Page 917 - Week 04 - Wednesday, 17 June 1992
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are already in place. I envisage that pharmacies will not be used for methadone treatment in its initial stages, but that they will provide a service to stabilised addicts. However, the responsibility of determining the conditions of such a service would fall to the approving authority.
Let me say something about the philosophy underlying this Bill. Community pharmacies are recognised as being part of methadone programs in New South Wales, Victoria, Western Australia, South Australia and Queensland. There is actually no methadone program in Tasmania or the Northern Territory. So, in all States that have a major methadone program, pharmacy is regarded as being an integral part of that program.
Methadone programs have existed in Australia for in excess of 20 years. During this time, the programs have changed quite substantially. In their early days, methadone was regarded as a short-term treatment to wean dependent persons off heroin. It was soon found that this sort of treatment, with forced withdrawal, was not overly effective in the majority of cases. In the following years, a new philosophy has emerged. This is the philosophy of harm minimisation. This means that addicts might find themselves on the methadone program for a prolonged period of time, and sometimes even for life. This change has necessitated a reassessment of the number of places available on methadone programs, and of the sort of treatment that should be available on these programs.
Over recent years in New South Wales, the number of people on the methadone program has increased dramatically, from about 840 in 1985 to in excess of 4,000 today. In Victoria there were 100 people on the program in 1981; today there are over 1,700. Although places in the ACT program have increased, it is still regarded that at least double the number of currently available places is required in order to maximise the benefit of the program. It is also necessary to reassess what we are trying to achieve with our methadone program. It must be understood that the intensive programs of the past should be considered only a small part of a total methadone program. Such programs have been authoritarian in nature. They often involve frequent urine tests carried out under conditions which, to say the least, do little to promote personal dignity. They require the client to toe the line on many rules and regulations, often with clients threatened with being thrown off the program if they transgress.
This is the basis of the program we have had at Woden Valley Hospital. This sort of program addresses only the first stages of coping with heroin addiction. It does not address a dependent person's need to regain a position in the community and a sense of real personal worth. As we now know, addicts are likely to be on the methadone program for a long time, which means that we must provide a program which actually allows them to maintain a normal lifestyle. The program must not be intrusive into their efforts to build a stable family life, to maintain employment and to undertake education.
This program should not be judgmental in nature. It must not make the people on the program feel any less worthwhile as human beings. This means that the sort of treatment that may be appropriate when a person first comes onto the methadone program may not be right for the stabilised addict or for somebody who has been on the program for some time. This is where pharmacy fits into the overall program of rehabilitation. Community pharmacies represent a pre-existing and cost-effective network to supply methadone. They provide a
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