Pharmacotherapy, also known as Opioid Replacement Therapy (ORT) or Medication Assisted Treatment of Opioid Dependence (MATOD) is an effective, evidenced-based approach to treating patients with Opioid Use Disorder. Pharmacotherapy involves the use of methadone, buprenorphine, or buprenorphine/naloxone to help control an individual’s craving and withdrawal, providing a level of stability upon which further support structures may be established.
Opioid Use Disorder (commonly referred to as opioid dependence) is a chronic, relapsing condition, which affects people from all walks of life. While it is commonly perceived as being an issue related to street drugs such as heroin, the misuse of pharmaceutical (i.e. prescribed) opioids has been growing steadily over the last two decades.
With the use of SafeScript now mandatory, more patients may be identified as having a dependence on opioids. The hardships experienced by many people due to the wide-ranging impacts of the Covid-19 pandemic have also resulted in an increased number of individuals seeking treatment for substance use disorder.
Now more than ever it is important for health professionals to be confident in this treatment space in order to make safe and appropriate clinical decisions.
Opioid pharmacotherapy in Victoria
In Victoria, pharmacotherapy is prescribed in the community by accredited GPs or nurse practitioners and is most commonly dispensed in approved community pharmacies. An increasing demand for treatment coupled with a decreasing number of pharmacotherapy prescribers has resulted in a gap in service provision in this sector.
The Area 4 Pharmacotherapy Network (A4PN)
A4PN works tirelessly to improve access to pharmacotherapy services in southern and eastern metropolitan Melbourne and offers a variety of supports for health professionals managing patients who are living with opioid use disorder.
This initiative is funded by the Victorian Department of Health and is led by South Eastern Melbourne PHN working in partnership with Eastern Melbourne PHN.
To contact the Area 4 Pharmacotherapy Network email A4PN@semphn.org.au or call 03 8514 6600.
How medical practitioners can help
In recognition of the safety and efficacy of buprenorphine pharmacotherapy, the Victorian DHHS Policy for Maintenance Pharmacotherapy for Opioid Dependence was amended in April 2021 to allow all medical practitioners to prescribe selected buprenorphine formulations for up to TEN (10) patients without undertaking the formal RACGP pharmacotherapy training. This is an important change to improve patient access to pharmacotherapy.
The formulations which any general practitioner may prescribe are
- Suboxone™ - buprenorphine/naloxone film (daily, regularly supervised dosing)
- Buvidal™ – buprenorphine subcutaneous depot (weekly-monthly injection)
- Sublocade™ – buprenorphine subcutaneous depot (monthly injection)
The Brief clinical guidelines for long-acting injectable buprenorphine have been updated for 2021, and are available at the Department of Health Pharmacotherapy hub.
An even more concise buprenorphine prescribing guide can be found in this six-page guide as well as Dr Paul Grinzi’s 16-minute video which outlines the step-by-step process for prescribing sublingual buprenorphine.
Further (free) training is available for clinicians interested in broadening their knowledge of MATOD through the RACGP Victoria MATOD Modules
- Module 1: How to implement safe and effective opioid prescribing. How to recognise, prevent and respond to problematic opioid use. A prerequisite for Module 2.
- Module 2: Recordings of 'essential knowledge', including interviews with MATOD experts, as well as two live Zoom sessions that will allow you to ask questions of the experts. On completion you'll be trained and recognised as a prescriber for both methadone and buprenorphine assisted treatment of opioid dependence.
- Module 3: Improve your knowledge and confidence in prescribing and administering long-acting injectable buprenorphine, including how to select, initiate and manage patients who have been prescribed these new formulations.
A4PN General Practitioner Supports
A4PN offers a variety of supports for GPs managing patients with opioid dependence:
- GP Mentoring (via phone, email or face-to-face)
- Addiction Medicine Specialist advice and secondary consultation (via phone or face-to-face)
- Onsite RACGP-accredited education for GPs and practice staff – the who, what, why and how of diagnosing opioid dependence and prescribing buprenorphine/naloxone
- Onsite training for practice staff and practice managers – guidance about practice systems and policies, including Medicare billing
- Bi-monthly RACGP-accredited Small Group Learning meetings – held in Box Hill, Bayside and Frankston-Mornington
- Multidisciplinary Community of Practice events
How pharmacists can help
Supervised dosing of pharmacotherapy in community pharmacy has been the backbone of Victoria’s pharmacotherapy program for decades, with dedicated pharmacists making a positive difference in the lives of countless people participating in the MATOD program over this time.
Pharmacotherapy training for pharmacists is invaluable, and can be accessed for free (funded by the Department of Health) at the Pharmaceutical Society of Australia website.
This Victorian Opioid Pharmacotherapy Program covers supervised dosing of opioid pharmacotherapy in detail. An additional module is available to train pharmacists in the administration of long-acting injectable buprenorphine.
Long-acting injectable buprenorphine is an alternative to supervised dosing, available as a weekly or monthly depot injection. In April 2021 the Victorian Pharmacotherapy Policy was updated to include guidelines for pharmacist administration of depot buprenorphine. Involvement in this aspect of treatment is currently being considered by a number of pharmacies keen to augment their supervised MATOD programs.
You can apply to provide pharmacotherapy services by completing an application form found at the Department of Health pharmacotherapy forms page.
A4PN Pharmacist Supports
A4PN offers a variety of supports for pharmacists managing patients with opioid dependence:
- Advice about accredited training and obtaining approval to provide pharmacotherapy services
- Advice about how to set up a new pharmacotherapy program
- Education for pharmacists, including Small Group Learning meetings and Community of Practice events
- Local ancillary services, such as Alcohol and other Drug and Mental Health services
Contact the Area 4 Pharmacotherapy Network to access any of these free supports.
Project Echo is a free learning and guided practice program on opioid management delivered via teleconferencing sessions. The program sessions are a blend of didactic learning and case-based discussion. They are delivered live every Wednesday morning from 7.30am to 8.30am and are led by expert clinicians from the Department of Addiction Medicine at St. Vincent’s Hospital, Melbourne.