Harm Reduction Victoria

Information for Families & Friends

Information for Families & Friends

 

This section has been written especially for people who have never been on a pharmacotherapy program themselves, but are either living with and/or caring for a person who is starting on a program or who has been on a program for a long time. If you are in this situation, it is a good idea to read the sections under the ‘clients/others’ and ‘general information’ parts of this site.

REMEMBER: If you are struggling with somebody else’s’ opioid use, make sure you get some help and support for yourself.

 

If you feel you need somebody to talk to, you can call any of the following:

 

Family Drug Help: 1300 660068 – A peer run support service for family members and friends of people who are struggling to cope with the drug use of a loved one.

PAMS PH: 1800 443 844 – PAMS can help with info on the system, we have a good insight and understanding of drug users and have established effective working relationships with many of the pharmacotherapy service providers. If we can’t help you, we usually know somebody who can!

Direct Line PH: 1800 888236 –  24 hour alcohol and drug counselling and referral.

 

Does ‘tough love’ work? – Be careful, do your research and if you do not know what to do, get some help (try the help lines above to start with). In many instances tough love is not the right approach.

 

Some things to think about are:

Has the person you are concerned about tried other forms of drug treatment? Did they work? If not, why not? If so, for how long?

Other forms of drug treatment include:

  • specialised drug and alcohol counselling (usually provided by a psychologist or social worker)
  • drug detoxification programs – either home based withdrawal or inpatient (residential) detoxification programs, both of which last approximately 7-10 days
  • rehabilitation programs – residential, long-term programs, usually 3-6 months or more

It can be a good idea to try other forms of drug treatment first. Counselling can be very effective for some people, but finding the right counsellor is essential. Counselling can also work well for many people in conjunction with other forms of treatment.

Drug detoxification programs do work for some people, but many have to detox a number of times before they are able to remain drug free for the long term. The risk of drug overdose is significantly increased immediately post detox or rehabilitation. Usually, the more times somebody endures an opioid detoxification, the more severe the withdrawal can be, both mentally and physically.  

 

Has the person ever been on a program in the past, what happened?

Pharmacotherapy programs work best when they are viewed as a long term solution. Some people get ‘sick of daily dosing’ or feel they have their use of illicit drugs under control and just ‘jump off’ (suddenly stop taking) their pharmacotherapy. This results in severe withdrawals that continue for months and frequently leads to relapse to illicit drugs. If this has been somebody’s past experience of a program reassessing things in the current context may be useful. Just because the program did not work the first time, this does not mean that it won’t work this time.

 

Has the person you care for experienced a number of drug related overdoses? If so, how many times has this occurred and how recently?

As mentioned above, the likelihood of a fatal drug overdose is significant post detox and/or rehabilitation. However, mixing opioids with other central nervous (CNS) system depressants (such as benzodiazepines and alcohol) can also lead to a fatal drug overdose. Some opioid users deliberately mix opioids and CNS depressants to get more of a ‘ high’ – this is very dangerous!

 NB: Both methadone and buprenorphine programs reduce the likelihood of opioid related overdose as the person has a high tolerance to opioids. However mixing methadone or buprenorphine with other CNS depressants is very risky. If the person you care for has overdosed on a number of occasions, a methadone or buprenorphine program may very well help keep them alive.

 

Does the person want to go onto a program – is it their decision? Are you (or anybody else) trying to coerce them into this treatment?

Pharmacotherapy programs often do not work very well if the person on the program has been forced or coerced into treatment, if it is their decision, the treatment is often more effective.

 

Does the person you care for have children in their care? Do they have a job or are they studying?

Having responsibilities such as the care of young children can be incredibly demanding for parents, children are also expensive! Using illicit opioids takes a lot of money and time and this can result in less time and money being available for feeding, clothing and caring for kids. In this instance a pharmacotherapy program can really help the whole family. In cases where the Department of Human Services (DHS) is involved with families where there is parental drug use, the DHS usually looks upon the pharmacotherapy program quite favourably – call PAMS if you wish to discuss these issues in further detail.

It can be very hard to maintain a job or commit to full time study in conjunction with an illicit drug dependence. A pharmacotherapy program can mean the difference between keeping a job or getting a degree or not!

 

How long has the person been using illicit drugs for? How old are they? How much are they using and how often do they use?

If the person you care for has not been using opioids for very long, especially if they are not dependent then it may be advisable to try alcohol and drug counselling or a drug detoxification program before getting onto a pharmacotherapy program.

There is no age limit (upper or lower) in terms of eligibility for a pharmacotherapy program in Victoria.

If the person is using a lot of opioids (for example more than one gram a day), pharmacotherapy may be a better option.

 

Commonly Asked Questions 

What follows is a list of questions that we frequently asked by family members, significant others and carers of those on a program or considering a program. We hope you find this information helpful, but strongly encourage you to call us. If we are talking to you we can make sure that the information we provide is tailored to your meet your individual needs.

 

Q. How do I know if a pharmacotherapy program is right for somebody I care for?

A. Pharmacotherapy for opioid dependence is one of the most thoroughly researched and highly effective treatments we have today. It is provided in Victoria as a harm minimisation strategy (it reduces the harms associated with the use of illicit opioids for the individual and the community and it reduces the overall demand for illicit opioids).

Q. How does methadone or buprenorphine work?

A. for information on the pharmacology of the different pharmacotherapy drugs click here (take to pharmacotherapy medications, ‘methadone, ‘buprenorphine’ etc).

