Libs support pain services, not safe injecting


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The Victorian Opposition has pledged to both invest in pain services, and shut down Richmond’s injecting room

Anthony Tassone, president of the Pharmacy Guild’s Victorian branch, has welcomed the former announcement, but condemned the latter.

As Victorians head to the polls on Saturday, Shadow Minister for Health, Mary Wooldridge, said the Opposition would inject $40 million into pain services across the state.

“Victoria has a number of specialist pain clinics, but waiting lists are often long, sometimes even a couple of years,” the Opposition said in a statement.

“Regional areas are significantly affected, with high rates of opioid prescribing and excessive waiting lists for public pain clinics.

“Further, there are more Victorians experiencing opioid addiction than ever before but since 1 February 2018, codeine has not been available without a prescription and with the roll out of Safe Script underway Victorians have been moved off opioid painkillers but left without accessible and evidence-based treatment options to manage their pain.”

The Liberals Nationals plan is to support pain management via:

  • Expanding services at every public pain clinic to improve access and bring down waitlists and waiting times;
  • Developing a state-wide pain management plan;
  • Establishing a musculoskeletal/pain network to assist clinical innovation, policy development and improved care and access to services.
  • Undertaking targeted interventions to reduce opioid prescription in hospitals; and
  • Enhancing the management of patients with pain as a result of the implementation of Safe Script, including data collection and targeted training in the quality use of medicines.

Each pain clinic would receive a funding boost to deliver more services, with larger clinics providing linkages to help smaller services with training and specialist support.

“Too many Victorians are waiting too long for desperately needed treatment for their pain,” said Ms Wooldridge.

She cited data showing that at Monash Health, patients have waited up to 712 days for treatment, and up to 648 days at Barwon Health.

“The Liberal Nationals will enable 35,000 more Victorians with chronic pain to get the treatment and support they need.”

Anthony Tassone said that with an estimated one in five Australians living with chronic pain, there is a real need to help provide patients the necessary advice and support to help them manage this potentially debilitating condition. This additional investment is welcomed, he said.

“The currently underway Chronic Pain MedsCheck trial as part of the 6CPA through community pharmacy can potentially play a complimentary role to additional investment in pain management clinics,” said Mr Tassone.

“Since codeine has been upscheduled to prescription only in February, there has been a double digit increase year on year of PBS subsidised codeine prescriptions dispensed. 

“The evidence shows that codeine has a very limited (if any) role in chronic pain. With the ongoing roll out of SafeScript real time prescription monitoring in Victoria we need to ensure we have sufficient treatment and support services to not only address chronic pain but also prescription drug dependency concerns for affected patients.

“Community pharmacists as medicine experts can play a vital role in helping patients understand medications used in pain management, help patients form realistic expectations of the benefits that analgesics can provide as well as refer to other healthcare professionals where appropriate.”

Shutting it down

However Mr Tassone also criticised State Opposition Leader Matthew Guy’s pledge to close the Richmond supervised injecting facility – within a week, if the Liberal Nationals are elected.

“I wouldn’t want an ice injecting room next to my sons’ primary school and therefore I won’t tolerate it next to anyone else’s childrens’ primary school – that’s why we’ll shut it down,” Mr Guy reportedly said.

Premier Daniel Andrews responded, according to The Age, by stating that the injecting room trial is saving lives.

Mr Tassone wrote to the editor of The Age, calling Mr Guy’s position “alarming”.

“There is compelling evidence both in Australia and overseas that medically supervised safe injecting rooms save lives and reduce harm,” he wrote.

“Despite early concerns from some local business and community groups, there is now strong and broad support for the ongoing trial and operation of the Richmond safe injecting room due to its clear benefits.   

“The sooner any prospective premier or government stops stigmatising people with a drug dependency concern, understands that we can’t arrest our way out of this issue and realises that the ‘war on drugs’ was lost long ago the sooner we can work together for actual effective solutions in getting people back on the right track.”

Mr Tassone is among a number of health stakeholders to criticise the election promise.

 

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12 Comments

  1. pagophilus
    24/11/2018

    Sydney’s injecting room hasn’t saved lives. It takes a misinterpretation of the evidence to show that it has. I agree with the Opposition that Melbourne’s injecting room should be shut down and the drug problem tackled in other ways. Normalising drug use will never reduce the problem. Pharmacy leaders shouldn’t be so quick to jump on certain bandwagons.

    • Anthony Tassone
      24/11/2018

      Pagophilus

      Whilst you are entitled to your opinion, I strongly disagree.

      Below is a link to a webpage with all published independent evaluations of the Uniting Medically Supervised Injecting Centre (MSIC) in Sydney, along with some additional background resources.

      https://uniting.org/who-we-help/for-adults/sydney-medically-supervised-injecting-centre/resources

      Some headline figures from the MSIC in Sydney (from the Alcohol and Drug Foundation webpage via; https://adf.org.au/insights/medically-supervised-injecting-centres/ )

      Evaluation of the Sydney MSIC has found that as of 2015:

      – More than 965,000 injections have been supervised
      – Management of more than 5,925 overdoses without a single fatality.
      – Over 15,300 people have registered to use the centre since opening.
      – 70% of the people visiting MSIC had never accessed any local health services prior to visiting the centre.
      – More than 12,000 referrals have been made to external health and social welfare services.
      – The number of ambulance call outs to Kings Cross has reduced by 80% since MSIC opened.
      – There has been no increase in crime in the Kings Cross area.

