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The factors influencing harmful drug use and drug dependency are known to be complex and diverse, and associated with a range of life issues and problems. A diversity of options for recovery and for minimising harm need to be available to the different groups of people who use drugs harmfully, who become dependant, and their families.
Pharmacological interventions are an element. Point 2 of the Government's Three Point Drug Plan, includes the clear statement that "Under Labor, doctors will be able to treat addicts with any pharmacological intervention approved by the Commonwealth." (Building A Safer Community: Tough On Drugs. Position Paper: March 2001.)
It is vital to identify the measures that prevent drug and substance misuse and associated problems from developing, and to ensure that early assistance is available to those who need it.
The NT Minister for Health and Community Services has established a Taskforce on Illicit Drugs, to consult widely across the NT and review the evidence base. It will consider a range of priorities, and includes the role and practical application of pharmacotherapies in the NT context. It is due to report in mid- 2002.
Since 1996, NT legislation has made provision for methadone to be prescribed for opiate dependant injecting drug users under certain conditions:
Prescribing and monitoring is in line with national methadone guidelines, including the requirement for the prescribing doctor to be appropriately trained and skilled. In the NT, the doctor must contact the Chief Health Officer to have a client endorsed as meeting the criteria.
The Department of Health and Community Services was able to provide an appropriately qualified doctor to assess and stabilise clients for general medical practitioners (GPs) until late 1999. A number of committed GPs were also trained with the assistance of interstate experts, so that the program could be made available closer to where people live, and could operate for the majority of clients without relying on a Department doctor. A network of pharmacies has also participated in the program. Expert medical practitioners in this field are difficult to recruit across Australia and it has not been possible to recruit to the NT since early 2000. A number of the trained GPs continued to provide shared care services such as assessment, shared care of pregnant women with antenatal services, methadone withdrawal, through the Department. Over time they have taken up new practice opportunities. They remain able to prescribe methadone under the same legal framework, and some have done so for selected patients.
The Department recognises the need to provide an expert referral and support service to the primary care sector in the alcohol and drugs field and is continuing the recruitment effort. In the context of the availability of buprenorphine for withdrawal over 6-12 months, it is unlikely that a three month withdrawal program using methadone would be considered the therapy of choice for the vast majority of opiate dependant individuals. Maintenance issues will be considered by the Ministerial Taskforce on Illicit Drugs.
In July 2001, buprenorphine became legally available in the NT, to assist withdrawal from opiate dependancy over 6 to 12 months, subject to national guidelines. Among others, these include the requirement for prescribing doctors to undergo approved training as a requisite to register as a buprenorphine provider with their jurisdictional health authority. In partnership with the Divisions of General Practice, the Department is organising training by interstate experts early in 2002, and establishing a system to enable buprenorphine to become available. Maintenance issues will be considered by the Ministerial Taskforce on Illicit Drugs.
Doctors in the NT are able to prescribe Naltrexone in the same way as any other jurisdiction according to national best practice guidelines.