The pharmacotherapy program mainly works because it gives somebody the chance to focus on ceasing use of illicit drugs without having to go through a gruelling and uncomfortable psychological and physical withdrawal. It gives a person the chance to make new friends, gain employment or undertake volunteer work, address other health issues (depression, anxiety, mental health), restore family relationships, undertake study or travel, address legal issues or secure safe, affordable housing etc.

Q. How long does this program last?

A. Pharmacotherapy programs work best when the medication is taken for a number of years. Once a person has got to a point where they are not using any illicit opioids and they have a lifestyle that does not revolve around the use of illicit drugs, then it may be time to start slowly reducing the daily dose amount with a view to getting off the program altogether. If the person is on methadone, it is worth looking at swapping over to buprenorphine-naloxone (Suboxone) once the daily dose amount is 30mg per day or less. The GP prescriber is the best person to provide advice here.

Q. Are there any safety concerns with a pharmacotherapy program?

A. Yes, there can be the potential for a drug overdose, especially in the first few days of a program (especially with methadone) or while the dose amount is still being adjusted or if the person is mixing other CNS depressant drugs (such as benzodiazepaines) with their pharmacotherapy medication.

HINT: If you are living with an opioid user or somebody on a pharmacotherapy program it is helpful to learn first aid – know how to recognise the signs and symptoms of an opioid overdose and call an ambulance!

Q. What are the signs of an opioid overdose?

A. For resources that detail the lifesaving recovery position– browse the HRV Overdose section &  Recognising and Responding to an opiate related overdose. 

The Australian Resuscitation Council Online displays the updated DR.ABC chart (Now called DRSABCD)

 

Simple signs of possible opioid overdose can include any or all of the following:

  • Loud, laboured breathing or snoring (especially if this is not usual)
  • ‘Nodding off’ for example falling asleep mid-sentence or when engaged in other activities.
  • Blue lips
  • Very constricted pupils
  • Slurry speech
  • Slow heart rate
  • Unconsciousness

Q. Is it possible for somebody on a program to be able to hold down a job?

A. Absolutely! There are many people who are on pharmacotherapy programs throughout the world that work full-time, very responsible jobs. Getting to the pharmacy to dose on a daily basis, especially in the early stages of treatment can be difficult, but in Victoria, your GP may be able to assist with take-away doses (TADs).

Q. How do I know if somebody is on the right dose, (dose amount)?

A. The right dose of pharmacotherapy (methadone and buprenorphine) will keep a person free of the physical signs of opioid withdrawal for 24 hours when it is dispensed daily. The person should not appear intoxicated, nor should they be waking up in the morning feeling any withdrawal sickness.

NB: It can take longer (from 2-5 days, possibly longer) for somebody to stabilise on a dose of methadone in comparison to buprenorphine which usually takes between 1-4 days. The person on the program needs to discuss this with their prescriber.

Q. What do I do if the person I care for can’t get their dose?

A. It depends why they are not able to get a dose. It is probably best to call PAMS so we can help work out what to do. Missing doses is NOT a good idea and will lead to symptoms of opioid withdrawal.

Q. We want to go away on a holiday – is this possible for somebody on a program?

A. This is totally possible. The person’s GP may be able to provide enough TADs for the holiday period, if not a ‘transfer’ can be arranged (this means arranging for the person to dose at a pharmacy or clinic near where they are holidaying). Please remember, holidays usually need to be arranged in advance, inter-state transfers can take up to 10 days to arrange. PAMS can help with arranging travel, including intra-state, inter-state or overseas.

Q. The person I care for says they can’t afford to pay for their program – how could this be true?

A. Unfortunately, if the person is living on a low income (for example a Centrelink benefit), it is quite possible that there may be a time where they are struggling to pay for the cost of the pharmacotherapy program. Most pharmacies charge $5 per dose, however some can charge $7.50 or even $8 per dose. The weekly cost is often cheaper, (for example $30/$35 per week).

A lot of people think that if a person can afford the cost of illicit drugs, then they must be able to afford $5 per day for methadone or buprenorphine. However this is not the case. Some people support their use of illicit drugs through an illicit means, for example committing crime, engaging in sex work. When a person goes onto a pharmacotherapy program they frequently move away from illicit means of revenue raising, & thus find themselves spending a significant portion of their income on their medication.

Q. What do I do if the person I care for is on a program and continues to inject illicit drugs?

A. This issue needs to be looked at in context. Many people struggle to stop using illicit drugs, especially injectable drugs such as heroin or other opioids as soon as they go onto a program. However, most people dramatically reduce their use of illicit opioids after stabilising on a pharmacotherapy program and most eventually stop altogether. It can take a long time to become a dependent injecting drug user, it can also take a long time to completely stop.

Q. What if the person I care for suddenly stops taking their methadone or buprenorphine?

A. This is not advised, unless the person has slowly reduced their dose over many months, even years and the dose reductions have been carefully monitored by the person’s GP. If somebody suddenly stops taking methadone or buprenorphine, they will start to experience opioid withdrawal symptoms which will gradually get more severe as time goes on. Withdrawal symptoms from methadone and buprenorphine can continue for weeks to months. The amount of time & the severity of the symptoms can largely depend on the dose that they were prescribed & the amount of time that they spent on the program. This being said, everyone’s body reacts to these things differently so it is far from an exact science.

Q. What are the signs of methadone and buprenorphine withdrawal?

A. Basically, very similar to other opioid withdrawal symptoms, however they usually come on more gradually but continue for much longer due to the extended half-life of these drugs compared to other opioids.