PAMS HISTORY The Long & Short of it...... The Short...... Since its beginnings in 2000, PAMS has evolved on a number of fronts. The service was originally established to help express consumer-related complaints and grievances, but has moved on to the negotiation and solving of these issues. This development was driven by service users, most of who are less interested in making a complaint than having their problem actually solved, usually within a short space of time. Other developments since the service first began include: the number of cases dealt with by PAMS has increased annually the name of the service has changed from MACS (Methadone Advocacy and Complaints Service) to PAMS the method of data collection and analysis has been computerised the service has become more widely known across the drug treatment sector the service has become increasingly professional. From small beginnings, PAMS has grown into a established service that plays a vital role within the Victorian opiate pharmacotherapy system. The Long..... The Pharmacotherapy, Advocacy, Mediation and Support’ (PAMS) Service was conceived by a small group of methadone consumers who used to meet regularly at the office of VIVAIDS (the Victorian Drug User Organisation) in the mid to late 1990s. A number of people in this group had experienced a range of problems with their methadone program they were not able to address effectively on their own. Further still, the group members felt there was no avenue through which they could get these issues addressed in a timely and effective manner. As a result, VIVAIDS undertook some qualitative, action based research to investigate the nature of these pharmacotherapy consumer concerns. This report ( ‘pale blue report’ by Kirsty and Nicola) is available upon request from pams@hrvic.org.au . In the year 2000, Turning Point Alcohol and Drug Centre was funded by the Commonwealth Government to run a number of trials of ‘new’ pharmacotherapies, including buprenorphine (mono formulation), slow release oral morphine and leva alpha acetyl methanol (LAAM). These trials were undertaken as part of the ‘National Evaluation of Pharmacotherapy for Opioid Dependence’ (NEPOD). Turning Point then agreed to fund VIVAIDS to pilot a telephone service for the pharmacotherapy consumer group to address the need for any of the following: Information and support Resolution of complaints and grievances Advocacy Mediation Referral Although the service was funded by Turning Point, it was available to any pharmacotherapy consumer in Victoria. The service focussed on the resolution of pharmacotherapy consumer related complaints and grievances and was called the ‘Methadone Advocacy and Complaints-resolution Service’ (MACS) and located at the VIVAIDS office in Carlton. MACS was promoted to the methadone consumer group at pharmacies, GP clinics, community health services, NSPs, welfare services, community legal centres and housing agencies. MACS initially operated from a mobile number, it was run by one staff member (who coordinated the service) and was available from 10AM to 6PM, Monday to Friday. A steering group was established to provide advice and strategic direction for MACS. Members of the steering group included: A GP (experienced pharmacotherapy prescriber), A pharmacist (experienced in the dispensing of methadone), A consumer representative (on a methadone program), The coordinator of MACS, A representative from Turning Point (clinical services), The manager of VIVAIDS Representatives from other relevant alcohol and drug services. In keeping with the other VIVAIDS programs and projects, MACS maintained a strong focus on peer support and representation. The methadone consumer group had access to a peer support worker (from MACS/VIVAIDS), GPs had access to another GP prescriber and pharmacists had access to a pharmacist (pharmacotherapy dispenser) through MACS. The GPs and pharmacists who provided support to their peers involved in a MACS case were available on an ‘on call’ basis. VIVAIDS chose to operate MACS in this way because peers have credibility amongst their peer group. It was also because MACS was new and unknown to GPs and pharmacists and the best way to promote it was again, through the respective professions (peer groups). In practice, this resulted in MACS operating in the following way: A methadone consumer contacted MACS because he felt that his GP (prescriber) did not understand his need for more than one methadone TAD per week. The consumer maintained that he had just been offered part-time work in a family company; nobody in his family knew he was on the program and he said he could not get to his pharmacy during working hours. The consumer said that if he disclosed to his family that he was on the program, any offer of work would be withdrawn. The MACS worker would discuss the issue with the consumer and try to work out a possible solution. The consumer said he would require a minimum of 3 TADs per week in order to work for his family. The MACS worker established that the current dosing point was the only pharmacy with a vacancy in the area. The MACS worker would ensure