COVID aka Coronavirus, SARS CoV-2, Covid 19 Last Updated 04.10.2021 Some Things You Should Know: for People Who Use Drugs WHAT IS IT? SYMPTOMS TRANSMISSION VACCINE INFO VACCINE LOCATIONS LIST First Things First- What Is A Coronavirus? Coronaviruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) . The most recently discovered coronavirus causes SARS CoV-2 or as we know it- COVID-19 ( The one we are dealing with now around the world.) WHAT This new corona virus (COVID-19) and it's variants were unknown before the outbreak was announced in Wuhan, China, in December 2019. What Are The Symptoms? SYMPTOMS COVID-19 affects different people in different ways. Most infected people will develop mild to moderate illness and recover without hospitalisation. The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Less common symptoms are aches and pains, sore throat, conjunctivitis, headaches, loss of taste or smell, diarrhoea and a rash on skin or discolouration of fingers or toes. These symptoms are usually mild and begin gradually. Serious symptoms include difficulty breathing or shortness of breath, chest pain or pressure and loss of speech or movement. Some people become infected but don’t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Seek immediate medical attention if you have serious symptoms. Always call before visiting your doctor or health facility. People with mild symptoms who are otherwise healthy should manage their symptoms at home. On average it takes 5–6 days from when someone is infected with the virus for symptoms to show, however it can take up to 14 days. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, and immune deficiency issues are more likely to develop serious illness. How Does It Spread? Transmission Current evidence suggests that the virus spreads mainly between people who are in close contact with each other , typically within 1 metre (short-range). A person can be infected when aerosols or droplets containing the virus are inhaled or come directly into contact with the eyes, nose, or mouth. The virus can also spread in poorly ventilated and/or crowded indoor settings, where people tend to spend longer periods of time. This is because aerosols remain suspended in the air or travel further than 1 metre (long-range). People may also become infected by touching surfaces that have been contaminated by the virus when touching their eyes, nose or mouth without cleaning their hands. Further research is ongoing to better understand the spread of the virus and which settings are most risky and why. Research is also under way to study virus variants that are emerging and why some are more transmissible. Infected people can be contagious and the virus can spread from them to other people, whether they have symptoms or not . Laboratory data suggests that infected people appear to be most infectious just before they develop symptoms (namely 2 days before they develop symptoms) and early in their illness. People who develop severe disease can be infectious for longer. While someone who never develops symptoms can pass the virus to others, it is still not clear how frequently this occurs and more research is needed in this area. **Research is ongoing and HRVic will update this information as new discoveries are made. Which COVID-19 vaccines are available in Australia? Australia’s Therapeutic Goods Administration (TGA) has provisionally approved vaccines for COVID-19: Comirnaty, the Pfizer -BioNTech COVID-19 vaccine, provisionally approved for people aged 12 years and older Vaxzevria, the Oxford University-AstraZeneca vaccine, provisionally approved for people aged 18 years and older Janssen, the Janssen-Cilag Pty Ltd vaccine, known as Johnson & Johnson , provisionally approved for people aged 18 years and older — this vaccine is not included in Australia’s COVID-19 vaccination program Spikevax, the Moderna Australia vaccine, for people aged 12 years and older “Do you want a vax?” Here’s what Professor Margaret Hellard has to say about it. Margaret is known and loved and trusted by many in our community and has treated many of us for hep C and HIV over the years. VACCINES FAQs VACCINE VACCINE What Vaccines are what? What's the difference? Find Out HERE. What if I can't afford the covid vaccine? You do not need a money to get a COVID-19 vaccine. It is FREE. What if I don’t have a Medicare card? You do not need a Medicare card at Commonwealth State clinics to get a COVID-19 vaccine. Check with the clinic you have booked at I have a medical condition. Can I get an exemption? You may be exempt if you are unable to be vaccinated because you have a medical contraindication as determined by ATAGI clinical guidance . You will need evidence from a medical practitioner about this – such as a medical certificate or a letter. MASKS- Do I have to wear a mask and if so, when do I have to wear it? Anyone 12 years and over must wear a fitted face mask whenever they leave their home, indoors or outdoors, unless lawful exception applies . The Victorian Department of Health and Human Services has developed a series of badges for people who are unable to wear a face covering for a valid reason . The badges can be downloaded onto smartphones or printed to keep in a wallet or lanyard holder. Smartphone badges I am exempt from wearing a face-covering for valid reasons - blue badge (jpg) I am exempt from wearing a face-covering for valid reasons - white badge (jpg) For people who are deaf or hard of hearing and need the person they are communicating with to remove their face mask: Please remove your face covering so we can understand each other better - blue badge (jpg) Please remove your face covering so we can understand each other better - white badge (jpg) Print-ready badges I am exempt from wearing a face-covering for a valid reaso n (PDF) Please remove your face covering so we can understand each other better (PDF) HRVic's COVID-19 SEPT 13 UPDATE (Lockdown #2 Victoria) HRVic's COVID-19 SEPT 27th 2020 UPDATE (Lockdown #2 Victoria) HRVic's COVID-19 & Drug Use Resource #1 DOWNLOAD PDF HRVic's COVID-19 & Planning For the Substance Dependent Resource #2 DOWNLOAD PDF HRVic's COVID-19 & Pharmacotherapy Resource #3 DOWNLOAD PDF HRVic's COVID-19 SEPT 27 UPDATE (Resource #4 Lockdown #2 Victoria) DOWNLOAD PDF Some MORE Helpful Tips for People on Pharmacotherapy - Methadone and Buprenorphine (Suboxone and Subutex) : CLICK HERE

