FINDING YOUR WAY: OST AT A PUBLIC CLINIC
Tony has been on Opiate Substitution Treatment (OST) for several years and as an experienced Peer Support Worker at a public OST clinic, he has helped people navigate the system for over two years. Here are his Top Tips for getting the most out of your public OST clinic.
1. GETTING STARTED
Make a plan
What are your goals? Are you looking for eventual abstinence, a break or a safety net? You will need to decide whether to go onto methadone (or Biodone) or buprenorphine (Suboxone or Subutex).
Speak to people who have been on or are on different types of OST. Don’t make up your mind until you’ve heard a range of views. You definitely need more than the opinion of someone who’s finger-wagged you to “Never get the liquid handcuffs!” There is so much more to OST than that. Do a Google search. Call NUAA and talk to someone. Just don’t go onto OST blind.
Work with your doctor
Let your doctor know your needs and why you would like to go down either the ‘done or bupe route. If you have no plan, they’ll often take the decision for you and pick what’s easiest for them. If they’re trying to push you in a particular direction, ask why. Start a two-way conversation with your doctor. Nobody can tell you what’s right for you, only what worked for them. This is your life.
2. GETTING CONNECTED
Find out what other services your clinic offers
Your opiate habit may just be at the top of things you need to work through. OST can give you access to other tools that can make a difference in your life. But if you don’t ask, you won’t necessarily be told about available services.
Get healthy, get hep C free
All public OST clinics in NSW offer hepatitis C testing and treatment on site, so you can get this sorted easily. Because public clinics are connected to hospitals, you can also have other medical issues looked at, and your hep C treatment and mental health meds dispensed with your dose.
Your allocated caseworker can coordinate services for you. For example, you should be able to see a counsellor to help with things like grief or trauma, or a social worker to support you around housing or income security.
3. USE YOUR OST HOW YOU WANT
However you use your OST is totally valid. Nobody else can decide what’s best for you. My biggest piece of advice is to use OST the way it works for you. If you find it’s not working the way you planned, try another way.
OST can be a long-term safety net
Many people, including me, go in with a vague intention to get onto methadone for a couple of months and then come off. Months can turn into years and then decades.
If maintenance - staying on methadone and occasionally using (or not) - is what you decide you want to do that’s perfectly valid! OST is a tool to make our lives more manageable. I think of it as a safety net. Not everybody wants to remain abstinent, but neither do they want the chaos and desperation a heroin habit can bring.
If you are on OST, you won’t wake up hanging out every morning and this simple change can give you time to improve your life. Getting onto OST takes courage and commitment. Be proud of yourself for making that step.
OST can be a step to abstinence
You might want to find a dose that makes you feel comfortable and gives you some space away from heroin and injecting so that you can get away from the obsession and craving, then start coming down until you are OST- and heroin-free. Suboxone seems to work best for this.
Support can make all the difference. A counsellor can be someone to talk to and make plans with, and discussion groups attached to your service can provide twoway peer support.
OST can be what you want
OST can also be used as a ‘gap year’ to get your head together and work out what you want out of life. You can do OST in combination with counselling, SMART or a 12 step program. If you want to be on a program and not use on the side, you can go to rehab and stabilise. You can also go to rehab and come off your OST when you’re ready.
It’s your choice. Nobody can tell you what’s right for you, only what worked for them. This is your life.