      The Kings Cross MSIC has been independently evaluated multiple times. All results show the centre is successful and cost effective.
      The number of publicly discarded needles and syringes halved in Kings Cross after the opening of MSIC.

      It would be hard to argue that without the MSIC in Kings Cross, with thousands of overdoses likely to have occurred during that period that there would not have been any fatalities.

      Further to the evidence supporting reducing harm in reducing fatalities, MSIC’s can act as an entry point into the health system for referral in drug addiction treatment and support – which renders the argument of ‘normalising drug use’ as flawed.

      I’m unclear on what ‘tackling the drug problem in other ways’ would involve – but am clear on the consequences of shutting down the Richmond facility in the meantime without an alternative already showing benefit.

      Anthony Tassone
      President, Pharmacy Guild of Australia (Victoria Branch)

      • pagophilus
        26/11/2018

        Drug Free Australia produced an analysis of the KPMG evaluation of the King’s Cross injecting room. It can be found here:

        http://www.drugfree.org.au%2Fimages%2F13Books-FP%2Fpdf%2FDFA_Analysis_Injecting_Room_2010.pdf&usg=AOvVaw2OJpdLvz2UelSDzUYxSEH1

        And here’s another interesting document:

        https://www.parliament.vic.gov.au/images/stories/committees/SCLSI/Injecting_Centres/Submissions/S45-Drug_Free_Australia.pdf

        (Or if that link doesn’t look right, google “drug free australia injecting room” and click on the first link that comes up.)
        Summary of some points:

        They calculated that the injecting room saved less than 0.5 lives per year (4 lives in 9 years) at a cost of $23 million.

        The overdose rate inside the facility was 32 times higher than the overdose histories of clients before they registered to use the facility.

        The conclusion that the injecting room reduced ambulance callouts did not take into account a heroin drought and increased sniffer dog policing.

        Of the referrals made to drug treatment or counselling on 11% were taken up.

        • Jarrod McMaugh
          26/11/2018

          That analysis has been debunked before Leo.

          I’ve seen the data from Richmond, and I’ve attended the facility. When the data is published, you’ll get to see unequivocal evidence of harm reduction

          • pagophilus
            26/11/2018

            Please provide evidence of debunking.

        • Andrew
          28/11/2018

          That’s a wilful misunderstanding of the body of evidence and we should rightly have concerns about the suitability to practice of a health professional who;

          – Ignores the empirical consensus and lived experiences that demonstrate the public health benefits of supporting IVDU in this way.

          – Applies individual morality to a societal problem, in particular advocating for execution of addicts.

          I’d like to say more but I suspect it wouldn’t get past moderation.

    • Greg Meaghan
      26/11/2018

      Not having a go,..but I am wondering what approach you think should be taken to address this problem?
      A tough/zero tolerance law and order approach? I have some police mates who will argue strongly for this…
      Greater subsidy of methadone (ie PBS listing) or more dollars towards detox/rehab facility?

      About 2 years ago I was walking along Victoria St towards Ikea and it is pretty clear to anyone who was there at the time that something needed to be done.
      I admit I haven’t been there since the injecting room open, but if we are getting the problem off the streets and under supervision, reducing ambulance callouts, not having local residents and businesses having to clean up syringes or resuscitate people at their back door then surely some good is being done?

      • pagophilus
        26/11/2018

        I support a zero tolerance/law and order response. And before anyone claims it hasn’t worked – it hasn’t been done properly. Singapore is doing it properly and it works there. But there’s more to it than law and order. Singapore also has a culture of being law abiding citizens. We have a culture of permissiveness, we idolise celebrities (actors, musicians) who do drugs, and then we wonder why we have a problem.

        Re some of the points you made eg getting the problem off the streets and reducing ambulance callouts, it’s not really happening. See the link I mentioned above in my reply to Anthony Tassone’s reply.

        • Jarrod McMaugh
          26/11/2018

          If Singapore’s system works, then they would have zero executions, right?

        • MaximGorky
          27/11/2018

          What about Portugal? The evidence is pretty clear that since they decriminalized drugs and adopted a harm reduction policy it has lead to a reduction in illegal drug use. A decrease in HIV and other IV associated diseases.

          Personally I am glad there is an injecting centre in Sydney. I am glad I was able to use the facilities. They gave me clean supplies and treated me with respect. I am glad I was treated with compassion and understanding rather than trying to arrest me and put me in jail. Because of our policies I have a second chance which I have firmly taken.

          Our society is quite similar to the US and they have demonstrated how tough on drugs does not work. Treating drug users as a health issue rather than a crime issue means that when people go into recovery they can re enter society without black marks on their name. In the US you can be charged for having a spoon or other ‘paraphernalia’, which can prevent them from getting some jobs. Why should someone be punished for the rest of their lives for being a drug user for a short time.

          And let us not forget that mental illness is often directly associated with drug addiction. I know it was with me. Another reason why we need to have compassion rather than hatred towards drug users. Australia already tried being tough on drugs throughout most of the 20th Century, and that didn’t make our society any safer or better for our citizens.

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