METHADONE Methadone Methadone is the most successful, well-researched and cost-effective treatment for opiate dependence. Although it is available in both liquid and tablet forms, the Victorian pharmacotherapy program uses the liquid form alone (except in instances of limited overseas travel). There are two brands of methadone liquid: Methadone Syrup and Biodone Forte. Their contents and strength are the same. Basic Pharmacology of Methadone Methadone is a full opiate agonist. The higher the dose, the greater the opiate effect. If too much methadone is consumed, breathing and heart rate will gradually slow, leading eventually to unconsciousness and death. Other full opiate agonist drugs include heroin, morphine, oxycodone, fentanyl, pethidine etc. When a client begins taking methadone, the doctor will prescribe a safe, low dose which can be adjusted as required until no feelings of opiate withdrawal are experienced for the full twenty-four hours between doses. If doses are missed or other opiates are used, it will take longer to stabilise on a daily dose. Methadone Take-Away Doses For the first two months of treatment, clients must attend each day for their dose. After this, if the client is considered stable, some takeaway doses may be prescribed, see below for further details: after two months of continuous treatment and considered stable (on the correct dose and not missing doses) – eligible for up to 2 take away doses per week after six months of continuous treatment and considered stable (on the correct dose and not missing doses) – eligible for up to 4 take away doses per week

Services and Programs Needle & Syringe Program FIND OUT MORE DanceWize Peer run event care and on site outreach FIND OUT MORE Naloxone Opioid Overdose Recognise and Respond using Naloxone FIND OUT MORE P.A.M.S Pharmacotherapy Advocacy Mediation Support Phone Service FIND OUT MORE Safer Using Info Vein Care and Finding Blood Borne Virus Overdose- Opioid and ATS FIND OUT MORE WHACK MAGAZINE HRVic's quarterly publication. Fuse Initiatives Harm reduction peer workforce advocacy & support. Getting Older & Getting On Peer support for older people who use drugs. The Stigma Project FIND OUT MORE FIND OUT MORE

