There is no one-size-fits-all solution when it comes to Opioid Agonist Treatment (OAT). What works for one person, may not work for another. The My Choice project highlights the importance of personal choice in drug treatment and shares the diverse experiences of people from around Australia.
The My Choice film and participatory photography project showcases diverse experiences of individuals around Australia accessing different available forms of OAT, or who choose not to receive OAT at all. It also features perspectives from General Practitioners, OAT prescribers, and other professionals involved in drug treatment policy or programs.
Alongside the films, participants share a glimpse into their lives and personal histories through a participatory photography project, which can be viewed at the bottom of this page.
Forms of OAT in Australia include methadone, buprenorphine/naloxone and long-acting injectable buprenorphine. The choice of which OAT a person may choose is varied and nuanced, and it can also change over time due to evolving lifestyles and priorities.
Why might people choose one OAT over another?
Fairly new to the Australian OAT landscape, the buprenorphine injection is being favoured by people who value its flexibility, with fewer trips to the pharmacy freeing up time and headspace.
I used to go to Queensland a lot and it was a big endeavour to get my methadone doses…now with bupe, it’s every four weeks and it feels like it’s in the background. It’s a minimum regulation program and it’s given me a taste of freedom I haven’t felt in a long time.
For another participant, a round trip to the pharmacy with a prescribing doctor is 300km away from the rural area they call home, with fewer appointments needed for injectable depot buprenorphine saving valuable time and money.
But, although the injection has proved invaluable for some, it should still be a choice.
We’re finding that more and more people [in Canberra Prisons] aren’t having the choice to choose methadone or suboxone and are being pressured to go onto the injectable buprenorphine.
Flexibility also means different things to different people. Sione Crawford, CEO at Harm Reduction Victoria, has been on methadone on and off for 15 years, as it lets him make choices about other drugs. For many My Choice participants, this is a driving factor on which OAT works best for them.
Buprenorphine/naloxone (Suboxone) has proven the preferred choice for another participant who tried various forms of OAT to manage their codeine addiction, which saw them overdosing every couple of days.
The choice has removed the shame and stigma that was felt for years and they are now able to take it whenever needed. And for other participants, their choice has been – and always will be – to say no to OAT in all its forms.
More choice starts with GPs and prescribers
Various GPs and prescribers across Australia are calling for more choice to be given to people on OAT programs, for more funding to be allocated, and for pharmacies to play a more proactive role.
Community pharmacies play a role by default and some run that really well and some not so well. To ensure I don’t judge and I don’t discriminate is a lifelong process. It’s important as a pharmacist to be able to put yourself in someone else’s shoes. That gives a deeper and better understanding of where the patient is.
Dr Andrew Palfreman is a GP and Drug and Alcohol specialist working two days a week with the PAT Outreach van, run by Directions Health, and owner of a GP clinic in Canberra. He would like to see more education for GPs on OAT options to help give them the confidence to start prescribing.
Professor Adrian Dunlop, Area Director at Hunter New England Local Health District meanwhile is calling for more funding towards drug treatment programs and other services for people who use drugs.
It’s really sadly neglected, with less than 1% of state health budgets. Whereas if you look at alcohol, tobacco and other drugs together it’s something like 14% of the burden of disease…there’s a tiny amount of funding and that’s what needs to change.
Participatory photography project
Premiered at the INHSU 2022 annual conference and on permanent display at the Harm Reduction Victoria Offices in Melbourne, the accompanying My Choice participatory photo project shares the experiences of people who use/have used drugs from across Australia. Thank you to everyone who took part.