History of Pharmacotherapy
History of Pharmacotherapy in Victoria
When pharmacotherapy for opiate dependence became available in Victoria in approximately mid to late 1970s, it was a very different from what we know today. The aim was abstinence and the only medication available was methadone, which was provided to a small number of clients who were classified as ‘treatment resistant’, i.e. they had ‘failed’ to overcome their dependence using traditional, drug-free methods involving (institutional) detoxification and rehabilitation.
Maintenance regimes of indefinite duration are common today, but unheard of during this period, when methadone programs rarely lasted beyond six weeks. In the main, doses were the minimum required, and a tight reduction schedule was generally enforced. Urine screening was mandatory and if continued use of illicit drugs was detected the response was punitive: clients were either discharged from the program or had their doses reduced. Prescribing and dosing occurred onsite at a few public hospital clinics, most of which no longer exist. Because these services were delivered in public hospitals they were free, while today a dosing fee is usually charged.
Things changed, however, from the mid to late 1980s with the emergence HIV/AIDS. Acting to prevent the virus entering Victoria’s injecting drug user population, health regulators greatly expanded the pharmacotherapy program. A harm reduction approach was adopted and pharmacotherapy became an AIDS prevention measure as well as a drug treatment. The aim now was to attract as many injecting drug users into treatment and to keep them there as long as possible. The benefit for users – beyond the issue of AIDS – was that treatment became easier to access and more responsive to their needs.