Page 2775 - Week 11 - Tuesday, 20 October 1992
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MR LAMONT: The way you are carrying on, Mr De Domenico, that will be the position for an extremely long time to come. I suggest to you that the main philosophical thrust behind an objection such as the one I have outlined about the privatisation of the dispensing of medical care should be one that concerns Mr Moore equally as much as it concerns the people on this side of the house. Mr Moore in the past has been quite supportive of an expansion of the public health system and retention of the public health system in the ACT. I believe that it is to some extent at odds on the one hand to hear him espouse that view and on the other hand to see him proceed in the way he has.
The other matter of some concern is that Mrs Carnell, in developing her Bill, has not determined what mechanisms need to be put in place to ensure that clients who are experiencing difficulties will be recognised and referred promptly for appropriate treatment. Do pharmacists have the training to make assessments which identify clinical complications associated with the dispensing of methadone? What assessments will be done to ensure that methadone doses are safe? Mrs Carnell has forgotten that methadone is not like a typical consumer product or a simple medication. The safe dispensing of methadone is not something that could be done in a supportive manner in a busy pharmacy where other clients may have competing priorities. Methadone treatment is a complex form of treatment, with complications and side effects that may differ for individuals.
I suggest that Mrs Carnell should have addressed some of these issues and considered the far-reaching consequences of her Bill before it was tabled. It appears that Mrs Carnell has used the interstate model of the dispensing of methadone through pharmacies as the basis for developing her Bill. I am surprised that she has done this, as interstate experience suggests that there have been major problems with pharmacies dispensing methadone, including the increased risk of overdose and black market diversion. Mr Berry outlined some of those earlier on.
New South Wales has introduced planning mechanisms to ensure that pharmacies involved in the dispensing of methadone are evenly distributed throughout the region. The same planning mechanisms have also taken into account the proximity of these pharmacies to residential areas. Private sector expansion has been necessary in other States because of the size and geographical spread of the population, whereas in the ACT we are in the enviable position of being able to take advantage of the relatively small area, which has enabled us to provide efficient government services. Mrs Carnell's Bill also exposes clients seeking treatment to financial difficulties. Charges for methadone will be left entirely to the discretion of individual pharmacies, and clients who cannot afford the treatment will be effectively excluded from the system. This form of exclusion is clearly against this Government's mandate to ensure access and equity to health services.
It is for those reasons in particular that we will be opposing Mrs Carnell's Bill. What it really comes down to is this: We try to set up a system. We look after a system in the private pharmacies, which is what Mrs Carnell is proposing to do. We set up the cartel - I was going to say "the Carnell cartel", but that would be inappropriate. It would be a very bad play on words, and I would probably be asked to withdraw it, so I would not say that.
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