that permission was obtained from the consumer to contact their GP. The MACS worker would then contact the GP prescriber who provides peer support to other GPs involved in any MACS ‘case’ (MACS GP). This GP then contacts the consumer’s prescriber and discusses the issue. The MACS GP then calls the MACS worker and a course of action is agreed upon. For example, a compromise in this scenario might be that the consumer can have a total for 3 TADs per week, but not for 3 days in a row. The MACS worker then puts to possible solution to the consumer and the MACS GP suggests the same solution to the consumer’s GP prescriber. If all parties agree, no further negotiation is required, if not then both the MACS worker and the MACS GP may go through the same process again until an agreement has been negotiated on behalf of the consumer and his service provider. Theoretically, this was an equitable, unique and supportive way to operate the service. However, due to the need to depend on the availability of the MACS GP (also a current prescriber with his/her own case load) and the MACS Pharmacist (also running his/her own pharmacy) and to resolve the cases quickly, (often so a consumer could dose within 24 hours), it simply became impractical. As the number of cases dealt with by the service rapidly increased, there was simply not enough time to utilise the services of the MACS GP and Pharmacist. Over time MACS gradually became known to GPs, Pharmacists and the methadone consumer group. After running the pilot for 12 months, (funded by Turning Point), VIVAIDS had collected enough data to indicate that MACS was a useful and effective service. VIVAIDS took the data to the Victorian Department of Health, (Drugs Policy and Services) and they agreed to fund the service. The Victorian Department of Health (DoH) have continued to fund the service to this day. After buprenorphine was approved by the TGA and registered on the PBS, meaning it became available as a treatment for opioid dependence in Victoria, MACS changed its name to the ‘Pharmacotherapy Advocacy and Complaints-resolution Service’ (PACS). However, PACS had a problem in as the name included the word ‘complaint’. Unfortunately, this resulted in GPs and Pharmacists feeling that “somebody had complained” (about them). This left providers feeling ‘on the back foot’ and defensive before any conversation had taken place. PACS was also compromised by the fact that it had no powers of enforcement to effectively deal with consumer complaints and grievances. If a pharmacotherapy provider did not want to negotiate with the PACS worker, there was often very little the service could do resulting in consumers feeling frustrated, powerless and that they had wasted their time. Interestingly enough, the majority of consumers in direct contact with PACS did not want to make complaints as such, they had problems they wanted resolved effectively and efficiently. These issues culminated in the name and the focus of the service changing. PACS changed its name to the ‘Pharmacotherapy Advocacy, Mediation and Support’ (PAMS) Service. This new name accurately reflects the role of the PAMS Service. PAMS SYSTEMIC ADVOCACY & REPRESENTATION ADVOCACY The PAMS service primarily works on resolving individual pharmacotherapy consumer-related problems and concerns. Through its work, the service develops a unique perspective into and an understanding of the Victorian Pharmacotherapy Service System. This specific knowledge and insight is often requested by policymakers, researchers and professional groups. For example PAMS has been involved in the following: Research Sub-Optimal Dosing of Methadone in Victoria Role of Methadone Take Away Doses in NSW and Victoria Post-Surveillance Marketing of Buprenorphine-Naloxone (Suboxone) Pharmacotherapy Funding Models Study Reviews Review of the Pharmacotherapy Rural Outreach Workers (PROW) Review of the Victorian Pharmacotherapy Program (2010) Review of the Specialist Pharmacotherapy Service (2013) Committees Harm Minimisation Committee (Pharmaceutical Society of Australia, Victorian Branch) Victorian Department of Health – Pharmacotherapy Reform Advisory Committee Inner East Medicare Local Pharmacotherapy Committee Policy Development Pharmacotherapy Policy for Maintenance Pharmacotherapy for Opioid Dependence (2008) – Victorian Pharmacotherapy Guidelines Pharmacotherapy Policy for Maintenance Pharmacotherapy for Opioid Dependence (2013) – Victorian Pharmacotherapy Guidelines Buprenorphine-Naloxone Prescribing for Non-Registered GPs (2013)

