Treating opioid use disorder in remote Australia
Use of opioids – sometimes heroin, more often prescription opioids – is common and problematic in rural and remote settings; it is more prevalent in Aboriginal communities. Opioid agonist treatment (OAT) involving methadone or buprenorphine is effective in reducing harm and enhancing prospects for recovery. However, OAT is often difficult to access, expensive, and patients receive little support and rigid rules. OAT has required daily attendance for supervised administration of medication, as otherwise drugs can be diverted to the black market, perpetuating drug problems in the community. However, advent of a new form of treatment, depot buprenorphine, means treatment no longer requires daily attendance. A partnership of local Aboriginal health Services, Western NSW LHD, and Bila Muuji has commenced a pilot program offering depot buprenorphine at no cost in Bourke. Individual and group support for participants is provided by local Aboriginal Health services. We are developing an evaluation of the program, looking at uptake, attitudes and experiences of participants and treatment providers, and identifying obstacles to effective implementation.