A telehealth opioid replacement therapy service is changing lives in a community short of prescribers.
Residents in the Sunraysia region are getting by with a little help from some new friends.
Dr Paul MacCartney – not to be confused with the octogenarian Liverpudlian from The Beatles – is passionate about treating people with substance use disorders.
“It’s the best,” Dr MacCartney told delegates at the 2024 General Practice in Addiction (GPADD) conference, held last month in Melbourne.
“There’s nothing else you can do in medicine that makes such a difference to people’s lives so quickly.”
One way Dr MacCartney helps improve the lives of people with substance use disorders is through an opioid replacement pharmacotherapy telehealth service to residents of the Sunraysia region, located in northwestern Victoria and southwestern New South Wales.
Dr Dean Membrey, a fellow GP and addiction medicine specialist from the non-profit cohealth, said the idea to offer their services came from hearing about the “prescribing crisis” that was affecting towns in the area, including Mildura, Robinvale and Wentworth.
“There was a doctor who was retiring, and [while] there were a couple of other doctors providing opioid replacement pharmacotherapy in town, they were in no position to take on the extra patient load,” Dr Membrey told The Medical Republic.
“People in the area who were on opioid agonist therapy were facing being cut off [from] their medications because no one was able to continue prescribing for them.”
Attempts to employ an addiction medicine specialist, GP or nurse practitioner to provide opioid replacement pharmacotherapy services to the region proved unsuccessful, resulting in Dr MacCartney and Dr Membrey stepping in to fill the gap with a weekly telehealth service.
There was some initial wariness from patients about the new service and about what kind of reception they would receive, which Dr Membrey chalked up to some less than pleasant previous experiences with other health services.
But these walls have slowly been taken down over time as locals have developed a sense of trust in what Dr MacCartney and Dr Membrey are doing.
“We’ve seen instances where we’ve stabilised someone on treatment [one week], and then their husband has come for treatment the next week, and their friend the week after that,” Dr Membrey said.
Their efforts have had a significant impact on the local community.
“We’ve seen a number of people who had previously been stable on pharmacotherapy, been cut off their medication – through no fault of their own – and had resumed using another prescription opioid, illicit prescription opioids or heroin,” Dr Membrey said.
“These people were keen to be treated, so they’ve been thankful that they’ve been able to be seen. The most common phrase we hear is ‘I just want to get back to work’.”
Dr MacCartney shared one particularly powerful patient story with GPADD attendees.
“One person who had recently arrived [in Australia] and who didn’t have a Medicare card had used more than $200,000 worth of heroin over the past year. They wanted to get treatment that whole time, [but] nobody was providing it.
“I saw him one week and put him on 2mg of suboxone, because he’d been able to stop [using heroin] but had these terrible cravings. I spoke to him the next week and he said, ‘I just started work yesterday’.
“This is transformational stuff. And it’s not hard.”
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The cohealth pair feel they have proven the telehealth service to be a viable model that can be used in other regional areas when the need arises – provided patients can engage with, and be supported by, services like a community health centre between the telehealth appointments.
Dr MacCartney highlighted the work of the Sunraysia Community Health Service and the Pharmacotherapy Area Based Network in setting up local supports. Dr MacCartney also acknowledged the funding support provided by the PABN as well as the work of mental health, drug and alcohol intake coordinator Emma Steele.
“It’s worked really well because we have a range of community health workers there, including a wonderful drug and alcohol coordinator who can engage patients and help them get on the video consults,” Dr Membrey reflected.
The opioid replacement therapy telehealth service can be accessed through the Sunraysia Community Health Service.
