naltrexone, heroin, detox, implant, counselling

Treatment Options

First Step Program's primary focus is on people with a heroin dependency (addiction).  Someone who is dependent on heroin or other opiates and wants to bring about positive change in their life has several options.  Chances of success are usually higher if the options are used in intelligent combination, and counselling can be a valuable addition to any person's situation.

A person's main options include (options in blue are available at First Step):

1) Strengthening their inner resolve and working to improve aspects of their lives (work. relationships, housing etc.) so that they can resist heroin.

2) (Not available at the First Step Program) Undergoing a detoxification (detox) from opiates including: 
              - cold turkey (simply ceasing heroin use) 
              - self-monitored home detox with prescribed medications 
              - (not available at the First Step Program) supervised detox at a medical centre 
              - (not available at the First Step Program) inpatient detox at a hospital

3) Getting a prescription for legal alternative opiates (this is called replacement pharmacotherapy or maintenance treatment) such as methadone or buprenorphine.  These drugs provide a stabilising alternative to heroin, with a view to eventually reducing opiate use to zero.

4) Using an opiate antagonist, naltrexone, to block the effects of any further heroin use.  Options here include:
                                                    - naltrexone tablets taken daily
                                                    - naltrexone implants lasting for several months

5) working with a counsellor on overcoming their emotional dependence on heroin or other opiates and on aspects of their life such as employment, housing and relationships.

These and other options are presented in more detail below.

Counselling Free individual counselling is available from the doctors and psychologist at the clinic. Regular counselling can be extremely valuable for people who are open to it, and is widely considered to be an important option for overcoming dependence on heroin, other opiates or other drugs.  Counsellors often work with people on issues in their life that need to be better understood before or while they  move on to improving their life situation. Contact the clinic by phone to arrange an appointment for counselling.

First Step has a program for getting people back to work by determing what kind of work they are interested in, helping them to get any training they might need, and placing them in a job with one of our participating businesses once they have detoxed and demonstrated an ability to stay clean.  This is known as the Second Step Employment Program which has had great success in placing people in real and meaningful employment.

Opiate Maintenance and or Reduction
One form of maintenance treatment is opiate maintenance on the methadone or buprenorphine programs. If you are accepted onto the program you must go to the pharmacist every day (or sometimes every second day) to receive a specific dose of methadone (in liquid form) or buprenorphine (in tablet form) upon payment of a dispensing fee (around $5).

Methadone is an opiate and is just as habit-forming as heroin.  However, methadone is slower acting and more predictable in its effects. Buprenorphine is known as a 'partial agonist' which means that it does have a pleasure effect, but it also makes you feel sick if you use heroin on top of it.  Methadone particularly is by no means a cure for heroin dependence, but can be used to stabilise a person's life while they address other issues, such as work, relationships, grief etc.

Methadone and buprenorphine are of course legal, and much cheaper than heroin, so the methadone and buprenorphine programs also reduces the amount of money that opiate dependent people need to obtain to avoid hanging out. These programs also result in less injecting drug use and thereby minimize the harm caused by needle sharing.  Dr Gunzburg or Dr Kleine at First Step can discuss with you the suitability of the methadone or buprenorphine programs for your own needs. Call the clinic to make an appointment.

An alternative to opiate maintenance therapy is naltrexone maintenance. To download a more in-depth discussion of these issues click on this link to our Naltrexone and Maintenance Treatment Options Leaflet.