Vaccine Locations With all of the Covid confusion, regardless of where it's come from, you'd be forgiven for not knowing how to go about getting the Covid vax if you choose to. We know that there are people in our community who do choose to be vaccinated and may be having trouble doing so- whether it's trouble with finding a clinic close to them or having trouble booking to get it done because of not having ID or a medicare card, or frustrating wait times etc, HRVic have decided to make sure that anyone in our community who chooses to partake- will not miss out. We absolutely respect our community's autonomy ( the right to self govern) around their health and respect your choice whatever it may be. We do however, want to ensure that this isn't another reason for society to leave us out in the cold. Already, the stigma and discrimination around someone who takes substances exists in spades and we don't need something else to move us to or keep us in 'the back of the line' in life. There are already many venues and businesses that have decided that people can not enter or partake without being vaccinated. The Basics: Everyone in Australia aged 12 and over can receive a COVID-19 vaccination If they choose. The Covid vaccines are FREE . You are allowed to travel more than 15km from home to receive a COVID-19 vaccine. View more information about current restrictions . There are a a few different types of vaccination clinics: Commonwealth Vaccination Clinics State (and Territory) Vaccination Centres General Practices (GPs) Aboriginal Controlled Community Health Services Community Pharmacies Hospital Immunisation Hubs Outreach Services and 'Pop Up' clinics Aged care in-reach Reserved appointments are available for people accessing alcohol and drug services to get vaccinated at state vaccination centres. Appointments for ALL areas are only available by calling (freecall) 1800 675 398. We have compiled a list of clinics and services who are offering the vaccines. Click on the area name that you want to find a clinic in to see locations in that area. NEW Pop Up and Walk In Vaccine Clinics List A 'Pop Up' vaccine clinic is a non permanent location where you can get your jab between certain dates. You may still need to book. Please check with individual locations to avoid disappointment. A 'Walk In' vaccination clinic is a clinic where you don't need to book. The Victorian Government is bringing the vaccines to areas that need them most, by launching a massive community pop-up vaccination program targeting 100 priority postcodes across the state. HRVic will continue to post UPDATED lists in PDF form so you can print them out, for you as they arise so nobody has to miss out. POP UP VACCINE CENTRES WALK IN VACCINE CENTRES INNER CITY The Inner City covers North Melbourne, Carlton, Collingwood, Richmond, East Melbourne, West Melbourne and South Melbourne. BAYSIDE The Bayside areas covers Albert Park to Mordialloc to Clayton, Malvern to Toorak. INNER EAST & EAST The Inner East and East areas cover all suburbs from Kew to Chirnside Park, out to Eltham to Warburton and back to Ferntree Gully and back to Caulfield. WEST & SOUTH WEST The West & South West areas covers Williamstown to Wyndham Vale and Eynesbury to Caroline Springs back to Footscray. NORTHERN SUBURBS The Northern Suburbs area covers Maribyrnong & Essendon to Taylors Lakes & Tullamarine up to Craigieburn to Bundoora and back to Reservoir, Thornbury and Northcote. SOUTH EAST & MORNINGTON PENINSULA The huge South East area covers from Dandenong to Warneet to Druin to Narre Warren and back to Emerald. REGIONAL VICTORIA Regional Victoria covers everywhere else- from Geelong to Ballarat to Bendigo to Gippsland to the mountains. CAN'T FIND A CLINIC IN YOUR AREA? TRY THESE OTHER RESOURCES Victorian Government Covid Vaccination Centre website TAKE ME THERE Australian Government Covid Vaccine Clinic Finder website TAKE ME THERE

Regional Victoria Regional Victoria covers everywhere else- from Geelong to Ballarat to Bendigo to Gippsland to the mountains. 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) unless it states otherwise. GEELONG Barwon Health Community Vaccination Hub 2-30 North Shore Road, Norlane 3214 (old Ford factory). Parking available on-site and easy access to bus stops and public transport. Book here Walk-ins accepted for AstraZeneca, although you are encouraged to book via the links above. Walk-ins are not available for Pfizer. If you walk in, you should be prepared to wait. Walk-ins are only accepted from 8.30am to 3.30pm each day. COBRAM Cobram NCN Health 1 O'Dwyer Ave, Cobram VIC Open Monday, Tuesday and Thursday 8.30am - 4:30pm Open Wednesday 8.30am-8pm Closed public holidays Use the online booking system or call 1800 675 398 for availability. Walk ins are not accepted at this vaccination centre. HORSHAM Horsham Community Clinic 20 McLachlan St, Horsham VIC Open Monday to Friday 9.30am-4pm Closed public holidays Use the online booking system or call 1800 675 398 for availability. Walk ins are not accepted at this vaccination centre. SHEPPARTON Shepparton Showgrounds - McIntosh Centre Corner of Thompson Street and High Street, Shepparton VIC Open Monday, Wednesday, Thursday and Friday 9am-4.30pm Open Tuesday 9am-8pm Open public holidays Walk ins are accepted at this vaccination centre. CASTLEMAINE Castlemaine Health 142 Cornish St, Castlemaine, VIC 3450 Open Monday, Wednesday and Friday 9am-12:45pm and 1:30pm-2:30pm. Closed public holidays. Use the online booking system or call 1800 675 398 for availability. Walk ins are not accepted at this vaccination centre CORRYONG Corryong Vaccination Hub 20 Kiell Street, Corryong VIC Open Tuesday and Wednedsay 9am-4pm Use the online booking system or call 1800 675 398 for availability. Walk ins are not accepted at this vaccination centre. GIPPSLAND Sale - Gippsland Regional Sports Complex 116 Cobains Road, Sale VIC Open Monday, Wednesday and Friday 8:45am-3:30pm Open Thursday 15th July and Thursday 5th August 3pm-9pm) Closed public holidays Use the online booking system or call 1800 675 398 for availability. Walk ins are not accepted at this vaccination centre. SEYMOUR Seymour Health 1 Bretonneux Street, Seymour VIC Open Monday to Friday 9am - 4pm Use the online booking system or call 1800 675 398 for availability. Walk ins are not accepted at this vaccination centre. FIND A PHARMACY REGIONAL VICTORIA

