People with codeine dependence may present to their GPs, even before 1 February 2018.
Treating opioid dependence will be a key step to their recovery.
While referral to an addiction medicine specialist is available for complex cases, GPs can manage patients by prescribing pharmacotherapy for opioid dependence in their general practices.
Many people caught up in codeine dependence have good social support, and are not part of a drug-taking sub-culture. Their dependency is associated with anxiety and breakdown of social and work commitments. Codeine re-scheduling is the trigger for engaging with their GP.
GPs can prescribe pharmacotherapy for opioid dependence, in collaboration with a pharmacy registered to dispense and supervise dosing of pharmacotherapy.
Programs and resources for prescribing familiarisation are well established.
In 2013, the Drugs and Poisons Department introduced a policy that allows all medical practitioners to prescribe buprenorphine/naloxone sublingual film for up to five patients, without the need for formal face-to-face training or registration as pharmacotherapy provider.
That means that GPs can treat patients in their familiar medical centre, in collaboration with a pharmacy registered to dispense and supervise dosing of pharmacotherapy.
This policy also provides:
· opportunity for shared care arrangements with specialists
· opportunity for ongoing management of patients previously stabilised on therapy
Note: A treatment permit is required. The patient must be experiencing mild-moderate opioid withdrawal symptoms at the point of buprenorphine/naloxone initiation.
How to prepare now:
· Consider a De-Mystifying Opioid Replacement Therapy topic visit to your practice
· Share the learning and preparation with a practice colleague for ongoing back-up
· Review the Brief Guide to Prescribing Buprenorphine/Naloxone – to be safe and legal
· Contact local pharmacies to locate and understand available pharmacotherapy dispensing services (or contact DirectLine 1800 888 236)
· Locate appropriate counselling and allied health services for wrap around care
Support for new prescribers is available:
· Drug and Alcohol Clinical Advisory Service (DACAS) 24-hour phone 1800 812 804
· Pharmacotherapy Area-Based Networks
More information, contacts, and resources are available at www.emphn.org.au/codeine