Objective: To evaluate the costs of opiate maintenance treatment (OMT) on income poor individuals. OMT is primarily dispensed by community pharmacies. Consumers pay pharmacists’ dispensing fees to receive their pharmacotherapy. Dispensing fees for practically every other prescribed medication are subsidised under the Commonwealth Pharmaceutical Benefits Scheme.

Methods: PAMS provides mediation and complaints-resolution for pharmacotherapy consumers and service providers. PAMS data shows that a frequent concern and cause for negotiation is consumer inability to pay dispensing fees. The consequences of consumers’ inability to meet the costs of treatment were explored over 18-months with the participation of 120 individuals in OMT whose primary source of money was government income support.

Results: The financial obligations of OMT are the greatest obstacle to clients’ retention in treatment. To avoid treatment being discontinued, some prioritise fees over food and accommodation with consequences for health and safety. Others turn to crime and / or sex work to fund their treatment. This desperation reflects the knowledge that inability to meet financial obligations means removal from the program – and from the stability and accompanying opportunities that OMT may have afforded. Involuntary removal from treatment places individuals in a situation whereby they are dependent on opioids but have no legal access to them – with predictable results.

Conclusion: On the basis of equity, there is no reason to differentiate the dispensing of OMT from that of any medication prescribed to treat a health condition. Compelling the recipients of OMT to pay dispensing fees, despite the inability of many to do so, is discriminatory. It is the single greatest obstacle to retention in potentially life-saving treatment and the reason for the subsequent return of many to a lifestyle of dependent heroin use. The dispensing of OMT must be fully subsidised by the Commonwealth as a matter of urgency.