6.3.1 HistoryMethadone maintenance treatment for opioid dependence was developed in Queensland by a small number of private psychiatrists in the early 1970's. The first public methadone program was established at a Brisbane Psychiatric Outpatient Clinic in approximately 1975.
6.3.2 Current situationThere is a comprehensive "Policies and Procedures Manual" published in 1993 which provides guidance to medical practitioners authorised to prescribe methadone, other clinicians working in methadone maintenance programs, and pharmacists authorised to prescribe methadone. Doctors must be registered to prescribe methadone. They are usually attached to a methadone clinic, private psychiatrists, hospital superintendents or full-time medical staff in rural areas or appropriate general practitioners. There is a maximum number of clients allowed per prescriber and criteria for admission to a program are explicit.
The principles guiding Queensland's program are derived from the National Methadone Policy, 1993.
Programs are provided by the public and the private sectors or a combination of both, and in prisons. In the private sector, the majority of medical practitioners providing methadone treatment are psychiatrists.
Initial assessment of a prospective client is considered very important. Medical, drug, family, social and psychological and psychiatric history is taken. Physical examination is performed, and a series of routine investigations to gauge the general health status of newly registered clients. Ongoing urinalysis testing is part of the program.
Generally, clients will receive their dose from a retail pharmacy outlet although some occasions exist when dispensing treatment occurs at a clinic. Take-away doses are allowed under certain situations, and are generally closely monitored. Pregnancy and HIV are monitored in the client population.
There are guidelines for the management of clients in hospital, if the "outpatient" situation is not appropriate for an individual client.
Queensland is currently negotiating with relevant bodies to establish an accredited training course for methadone prescribers, based on the NSW documentation.
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6.3.3 StatisticsThe number of clients in the public and private sectors in Queensland since 1986 are contained in Table 5 below.
Of the 1,952 clients registered on the methadone program in Queensland in 1994:
- 60% were male (average age of 35 years) and 40% were female (average age of 33 years); and
- 48% of the total number of methadone clients were aged 35 years or over.
The data illustrate that, unlike NSW and Victoria, the private sector participation rate has been relatively stable, ranging from 0.23 persons per thousand in 1986 to 0.32 persons per thousand in 1994. Over the same period public sector participation rates increased from 0.44 to 0.99 persons per thousand. Overall participation rates nearly doubled from 0.67 persons per thousand population in the target group in 1986 to 1.31 persons in 1994, with most of the increase occurring since 1990.
As at June 1994, there were 7 GPs and 24 psychiatrists registered to prescribe methadone. GPs treated only 7% of the private clients in the State, with the remaining 93% being treated by psychiatrists.
As at the 21 September 1994, there were a total of 347 outlets authorised to dispense methadone syrup in Queensland. (See Table 6)
Table 5: Numbers of private and public clients in Queensland, 1986 to 1994
Table 6: Number of outlets authorised to dispense methadone in Queensland, Sept. 1994