Subutex is the less widely used of two buprenorphine formulations available to opiate pharmacotherapy consumers in Victoria, (Suboxone being the other). Subutex is a mono-formulation of buprenorphine available in 0.4, 2 & 8mg sub-lingual tablets. It was the first buprenorphine product to become available in Victoria, but has been largely superseded by Suboxone (a buprenorphine/naloxone formulation.) The presence of the opiate antagonist naloxone in Suboxone makes it less attractive than Subutex to clients who may wish to divert their dose with intention of injecting it. Because of the harms associated with this practice, doctors are less willing to prescribe Subutex and take away doses are only available in a handful of circumstances. Subutex tablets are placed beneath the tongue, where they are absorbed directly into the blood-stream through the mucous membrane. Clients on low doses sometimes find Subutex preferable because the 0.4mg tablet can allow for more accurate dosing. Basic Pharmacology of Buprenorphine Buprenorphine is a partial opioid agonist. It binds strongly to the same receptors as other opiates, but stimulates them only weakly, producing very little of an opiate effect. Once the buprenorphine molecule is locked onto the receptor, it remains there much longer than other opiates like heroin and methadone. If such drugs are taken while on buprenorphine, their effects will be much reduced. Buprenorphine’s affinity for the receptor is powerful enough to displace opiates like heroin and methadone. For this reason, the initial dose of buprenorphine should be low (i.e. < 8mg) and, ideally, the client should be in the first stages of opioid withdrawal. If a dependent client takes a large dose of buprenorphine after recent use of heroin – or before the onset of withdrawal – the buprenorphine can precipitate immediate and full withdrawal. This is an extremely unpleasant, uncomfortable experience to be avoided at all cost. The Ceiling Effect An interesting feature of buprenorphine is its ceiling effect. Up to a certain point, the more buprenorphine that is taken, the greater the opiate effect. Past that point, increasing the dose only results in a longer duration of action and no increased opiate effect. This means that some people can have their daily dose increased (usually doubled) and the dose will last for two days instead of one. This can be very useful for those who have difficulty reaching their dosing points, and can remove the need for take aways during the first month of treatment. Though scientific evidence is scant, this ceiling effect presumably varies with the individual. The maximum allowable dose of buprenorphine is 32mg. Injecting Subutex If another opiate – like heroin, methadone or oxycodone – is present in the system when Subutex is injected, precipitated withdrawal may result, as the opioid will be rapidly displaced from opiate receptors by the buprenorphine. Injecting Subutex carries serious health risks and is not recommended. If the medication is removed from the mouth prior to injection, these risks are compounded. For more information about the harms associated with injecting Subutex, please contact PAMS. Take Away Doses of Subutex There are no routine take away doses of Subutex, unless the consumer is: Pregnant and/or breast-feeding Has a documented allergy to the naloxone (present in Suboxone). Is on a dose of <2mg (this because a 0.4mg tablet of buprenorphine is available, but not in the combined buprenorphine-naloxone (Suboxone) formulation. If a person meets any of the above criteria, take away doses may be provided if the prescriber assesses the client as being stable and there are no other issues of concern. If you have any questions or want to discuss your individual situation, please contact PAMS PH: 1800 443 844.

HRVic is a community based and governed not-for-profit organisation. Our membership, staff and supporters include current and former people who use drugs. HRVic BOARD 2026 "The speed of decision making is the essence of good governance. -Piyush Goyal Board President PENNY HILL Penny Hill is the current Deputy Secretary of the Vienna NGO Committee on Drugs, Oceania Representative to the International Drug Policy Consortium’s Members Advisory Council, Board Member of Harm Reduction Australia, Vice President of Harm Reduction Victoria, and co-founder of Students for Sensible Drug Policy Australia. Penny's PhD thesis focussed on opioid overdose through the Burnet Institute, and currently works as an Emerging Drugs Research Fellow at UNSW. Penny started working in the harm reduction sector as an NSP worker, and has substantial experience working and volunteering in various harm reduction services, including peer-led supervised consumption sites, festival spaces and drug checking services in Australia, New Zealand and Canada. Board Vice President GABY BRUNING Gaby has been working primarily with Aboriginal clients in the AOD sector for the last 8 years as an AOD Clinician and Harm Reduction Practitioner. I wish to run for the Board because I believe in HRVic, and I believe in advocating for the human rights of people who use drugs. Board Secretary KATIA LALLO Katia is a community lawyer and advocate for the rights of criminalised people and communities. Her work is informed by de-carceration and grassroots organising, especially in the space of community legal education. Katia is interested in the way the law impacts on the lives of people who consume drugs, and its implications for individual and community safety and self-determination. Katia is a community lawyer and advocate for the rights of criminalised people and communities. Her work is informed by de-carceration and grassroots organising, especially in the space of community legal education. Katia is interested in the way the law impacts on the lives of people who consume drugs, and its implications for individual and community safety and self-determination. Board Treasurer PETER HIGGS ‘ Growing up’ in the inner suburbs of Sydney while studying a social work degree pre NSP in the mid-1980s meant learning lots about drugs and the people who use them. My first job in Melbourne in 1988 was on the North Melbourne high-rise housing estate which was ‘awash with heroin’. This led me to work with families who were greatly impacted and very confused about harm reduction. Much of my work over the past 25 years has been in and around the Footscray ‘street scene’ through a range of different iterations - with a couple of long stints in Vietnam doing HIV peer-based prevention work. Most of my recent work has a focus on hep C and changes in drug use patterns. I’m keen to give what knowledge and support I can to HRVic as I step back in my paid research work roles and look forward to the opportunities available. Board Member ROBYN DWYER (Coming Soon) Board Member LUCIEN KEENE (Coming Soon) Board Ex-officio Staff Member JANE DICKA (Coming Soon) Board Ex-officio CEO Sione Crawford (Coming Soon)

INTERNATIONAL DRUG USERS DAY 1:11:20 On this day we remember not only all those we have lost to the drug and all the years we have lost in prisons around the world but all the amazing positive difference we make – from overdose response to drug checking to peer support and education to hep C treatment navigation. The COVID-19 pandemic has hit our communities globally very hard. While Harm Reduction Victoria has been affected, the team have continued much of our work, despite being less able to engage in face to face & peer to peer work. We rallied quickly to reach out to community when the Flemington / North Melbourne Housing hard lockdown came down. We worked with close partners to do on the ground outreach in truly awful circumstances. We have worked with service providers and allies to provide naloxone and needle and syringe outreach to the hotels in central Melbourne. We have delivered naloxone training online and PAMS has assisted hundreds of people to start or remain on opioid substitution treatment over their phoneline. Our ace designer and Health Promotion Team have pushed out awesome info about COVID-19 and DanceWize has not missed a beat in supporting their community. Today we are so proud to release a new video in partnership with SSDP and Pill Testing Australia. "Pill Testing Explained" -2020

!!**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

Join our vibrant Sunday workshop at the IDUD Makers Market. This session offers a unique hands-on experience to purchase from local artisans in a collaborative environment. Perfect for hobbyists and serious makers alike looking to sell their wares... (in Progress)