The closure of a Melbourne general practice on Friday will leave more than 10% of Victorian methadone users without treatment in what health experts say is symptomatic of the state’s “broken” pharmacotherapy system.
Pharmacotherapy is recognised by the World Health Organization as an essential treatment for opioid dependency, replacing the drug of dependence with a legally prescribed substitute, such as methadone or buprenorphine.
However, in Victoria there are only a small number of general practitioners offering prescriptions to 15,000 patients in what is “an increasingly broken system”, according to Scott Drummond, the acting executive officer of the Victorian Alcohol and Drug Association.
Frankston Healthcare Medical Centre, a private general practice with 1,800 drug-addicted patients on its books, treats 12% of people in the state receiving pharmacotherapy treatment.
However, it will be forced to close down after the funding the Victorian government promised to provide while its full-time GP was on leave fell through, the director of the centre, Nadia Siciliano said.
The full-time doctor on leave is approaching retirement and the practice will not open its doors again when he returns, Siciliano said: “There’s just too much pressure for him.”
Siciliano said she believed the closure would push the 500 patients they treat each week towards the emergency departments.
“We’ve all been crying today because they are going to relapse now,” Siciliano said.
Matthew, a long term heroin user, told Guardian Australia without methadone the experience of withdrawals are “indescribably terrible”.
The treatment has stabilised his life and allowed him to regain employment in a way that would have been “unimaginable” when he was drug dependent.
Siciliano said “my nurse is beside herself, because she has been treating these patients for years. And the fact that we’ve got patients breaking down here because they don’t want us to close, it’s heartbreaking for all of us,” she said.
The patients will be protesting against the closure on Friday, Siciliano said.
Drummond said “this issue illustrates the fragility of Victoria’s pharmacotherapy system”.
“There are significant workforce shortages which in part are a symptom of stigma and discrimination towards people who use drugs. As it stands, for many, it is easier to score heroin than it is to engage support through pharmacotherapy,” Drummond said.
Matthew said the same: “It’s easier to score heroin than to find a doctor who prescribes methadone.”
Paul MacCartney, an addiction medicine physician at CoHealth, said the closure of Frankston Healthcare comes just 10 months after another general practice in the CBD with 250 pharmacotherapy patients shut its doors.
While NSW and Queensland have a hybrid model of people being able to access pharmacotherapy through general practitioners and publicly funded means, in Victoria GPs are the only providers, MacCartney, said.
However, few general practitioners prescribed pharmacotherapy because of lingering stigma that drug and alcohol disorders were a moral failing rather than a health or medical problem to be managed, MacCartney said.
Financial compensation was also an issue, MacCartney said, as pharmacotherapy was not financially rewarding because the patients were often on health care cards and needed to be bulk billed.
He said many GPs also perceived people with opioid use disorders to have complex needs, for which the Medicare system did not reimburse doctors adequately.
The premier, Daniel Andrews, said in a press conference on Thursday that the government was working to try to find an alternative service provider for Frankston Health Care’s clients.
Andrews emphasised that Frankston Healthcare was a private general practice running a business. “They’ve made their own decisions and I don’t think they were made in the last couple of weeks.”
The shadow minister for mental health, Emma Kealy, said she was concerned that “Frankston hospital is already critically overwhelmed” and that the closure will mean “people taking steps to get their life back on track are at a very high risk of falling back into heroin use”.
“Labor have completely lost their way when it comes to supporting Victorians facing drug and alcohol addiction,” Kealy said.
