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

HRVic's PAMS phone service provides info around Methadone/Suboxone/Subutex programs in Victoria PAMS FOR PHARMACOTHERAPY PROVIDERS We have the know-how you need. General Practitioners & Prescribers This section has been created to be a one-stop shop for pharmacotherapy providers. We have all the forms available or links to the forms for GPs here on our website. (including permits, resources & links to research & documents of interest etc) PAMS is funded to work on any pharmacotherapy, client-related issue or concern. PAMS provides short-term case management until the primary problem or issue of concern has been resolved. Please note, we do not work with patients who are on other S8 opioids – unless they wish to start a pharmacotherapy program. GP’s can contact PAMS or refer a pharmacotherapy patient if: You feel it's essential to start a patient on the program today, however, they don't have the money to pay for the first dose / few doses You have a patient who is re-starting a program and can't locate a dispensing point (possibly due to a poor track record in terms of payment or behaviour, or because there are no vacancies or because there are no service providers where the patient resides) You've had to terminate a patient from their pharmacotherapy program with your service and you would like PAMS to source a new GP prescriber You have a pharmacotherapy patient who informs you that they are not able to continue dosing at their current pharmacy (for whatever reason) and a new dosing point needs to be sourced asap You have the capacity to take on more pharmacotherapy patients You are retiring or leaving your current practice and need to find vacancies with other GP prescribers for some of your pharmacotherapy patients You have a problem with a specific pharmacotherapy patient or group of patients (that has not been mentioned above) and you think we might be able to help You have a patient or number of patients who are express concern about an aspect of their pharmacotherapy program and you feel this needs to be reported You need an independent third party (PAMS worker) to help negotiate a treatment agreement for a patient who has been difficult to manage in your clinic If you have a pharmacotherapy client related problem and you are unsure how we can help, give us a call. If we can’t assist, we will point you in the right direction. PAMS operates 11AM to 5PM , Monday to Friday via a state-wide telephone number PH: 1800 443 844. Please LEAVE A DETAILED MESSAGE on the answering machine after hours or if the phone is engaged. One of our busy staff will return your call as soon as they become available. (Please don't forget your name and phone number) LINKS & FORMS for GPs NEED MORE PAMS PROMO MATERIAL? Fill in the form below to receive more PAMS promotional material. Please allow 7-14 days for delivery.

Button Around 170,000 Australians are living with chronic hepatitis C infection. Many Australians do not know they are infected, or that they could be cured. These people are at risk of developing liver damage, cirrhosis, and liver cancer. Some people will require liver transplants, and many will not survive. They are also at risk of transmitting the virus onto others. The consequences of hepatitis C in Australia are far-reaching, but they don't need to be. Hepatitis C is treatable and curable. It's therefore essential that we test and treat as many at-risk people as we can. It's simple and cheap to be tested, and curative treatments are now listed on Australia's Pharmaceutical Benefits Scheme (PBS). HRVic is committed to working with the rest of Australia towards the World Health Organisation's goal of eliminating hepatitis C by 2030. HRVic have joined forces with the Burnet Institute and EC Australia. We have developed an approach that involves peer specialists working at strategic clinical services to assist our community to navigate and overcome the barriers to treatment and to access services. Introducing the PATH program- Peer Assisted Treatment for Hepatitis. and now the PATH-Ex program- an extension of the PATH program. The aim of PATH-Ex is to ensure that People Who Use Drugs are empowered, informed and supplied with the tools needed to access information, testing and treatment for hep C. We seek to take advantage of the unique empathy and support that comes only from the peer-to-peer relationship to encourage engagement with health services and ongoing support to jump through the hoops that life can put in our way when undertaking any longer term treatment course. You can read more about these principles here . Our PATH workers are outposted in St Kilda, the city and Footscray and the west. During COVID lockdown they are only able to undertake outreach, but as the lockdown end we are hoping to be back to more hours at Access Health, Living Room and cohealth West.

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.