CHANGING LANES Deciding to go onto pharmacotherapy- whether it's methadone, suboxone or the new long acting buprenorphine injection- is no small decision. Our PAMS program has put this series of 4 videos together- covering every aspect of pharmacotherapy- from the real voices of real pharmacotherapy consumers to you to assist you in making that decision. Changing Lanes Changing Lanes Play Video Share Whole Channel This Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Search videos Search video... Now Playing 20211015 720p INHSU Comm Rapporteur 08:07 Play Video Now Playing E01 Deciding To Go On Treatment 04:59 Play Video Now Playing E02 Accessing Treatment 05:31 Play Video

GP & Prescriber LINKS and Forms POLICIES & APPLICATIONS The Department of Health and Human Services has provided a number of additional resources to complement the revised policy. Pharmacotherapy providers are encouraged to use these resources when prescribing or dispensing to people on opioid replacement therapy. All are available from the Downloads section on the Health.Vic website . Some resources are also available in a number of community languages* Pharmacotherapy Policy 2016 Policy for Issuing Schedule 8 Permits Application for Approval as a Prescriber of Pharmacotherapy Notification Of A Drug Dependent Person NATIONAL CLINICAL GUIDELINES (To be used in conjunction with Victorian Policy) NCG for Methadone NCG for Buprenorphine NCG for Use for Naltrexone

