The arguments, justifications and treatment of these patients gets worse

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The federal government maintains a PBS that takes people on a reimbursed 'red carpet ride' to prescription opioid addiction and then literally abandons those wanting to end their dependence.

It is simply not any kind of exaggeration to say these patients accessing treatment through the Opiate Dependence Treatment Program (ODTP) have been abandoned.

Australians can readily access opioids through the PBS. They are reimbursed under Section 85 of the National Health Act 1953. This means any general practitioner can prescribe opioids and every community pharmacy is required to supply patients if they present with a PBS prescription. Patients pay the appropriate PBS co-payment - concessional or general - that then counts towards their safety net. Concessional patients get their opioids for free when they hit the safety-net.

Australian doctors write around 15 million prescriptions for opioids each year. Many people require these medicines because they live with debilitating and chronic pain. However, it is thought that around one-in-ten people who are prescribed an opioid becomes addicted or experiences some level of dependence.

Both the TGA and Pharmaceutical Benefits Advisory Committee (PBAC) have recognised the issue and recommended changes to make prescription opioids more difficult to access, including smaller pack sizes and tougher PBS prescribing restrictions.

The terrible impact of opioid addiction is not a secret. The federal government's own Australian Institute of Health and Welfare has consistently highlighted the issue in its regular reports on the impact of alcohol, tobacco and other drugs.

According to a report released in December last year - just two months ago and at the same time the Department of Health was working to entrench the ODTP through a legislative instrument - opioids were the most common factor in the 1,740 drug-induced deaths reported in Australia in 2018, accounting for 64.5 per cent or 1,123 deaths. Around 80 per cent of the deaths were unintentional. The rate of unintentional drug-induced deaths is three times higher in Australia's indigenous populations.

The Pennington Insitute's 2020 annual report on overdose in Australia found prescription opioids are responsible for around one-third of these unintentional drug induced deaths. That equates to more than one every day. At least one Australian dies every day as a result of prescription opioid use.

Health minister Greg Hunt has recognised this issue and acted, in part. He acted quickly on advice to restrict access to prescription opioids and made an overdose reversal nasal spray more widely available.

You have to believe he genuinely wants to address the issue of opiate dependence, addiction and death, and recognises the importance of access to PBS-listed treatment.

Yet the ongoing failure to act to address the manifestly unfair arrangements for people accessing treatment through the ODTP is so inadequate it can only be described as direspectful and even cruel.

Patients accessing PBS-listed treatment for their dependence, many of whom have been walked into their addiction through Medicare and the PBS, are denied basic protections every other Australian takes for granted.

The ODTP is established under Section 100 of the National Health Act 1953. 

Section 100 grants the health minister or their delegate the power to make 'special arrangements'. 

One example is the 'Closing the Gap PBS Co-payment Program'. It sets aside PBS co-payment arrangements for indigenous Australians. Those who would normally pay the general co-payment qualify for the concessional level. Those with a concession card pay no co-payment for almost all PBS medicines. In fact, the government even expanded the program in last year's 2020-21 Budget.

Of course, the ODTP is excluded, meaning indigenous Australians who are three times more likely than other Australians to experience an unintentional drug-induced death are forced to pay private dispensing fees to access their PBS-listed treatment for opiate dependence.

How is that contributing to closing the gap?

Some patients pay in excess of $200 per month to access treatment through the ODTP. To make matters worse, unlike their access to PBS-listed opioids, which are readily available at every community pharmacy, only some doctors and pharmacists are willing to prescribe and dispense their treatment for dependence.

The issue recently reached what was then its nadir when it was revealed that neither the minister nor his delegate have even made a 'special arrangement' for the ODTP through a legislative instrument.

They have the power under Section 100 to make a special arrangement but they have not even bothered and the ODTP simply exists as policy.

We only know the policy detail because it was released in response to a Freedom of Information request. Until then, it did not even exist on the public record.

Yet that nadir has now been beaten by something even more egregious.

The arrangements governing access to PBS-listed treatment for opiate dependence have been in place since the 1970s. The program was established at a time the treatments were made available through the public hospital system and rehabilitation clinics operated by the states and territories.  

A lot has changed since the 1970s.

Currently, around 75 per cent of ODTP treatment is administered through community pharmacy.

The PBAC has itself recognised this reality and the negative impact for patients.

According to a public summary document from its November 2018 meeting, its Economic Sub-Committee identified the potential beneficial listing of a long-acting monthly injectable for opiate dependence because it would likely lead to a "reduction in private fees charged, and that this is a benefit for patients who currently choose not to be treated due to prohibitive private fees for existing treatments."

With all due respect to whoever wrote that statement, the use of the word 'choice' must be an error.

Seriously, It is like saying someone chooses not to eat because they cannot afford food.

The more accurate description would be to say 'patients who currently cannot be treated due to prohibitive private fees for existing treatments'.

Yet both Minister Hunt and his departmental officials still maintain the ODTP's arrangements for dispensing, which were established in the 1970s, remain a state and territory responsibility.

As far as arguments go, it is illogical and indefensible.

It is the equivalent of saying the PBS should never change or evolve to properly accommodate the technologies and treatments for which it was established to provide funded access.

The first version of the PBS was established in 1919 to provide provide free pharmaceuticals to ex-service men and women. 

It was widened in 1948 and then became the program we know today in 1960 with medicines access for the general public. The Highly Specialised Drugs Program was established under Section 100 in the early 1990s.


The logical extension of the federal government's arguments about the ODTP is that it should have just stayed a program for ex-service men and women. Why does the government fund cancer treatment in public hospitals and have special arrangements for any medicine?

Of course, the idea of a system never changing it ridiculous. Yet that is exactly the argument currently being put to patients who simply want access to their PBS medicines under the same circumstances as their fellow 25 million Australians.