HRVic's PAMS service provides info and help with and around Methadone/Suboxone/Subutex programs in Victoria PAMS Pharmacotherapy Advocacy Mediation Support A phone service that assists with methadone / Suboxone / long-acting bupe injection (Buvidal / Sublocade) issues between clients and prescribers and dispensers. FREE CALL 1800 443 844 HRVic's PAMS service is Victoria's only pharmacotherapy advocacy and mediation service. PAMS is a telephone service ONLY. You will need to call the PAMS phone line if you have any enquiries or issues that are not in the Client or Providers FAQ sections. Please note: As we are a state-wide phone service, please be patient- you may get the answering machine when you call. If you do- PLEASE LEAVE A MESSAGE -include your first name, and a short message about your issue and a CONTACT number we can reach you on. *If your issue is URGENT, or you are calling from a prison or detention facility where a call back is difficult, please state that in your message along with a time you will call back or we can call you. Please do not keep calling if you get the answer machine as this only takes up our time checking messages when we could be calling you or someone else back. PAMS is a confidential service – we do not discuss you or your situation with any other party without your consent. (As we are a telephone service, consent is, in most cases, provided verbally.) CLIENTS New or Existing Patients SERVICE PROVIDERS Prescribers / Dispensers WHAT IS PHARMACOTHERAPY? Pharmacotherapy, when used with regard to substance use refers to the replacement of a person’s drug of dependence with a legally prescribed and dispensed substitute. HISTORY OF PAMS The information provided here is for people whose opioid dependency has currently become problematic or unmanageable for them. The most commonly used opioids in Australia today are prescription formulations (codeine, oxycontin, morphine, fentanyl, etc), illicit opioids such as heroin, and the pharmacotherapy medications methadone and buprenorphine. All opioids have the potential to produce physical dependence. Pharmacotherapy for opioid users is sometimes referred to as Opioid Replacement Therapy/Treatment (ORT), Opioid Pharmacotherapy Program (OPP), or Opioid Substitution Therapy/Treatment (OST) and now Medically Assisted Treatment for Opioid Dependency (MATOD). Though maybe not for everyone, many find that pharmacotherapy has the ability to stabilise their condition, allowing them to devote more time to managing or repairing their lives. Once stabilised, clients may find they wish to strive for a drug-free existence by slowly reducing their dosage – or else they may be satisfied with a maintenance program and stay stable. Pharmacotherapy has been found to reduce opiate-related harm to both the individual and society. Though other treatments exist (cognitive behavioural therapy(CBT) , drug detoxification and (rehab) treatment centres etc., being on a pharmacotherapy program is at present our most effective answer to the problems associated with opioid dependence. Pharmacotherapy programs are available throughout most of Australia. However, each state or territory has its own pharmacotherapy policy and programs can vary considerably. CLICK HERE for PAMS During COVID19 INFO PHARMACOTHERAPY CURRENTLY AVAILABLE IN VICTORIA (AUSTRALIA) There are four different pharmacotherapy drugs available in Victoria. Each has it's own advantages and disadvantages. When deciding with your doctor which is right for you, it may be helpful to check out our fact sheets below: METHADONE Methadone Syrup , Biodone Forte (liquid) Physeptone* (tablet) *Only available for travel SUBUTEX Buprenorphine (sublingual tablet) SUBOXONE Buprenorphine / Naloxone (sublingual film) NALTREXONE (tablet, subcutaneous implant, injection) BUVIDAL™/ SUBLOCADE™ Depot Buprenorphine (long acting buprenorphine injection) VICTORIA REASONS TO CALL PAMS: • you can’t get a dose or a number of doses • you have been told to get a new prescriber or pharmacy due to a problem • you feel you have been discriminated against or treated unfairly by your pharmacist or GP • are thinking of starting or resuming a pharmacotherapy program and have any questions or there is a problem or concern you are travelling inter-state or overseas and are on a pharmacotherapy program and need more information travelling OR If you are a prescriber or dispenser in need of information or advice, on ANY client related issue or concern All calls are entirely confidential. PAMS is a free, partially government-funded service. HOURS OF OPERATION PAMS is open from 11 am – 5 pm, Monday – Friday. INTERSTATE PHONE: PH: 03 93291500 or Email us: pams@hrvic.org.au NB: Email enquiries MAY take up to 72 hours for a response as we prioritise telephone enquiries. *Please note that our 'free-call' number is unfortunately NOT free from mobile phones. If you are calling from a mobile, let us know and we will call you straight back. OTHER STATES PHARMACOTHERAPY SERVICES NOT IN VICTORIA? If you are NOT in Victoria and you have a problem with your program, your local your state or territory drug-user organisation may be able to help you. QLD – Queensland Pharmacotherapy Advocacy Mediation & Support Service (QPAMS) PH: 1800 175 889 – a program of the Queensland Drug User Organisation (QUIVAA) WA – Opiate Replacement Pharmacotherapy Advocacy and Complaints Service ( ORPACS) PH: (08) 9321 2877 – a program of the WA Drug User Organisation (WASUA) NSW – MACS a program of Rankin Court (public clinic) PH: 1800 642 428 SA- DASSA Drug & Alcohol Services SA PH: 1300 13 1340 Check the AIVL (the national drug user organisation) website or phone AIVL directly on 02 62791600 for more info on your state.