HRVic's PAMS phone service provides info around & help with methadone or suboxone or Subutex programs in Victoria Top of Page FOR PEOPLE ON OR STARTING PHARMACOTHERAPY (METHADONE (liquid), SUBOXONE (bupe/naloxone), SUBUTEX(bupe), or BUVIDAL, SUBLOCADE (long acting bupe injections) HRVic's PAMS service has access to the latest pharmacotherapy information. ALREADY ON TREATMENT? How PAMS can help you: CHOOSE ONE I AM CURRENTLY TAKING PHARMACOTHERAPY (methadone / bupe / suboxone / long acting injectable bupe) NOT ON TREATMENT YET? I AM THINKING ABOUT STARTING or I WANT TO START TAKING PHARMACOTHERAPY FAQs Frequently Asked Questions We strongly encourage you to call us PH: 1800 443 844 so that we can make sure we thoroughly understand your situation. Scroll over the questions to reveal their answers CURRENTLY NOT AVAILABLE ON PHONES What is Suboxone? Suboxone is a combination of buprenorphine with naloxone. Suboxone comes in the form of a tablet and a dissolvable film that is placed under the tongue. What is buprenorphine? Buprenorphine is a synthetic opioid that produces weaker euphoric effects than say, heroin or methadone but it reduces or eliminates your symptoms. What is methadone? Methadone a powerful synthetic analgesic drug which is similar to morphine in its effects but less sedative and is used as a substitute drug in the treatment of morphine and heroin dependence. How many methadone take away doses (TADs) can I get? Usually 4, but COVID 19 has had a positive effect on take aways giving most clients up to 6 TADs a week. Personal Shoppers I've been told I can't be dosed at my pharmacy anymore. Are they allowed to do this? Yes. Pharmacies are private businesses. They do not have to provide a service to anybody, regardless if the person is on a pharmacotherapy program. Easy Returns My pharmacist refuses to dose me unless I have the money to pay for it? Is this legal? What can I do? Yes. Your pharmacist doesn't have to dose anyone who can't pay for it. If you need help with this, please call PAMS and we can try to work out a payment plan for you. Easy Returns My doctor has told me that I have to find another prescriber. Don't they need to find me a new one if they can't prescribe? Generally, if a GP bans a client from their practice- and YES they CAN DO THAT- they will make sure the person has a script to cover them for at least a week. Finding a new prescriber can be hard, contact PAMS as soon as you know you need a new GP and we can try to help. Easy Returns I have to go to court tomorrow and I will need another take away dose, Can my pharmacist just give me one extra? If you have used your prescribed take aways for the week, you will need to get your prescriber to add another T/A dose for this week. Make sure you ask BEFORE your court date. Some GPs will do this over the phone to the pharmacist-some won't. Easy Returns I have missed two doses this week. My script says I can have 4 take aways per week but my pharmacist is now refusing to give me any , What can I do? It is best to talk with your doctor about this. If you need help with this, please call PAMS and we can try to advocate for you. Some things to consider before going on 'the program'. The decision to start pharmacotherapy is often made in a state of crisis- in a rush, with little thought given to the long term consequences. Ask yourself a few things before taking the leap – particularly if you have not been on a pharmacotherapy program before. Is this your decision or do you feel pressured by others? Is there threat of incarceration or the removal of children? Is the program part of your parole or CBO conditions? If it’s not your decision, this may influence your chances of success. Is this the best treatment option for you at this point in your life? Why? Do you know about the different pharmacotherapy options ie. Methadone or Suboxone or long acting bupe injection? Do you know which is likely to suit you best and why? Are you aware of the alternatives to pharmacotherapy such as a detox program either at home or as part of a residential program? If you have tried the alternatives and they did not work, Why? Are you prepared to make a long term commitment? Pharmacotherapy usually works best as a long-term commitment. How long do you expect your pharmacotherapy program to last? Do you have to travel for work or regularly? It is still possible to travel (almost anywhere) when on a program, but it does mean you need to organise things in advance. Do you know about the different pharmacotherapy options ie. Methadone or Suboxone or long acting bupe injection? Do you know which is likely to suit you best and why? Are you aware of the commitments involved like visiting a GP at least monthly and a pharmacy every day (in the first few months)? Can you afford the dispensing fee (approx. $7.30 per 28 day prescription(w/ Health Care card) or $30(without)? Could you get to a pharmacy every day if it was required by your prescriber? Will picking up your daily dose interfere with your employment, family commitments, study etc? Are there service providers (doctor & pharmacist) near where you live and do they have vacancies ? Unfortunately, NOT ALL GPs will prescribe pharmacotherapy. This can be a particular problem if you live in a regional/rural area. Are you involved in any other type of drug treatment at present? (for example individual counselling) Have you spoken to others on a program? Although everybody’s experience is different, it can be extremely helpful to talk to your peers and ask them how the program works for them. Do you feel well informed? If the answer is yes, and you have decided to embark on a pharmacotherapy program, it is time to act.

Northern Suburbs The Northern Suburbs area covers Maribyrnong & Essendon to Taylors Lakes & Tullamarine up to Craigieburn to Bundoora and back to Reservoir, Thornbury and Northcote. 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) unless it states otherwise. Broadmeadows Town Hall 10 Dimboola Road Broadmeadows VIC Open Monday to Friday 9.30am-5.30pm Closed on weekends and public holidays Bookings accepted, check the online booking system or call 1800 675 398 for availability. Walk ins are accepted at this vaccination centre for Pfizer and AstraZeneca. Campbellfield Ford Complex Drive-Through Vaccination Clinic 358 Barry Road, Campbellfield VIC 3061 Open every day, 8am-8pm Bookings accepted, check the online booking system or call 1800 675 398 for availability. Walk ins are not accepted at this vaccination centre. COMING SOON Stay tuned for more locations. Latrobe University - Bundoora campus Car park 6, 45 Ring Road Bundoora VIC 3083 Open every day 8am-3pm Bookings accepted, check the online booking system or call 1800 675 398 for availability. Walk-ins are accepted at this vaccination centre, for Moderna only. Campbellfield Ford Complex In-person Vaccination Clinic 358 Barry Road, Campbellfield VIC 3061 Friday to Wednesday 8am-4.30pm, Thursday 11am-7.30pm Bookings accepted, check the online booking system or call 1800 675 398 for availability. Walk ins are accepted at this vaccination centre. COMING SOON Stay tuned for more locations. FIND A PHARMACY NORTHERN

