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					 Suboxone: freedom on a
       big stick
Some consumer concerns and perspectives
             By Damon Brogan
               VIVAIDS Inc.
          User involvement in Suboxone
                 implementation
• Reckitt Benckiser recognised importance of consumer
  participation in the introduction of Suboxone in Australia
• AIVL and its members (state user orgs) invited to participate via
  consumer forums from 2003.
                        Role of forums
• Information to user groups on pharmacology,
  pharmacokinetics of Suboxone, company’s plans and
  progress, progress of trials etc.
• Opportunity to voice consumer concerns
• If not to encourage demand, at least to minimise resistance
  Early user group debate and concerns

•Being used to market a drug unethically
•How could we trust a drug company – why should they
care what we think?
•Bupe / naloxone cited as “the big stick” – smacks of
control
•States might replace Subutex, reducing consumer
choice, and freedom
•Buys into moral panic over injecting, instead of rational
debate over injectable maintenance therapies
•Do we lose more by staying out or by critical
participation?
             AIVL Suboxone Forums
•   UK User orgs experience of working with Reckitt Benckiser OK

•   Same company markets Subutex and Suboxone

•   However cynically, user opinion was being sought

•   Some opportunity to influence implementation and State policy

•   High quality briefings on both the pharmacology and the trial (Dr
    James Bell)

•   Possibility, if not guarantee, of real gains for consumers:
    unsupervised dosing, affordable therapy

•   Grave misgivings remain around states using the Big Stick
    approach

•   Sets back injectables debate
             Aims of OST Pharmacotherapy
               User aims                                     Govt aims
•   Control, choice over own                 •   Control over users psychoactivity
    psychoactivity                           •   stop drug dealing and acquisitive crime
•   Freedom from black market prices,            from dependence on black market
    poverty, risks of CJS                    •   Stop / Reduced injecting and
•   Freedom from withdrawal +                    desperation, less ODs and BBV risk
    desperation                              •   Imposed abstinence (despite the talk
•   Safety from OD, BBV                          of HR)
•   Time and money to devote to other        •   Health treatment cheaper than CJS
    interests                                •   ? Consumer freedom, autonomy
•   Some genuinely desire abstinence for     •   ? Consumer social participation,
    its own sake, more just want an end to       wealth, status
    poverty, stress, alienation and risk
                                             •   ? Consumer health (not public health)
•   To be seen as a health consumer, not
    a public menace – self respect           •   Minimal political risk / adverse
                                                 headlines.
        Maximising community benefit from
                pharmacotherapy
  What is an optimum program?                      How?
• Facilitates consumers              • Freedom of movement so that
  participation as self-               employment, family, travel,
  determining individuals in the       leisure and creative pursuits
  economic, social and cultural        are feasible.
  life of the community
• Is cost effective (does not mean   • Same cost-benefit formula and
   cost neutral to govt)               PBS criteria as other drugs
• Is supported by consumers          • Recognises differing needs,
                                       offers choices, respects right to
                                       self-determination
• Significantly reduces risks,       • Safe, effective treatment and
  costs and harms of                   does not add to quantum of
  dependence on illicit drug use /     harm (eg the treatment /
  black market – does no harm          poverty trap)
       Suboxone can deliver if:
• Unsupervised dosing > Freedom of movement > social
  participation
• Dispensing fee based on same formula as other NHS /
  PBS drugs (same monthly fee to consumer)
• Offers an additional choice to consumers – doesn’t
  replace existing options
• Does not further disempower users – not used as social
  control device (Big Stick)
                  The Big Stick
• Replaces Subutex and perhaps methadone
• Is about coercion and loss of individual control
• Puts reaction to injecting / diversion before higher aims
  of the program
• Is a one-size fits all, pharmacological solution that won’t
  work to a problem that hardly exists
• Doesn’t investigate, quantify or detail the harms (or
  benefits) from diversion / injection of bupe
• Puts social control before social integration
 What we are seeing interstate
• Govts forcing people from Subutex to
  Suboxone
• Restrictive takeaway regimes maintained
• No fee relief for consumers
• Consumer loss of confidence in
  pharmacotherapy
  – Increased potential for individual and societal
    harms
  – More profits for crime cartels
  What we’re seeing in Victoria
• Best pharmacotherapy policy
• Cautious pathway to unsupervised dosing
• More discretion to prescribers, more
  methadone T/As, more choice
• Pharmacists still want daily dispensing fee
• Many pharmacists forcing consumers onto
  Suboxone – some GPs ?
• Consumer support poised in the balance !
PAMS Pharmacotherapy Advocacy
    Mediation and Support
 – Telephone service for pharmacotherapy consumers,
   providers and support workers:
    • Information, referral, mediation, support and training
 – Seeks win-win situations where disputes threaten
   service outcomes or continuity
 – Provides training to agency staff on consumer issues
 – New series of SUBOXONE workshops for agencies
   supporting pharmacotherapy consumers
 – Call Sarah Lord: 9329 1500
         Thank you

          VIVAIDS Inc
Recognising Rights, Reducing Harms

				
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posted:3/31/2010
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