Inner City The Inner City covers North Melbourne, Carlton, Collingwood, Richmond, East Melbourne, West Melbourne and South Melbourne. This list consists of the clinic names and their locations. If you click on their address you will open the google maps page for that location. To book at any of these locations, you will still need to call 1800 675 398 or through the online booking system (you need an email address to sign up) CoHealth Melbourne Town Hall 90-130 Swanston St, Melbourne Open Monday to Friday, 10:15am to 4:30pm. Walk-ins are available for: people experiencing homelessness people with English literacy limitations refugees international students If you don’t have a Medicare card or ID, you can still get the vaccine. North Richmond Community Health (NRCH) Community Room North Richmond Community Health 23 Lennox St, North Richmond 3121 Please click here to book an appointment online or call 9418 9800. C ohealth Centre West Melbourne 98 Abbotsford Street, West Melbourne Medical Hub @ RMIT RMIT University, Building 8, Level 3 368-374 Swanston St, Melbourne You must have a current Medicare Card to receive a COVID-19 vaccination here. C ohealth centre Collingwood 365 Hoddle Street, Collingwood Livingroom: COVID19 Vaccine MIHS VAN Phone: 9662 4488 for appointment Max 20 registrations in a day (Some capacity for drop-in on the day if some registrations do not arrive) FIND A PHARMACY INNER CITY

! !**DRUG ALERT**!! (Melbourne/Naarm, Victoria, and VIC wide) !!**COCAINE adulterated with opioid PROTONITAZENE**!! A white powder sold as cocaine in Melbourne has been found to contain the potent synthetic opioid 'protonitazene'. There have been recent serious harms in Melbourne/Naarm associated with a 'white powder' sold as COCAINE that contained the potent opioid PROTONITAZENE. The product appears to produce strong adverse effects such as loss of consciousness, respiratory depression, and life-threatening hypoxia. (lack of oxygen in your blood) Protonitazene is faster acting and is much stronger (100x) than heroin. It is important for everyone- REGARDLESS of the substance you are planning to take- to CARRY NALOXONE. **CARRY iT ON YOU!!- not keep in a cupboard at home or your glove box in the car. It could mean the difference between life and death for someone. Naloxone is a FREE, easy-to-use, easy to get medication that can temporarily reverse an opioid overdose – it is safe to use even if you are not sure whether someone has taken opioids. HRVic does FREE naloxone administration training EVERY 1st of the month. Naloxone can be accessed at HRVic's NSP and at participating pharmacies, other needle and syringe programs and from the medically supervised injecting centre. You can find an approved naloxone provider on the Take Home Naloxone program webpage. ( https://www.health.vic.gov.au/.../victorias-take-home ... ) Protonitazene is one of the many NITAZENES that have been circulating throughout Australia over the past couple of years. Read more about the types of Nitazenes and their effects in the latest WHACK magazine OUT NOW at your local NSP. Read the Nitazenes substance specific article here: If you are an HRVic Member and have not yet received a copy in the mail, email us at info@hrvic.org.au to UPDATE YOUR MEMBERSHIP. If you have any questions or want more info visit the Dept of Health alert : https://www.health.vic.gov.au/.../cocaine-adulterated ... or HRVic's Overdose page on our website: www.hrvic.org.au/dope

A pink and white capsule sold as ‘3C-P’ in Melbourne/Naarm contains the potent opioid protonitazene. The Department of Health has issued a new Drug Alert about a pink and white capsule or white powder sold as ‘3C-P’ or in Melbourne containing the potent opioid protonitazene. Opioids are central nervous system depressants, typically producing a range of effects including pain relief, sedation and respiratory depression (dangerously slow breathing). Respiratory depression often appears more quickly with novel synthetic opioids (NSOs), increasing the risk of life-threatening overdose. Protonitazene is an extremely potent NSO, which means it can produce strong effects in very small amounts. There has been one serious recent hospitalisation in Victoria associated with this pink and white capsule. Due to the potency of NSOs, the product produces strong adverse opioid effects such as loss of consciousness, respiratory depression, and life-threatening hypoxia (insufficient oxygen for normal functioning). It’s important to know the signs of opioid overdose and to carry naloxone to reverse opioid overdose-even if you don't plan to take opioids. HRVic has naloxone available for FREE from our NSP at 299-305 Victoria St Brunswick. We also have naloxone training EVERY 1st of the month ONLINE for FREE at 4:30pm. See website for details (www.hrvic.org.au/training) We can also do one on one training with you if you don't know how to use, when you come to pick up. Or check out our info on naloxone on our 'Recognise & Respond to Overdose' page. Anyone who experiences adverse drug effects or is present when someone has an unexpected reaction to a drug should seek help immediately by calling Triple Zero (000). See DoH drug alerts here: https://www.health.vic.gov.au/.../protonitazene-sold-as-3c-p