West and South West The West & South West areas covers Williamstown to Wyndham Vale and Eynesbury to Caroline Springs back to Footscray. 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) unless it states otherwise. Melbourne Showgrounds 04 Boulevard Pavilion Opening Hours: 8:00am – 5:30pm seven days a week due to high demands. Sunshine Hospital Sunshine Hospital Vaccination Hub St Albans, Vic. Capacity : up to 60 cubicles Purpose-built semi-permanent facility constructed in the ground floor of the site’s multi-deck car park. VU Whitten Oval (pop-up vaccination hub) The VU Whitten Oval COVID-19 Vaccination Hub only runs on certain days. Check the website for details and dates of operation. This site will be offering Pfizer only. Caroline Springs Leisure Centre Located at 9-19 The Parade Caroline Springs Bookings accepted, check the online booking system or call 1800 675 398 for availability. Walk ins are accepted at this vaccination centre for Pfizer and AstraZeneca. The Melton Vaccination Hub Located at 149 Barries Rd Melton West. This Hub has two vaccination services – a drive through service and a sit down vaccination centre. The drive through service is the first of its kind in Australia. Click here or on the following image to view a short video about this service. Chemist Warehouse Braybrook Home Co Tenancy 3A & 3B 340-342 Ballarat Road Burke & Butler Streets BRAYBROOK Phone: +61385271774 Bookings must be made online. Book HERE. IPC Health Vaccination Hub Caroline Springs Leisure Centre 9-19 The Parade, Caroline Springs Open Monday to Friday 10am-6pm and Saturdays 9am-6pm. Open public holidays Cohealth Centre Laverton 95-105 Railway Avenue, Laverton Open Monday to Friday, 9:30am to 4:30pm Call 9448 5552 Werribee St Vincent’s Private Hospital The Werribee COVID-19 Vaccination Hub is located at St Vincent’s Private Hospital, 240 Hoppers Lane, Werribee. The entrance and parking is available at the rear of the hospital. Wyndham Eagle Stadium Located at 35 Ballan Road, Werribee. This Hub has two vaccination services – a drive thru service and a sit down vaccination centre. Priceline Pharmacy Sunshine Marketplace Shop 45, Sunshine Marketplace S/C 80 Harvester Road SUNSHINE Open 09:00 to 17:30 +61393647133 Bookings must be made online. Book HERE. FIND A PHARMACY WEST & SOUTH WEST

Getting On, Getting Older (GoGo) is a new project in development: Targeting the health and social needs of us oldies who inject/use drugs – now and into the future. GOGO Project The Getting On - Getting Older Our Story Getting On, Getting Older (GoGo) is a new project in development: Targeting the health and social needs of us oldies who inject/use drugs – now and into the future. GoGo is where the elders of our community can gather to discuss our needs as older community members and more importantly, to communicate those needs in ways that effect the change that has to happen to be sure we are all looked after appropriately as we get older. What are you experiencing as an older person who uses drugs? What are your concerns for your future? How can services work with older drug users to maintain a certain standard or to improve their quality of care? If you consider yourself an ‘older’ drug user, we need your input. We want to know what YOU want. We want to know what your needs are or what you think you may need as you continue to age, while being a person who uses drugs. "Services for 'ageing drug users' simply do not exist. Why? -because until recently, we didn't get older. It's about figuring out what we need and want and then creating those services for ourselves and ensuring they're available in the future- for all people who enjoy substances" - Sam "I want to be taken seriously when I say I feel pain..and I want to be treated for that pain. I had to take and give my dying friend illicit drugs because their pain was not being managed appropriately while in palliative care-it was devastating." - Anonymous "I want to go to the doctor to and have my health issues and pain taken seriously- not just assume it's the result of my using." - Anonymous Let's Talk About it: Would you like to talk to another older person who is in the same situation First Name Last Name Email Message Thanks for submitting! Send

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)