Over the last 12 months the Pharmacotherapy Advocacy, Mediation and Support, (PAMS) Service has continued to meet the needs of current and potential pharmacotherapy consumers in Victoria. Our staffing levels have increased, our systemic advocacy continues, and we have seen a long-awaited fundamental change to the cost of treatment nationally.
Staffing:
We welcome Jimmy Harrington and Frank Bees to the PAMS staff team, both of whom bring a wealth of professional and personal experience. Daniel Ward left us for a few months to travel and has fortunately, now returned. We are lucky to have Bee Hayes move across to PAMS from the HRVic Dancewize team to assist us with the data project and more recently to work with our service users. PAMS is incredibly fortunate to have such a wonderful and committed staff team.
Pharmacotherapy Policy:
COVID-19 resulted in a couple of beneficial changes to the Victorian pharmacotherapy policy, namely ‘third party pick-up’ and increased take-away doses. Both changes were generally viewed as positive and have allowed consumers (on occasion) to have an alternative, (authorized) person collect their dose and, in some instances, receive up to 6 take-away doses per week.
Changes to the Cost of Treatment:
After what seems like a lifetime of advocacy, the cost of pharmacotherapy dosing fees are now on the PBS. Just like many other medicines, a 28-day supply of methadone or buprenorphine-naloxone now costs $7.30 with a health care card and up to $30 per month for those with no HCC. This significant development has been incredibly well-received by the consumer group; however, it has meant some changes to the way pharmacotherapy prescriptions are written and how pharmacists are remunerated for the valuable work they undertake daily.
The long-acting injectable buprenorphine is still provided to some medical practices directly by the wholesaler, however as of November 2023 all depot buprenorphine will also go through a PBS pharmacy. Unfortunately, the cost of treatment has risen substantially for those who are not eligible for a Medicare Care Card (e.g. asylum seekers). We believe this is a most unintended consequence and are working to find a way to address this issue to retain some of our most marginalized consumers on program.
Despite this astounding development in the cost of pharmacotherapy, unfortunately many medical clinics are no longer able to offer bulk-billing and instead are moving towards mixed and private billing. This is very concerning for the pharmacotherapy consumer group, many of whom are surviving on low incomes and do not have the money to pay for a medical appointment.
Treatment Choice:
Over the last 12 months we have seen an increasing number of people prescribed depot buprenorphine or the Long-Acting Injectable Buprenorphine (LAIB). These products, (Buvidal and Sublocade) are generally well-received by many prescribers and often viewed as “safer” treatment options. Although very beneficial for some, LAIB is not for everyone. In some cases, this possible prescriber preference has resulted in difficulties for those wanting to remain on or start/re-start on methadone. In these 12 months 51% of all PAMS service users were on or wanting to start on a methadone program, compared to 14.8% LAIB and 30% buprenorphine-naloxone (Suboxone Film).
Pharmacotherapy Prescriber Workforce:
Pharmacotherapy is rife with stigma and discrimination impacting on us all, the consumer, prescriber, and pharmacist. Unfortunately, it seems there is a growing shortage of pharmacotherapy prescribers which limits consumer choice, inhibits treatment access, and places significant pressure on those who continue to prescribe. Many of our Victorian prescribers are aging and understandably retiring, which, in the case of high-volume prescribers, has the potential to leave many consumers without a script or having to source a new prescriber. In the last 12 months we faced this scenario in central Melbourne. In addition, there were at least 3 other pharmacotherapy prescribers who ran into issues with the Australian Health Practitioners Regulation Agency, (AHPRA), 2 of which ceased prescribing and the other had their case over-turned. In these highly stressful situations PAMS staff, the Victorian Department of Health, (DH) and staff from the Pharmacotherapy Area Based Networks, (PABNs) meet and plan an effective response to ensure program continuity is preserved for the consumer group.
Rural/Regional Victoria:
Based on recent data, almost 30% of all PAMS service users live in regional Victoria. Anything that impacts on pharmacotherapy just hits harder when it lands in rural or regional Victoria. In the last 12 months, there were some areas of Victoria subject to floods, (e.g. Echuca, Rochester) which made access to prescribers and/or pharmacies for scripts and dosing a challenge.
Total Number of Cases 2022-2023 = 998 (almost 150 up from last year), an average of 83.2 cases per month.
Top 3 reasons for contacting PAMS are:
1. Problems relating to the cost of program at community pharmacy at 16.5%
a. 83% were provided with one-off financial assistance by PAMS.
2. Prescriber Retired or Moved on at 15.5%
a. 85% of consumers changed to a new prescriber, (sourced by PAMS)
3. Trouble Sourcing Both Pharmacotherapy Prescriber and Pharmacy at 10.7%
a. In 89% of cases, a new prescriber and/or pharmacy was sourced by PAMS staff.
New Service Users comprise 57.6% of all cases (i.e. over half of our service users have never contacted PAMS before)
Outcomes:
· 74.8% of all service users were retained in pharmacotherapy because of PAMS support and intervention.
· 20.8% started for the first time or re-started treatment because of support and/or intervention by PAMS.
· 86% of all PAMS service users were on program at the point of last follow-up by PAMS.
· 97% of all PAMS cases were completely or partly resolved.
Demographics of PAMS Service Users:
Gender:
· 33.8% identify as Female.
· 66% identify as Male.
· 0.2% identify as Transgender.
Age:
· Average: 42.7 years
· Maximum: 73.5 years
· Minimum: 18.9 years
ATSI
9.4% of PAMS Service users identify as Aboriginal and/or Torres Strait Islander