Bayside The Bayside areas covers Albert Park to Mordialloc to Clayton, Malvern to Toorak. 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. Access Health 31 Grey Street, St Kilda Walk-in covid vaccine clinic Friday 1st October 2pm –4pm Friday 8th October 2pm-5pm Friday 15th October 2pm-5pm Prahran Townhall Book your COVID-19 vaccination on the Star Health website. Malvern Town Hall, 1251 High Street, Malvern Opening hours – Monday to Thursday, 9:00am to 4:00pm Priority client cohorts - individual and group bookings can be arranged by our internal COVID Helpline on 8644 3311 Walk in appointments for priority clients and VCE students. Sacred Heart Mission 87 Grey Street St Kilda: Vaccine clinic: every Tuesday and Thursday 9.30am- 2pm Port Melbourne Town Hall 333 Bay Street, Port Melbourne Opening hours – Monday to Thursday, 9:00am to 4:00pm Priority individual and group bookings can be arranged by our internal COVID Helpline on 8644 3311 Walk in appointments for priority clients and VCE students. More Coming Soon Stay tuned for more locations. FIND A PHARMACY BAYSIDE

By people who use drugs for people who use drugs. Shared by community these are helpful tips and tricks to make your existing drug use harm free and happier. Drug Hacks Service Name This is a Paragraph. Click on "Edit Text" or double click on the text box to start editing the content and make sure to add any relevant details or information that you want to share with your visitors. Service Name This is a Paragraph. Click on "Edit Text" or double click on the text box to start editing the content and make sure to add any relevant details or information that you want to share with your visitors. Service Name This is a Paragraph. Click on "Edit Text" or double click on the text box to start editing the content and make sure to add any relevant details or information that you want to share with your visitors. Service Name This is a Paragraph. Click on "Edit Text" or double click on the text box to start editing the content and make sure to add any relevant details or information that you want to share with your visitors. Service Name This is a Paragraph. Click on "Edit Text" or double click on the text box to start editing the content and make sure to add any relevant details or information that you want to share with your visitors. Service Name This is a Paragraph. Click on "Edit Text" or double click on the text box to start editing the content and make sure to add any relevant details or information that you want to share with your visitors. Share your hacks with others Like what you see? Get in touch to learn more. First Name Last Name Email Message Send Thanks for submitting!

Inner East and 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. 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. EACH (Eastern Access Community Health) 47 Patterson Street, Ringwood East EACH (Eastern Access Community Health) & Mullum Mullum Indigenous Gathering Place to host pop-up COVID Vaccination Clinics for members of Indigenous communities in the outer east of Melbourne. Note: only the Pfizer vaccine is available Clinic dates: Thursday 14th October (1st dose) and Thursday 11th November 2021 (2nd dose) 10AM to 4PM at 47 Patterson Street, Ringwood East By appointment only Register at https://forms.gle/AVGnzvj9UFotzeaQ9 Free taxi services are available, please call the Coronavirus hotline on 1800 675 398 COMING SOON Stay tuned for more locations. COMING SOON Stay tuned for more locations. COMING SOON Stay tuned for more locations. COMING SOON Stay tuned for more locations. COMING SOON Stay tuned for more locations. FIND A PHARMACY INNER EAST & EAST

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

Contact Harm Reduction Victoria for more info on becoming a member, booking or sponsoring supplies to DanceWize or to book a workshop or training session contact us on info@hrvic.org.au Become a member of Harm Reduction Victoria today! HRVic is a uniquely peer driven, peer run and peer governed community organisation for people who use drugs. Harm Reduction Victoria Inc . ABN: 46 114 268 362 Street Address 299-305 Victoria Street Brunswick VIC 3056 Postal Address PO Box 87 Brunswick VIC 3056 Phone: (03) 9329 1500 Email: info@hrvic.org.au

Feedback or Complaints As your community based organisation, HRVic welcome any feedback, comment and/or complaint. We want to know what we've got right and also when we've missed the mark. Help us to be the best organisation we can be. First Name (optional) Last Name (optional) Email (optional) Feedback and Comments Do you want a response from HRVic? * Required Yes please! I want answers! No. I just needed to vent. Send Thanks for your feedback!

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 Harm Reduction Victoria is pleased to introduce you to 'GoGo'. 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 people who use drugs and more importantly, to communicate those needs in ways that effect change that has to happen to be sure we are all looked after appropriately as we get older. Are you 50 years young or over and use substances? Fill out this anonymous survey now or Do you work with people Over 50 who use drugs? Fill out this survey now 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 want your input. We want to know what YOU want. We want to know what YOU need or know what you think you WILL need as an older person who uses drugs- who is getting older. Service User Survey (client) Service Provider Survey (worker) "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: Interested in being contacted to be part of the GoGo consultation? Click here to go directly to survey or contact us by filling out this form: > First Name Last Name Email Message Thanks for submitting! Send