine-naloxone film for up to 30 patients without having to complete the MATOD specific training. Many of the opioid dependent people contacting PAMS had a GP with whom they saw regularly, however in most cases, these GPs refused to prescribe MATOD for their current patients. This results in consumers having to source another GP for their treatment.
We also continue to lose MATOD dosing points when a community pharmacy is bought out by a large discount pharmacy chain, which typically does not dispense MATOD. This has a negative impact on MATOD access, especially in regional Victoria.
Above: PAMS 'Changing Lanes' 4 video series about getting on pharmacotherapy.