Safer treatment and better recovery from opioid dependence
Pharmacotherapy, also known as Opioid Dependence Treatment (ODT) 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 minimise and manage an individual’s symptoms of craving and withdrawal, fostering a level of physical and mental stability upon which further support structures may be established.
Opioid Use Disorder (also commonly known to as opioid dependence) is a chronic, relapsing condition. While it has been perceived as being an issue only related to street drugs such as heroin, the misuse of pharmaceutical (i.e. prescribed) opioids has been growing steadily over the last two decades.
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 dispensed in approved community pharmacies. An increasing demand for treatment coupled with a decreasing number of pharmacotherapy prescribers has resulted in a critical gap in service provision in this sector.
Recent changes to the regulatory framework have made it viable for pharmacists to administer long-acting injectable buprenorphine, an ODT formulation which is seeing a significant growth in use.
The Area 4 Pharmacotherapy Network (A4PN)
A4PN works tirelessly to improve access to pharmacotherapy services in southern and eastern metropolitan Melbourne. We offer a variety of supports for health professionals who work with patients that are living with an 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 phone us on 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 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)
- The MATOD Clinical Placement Program
- Victorian Opioid Management ECHO (see Project ECHO)
- Bi-monthly RACGP-accredited Peer Group Learning meetings – held in Box Hill, Bayside and Frankston-Mornington
- Multidisciplinary Community of Practice events
Contact the Area 4 Pharmacotherapy Network to access any of these free support
How Pharmacist 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. You can apply to provide pharmacotherapy services by completing an application form found at the Department of Health pharmacotherapy forms page.
Although pharmacists do not require additional training in order to administer supervised dosing of pharmacotherapy, the Victorian Opioid Pharmacotherapy Program (VOPP), which covers supervised dosing of opioid pharmacotherapy in detail can be invaluable. It can be accessed for free (funded by the Department of Health) at the Pharmaceutical Society of Australia website.
Long-acting injectable buprenorphine (LAIB) is an alternative to supervised dosing, available as a weekly or monthly depot injection. The full requirements for pharmacist administration of LAIB can be found in the guidelines for pharmacist administration of depot buprenorphine.
Pharmacists who have already completed their vaccination training can easily access the module required to complete their training required for LAIB administration at the Pharmaceutical Society of Australia website.
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.
The Victorian Opioid Management ECHO is a weekly online meeting (Wednesday mornings, 7:30am-8:30am) facilitated by the Addiction Medicine team at St Vincent’s hospital, focusing on aspects of opioid management in Primary Care, including:
- Dependence on prescription and/or illicit opioids
- Chronic pain and opioid dependence
- Medication-Assisted Treatment of Opioid Dependence (methadone, buprenorphine)
- Management of overdose risk
- Regulations related to opioid prescribing
- Dual diagnosis
- Trauma-informed care
Each 1-hour meeting consists of a 30 minute didactic followed by discussion of participant-submitted case studies.
These meetings are recognised by RACGP and ACCRM as a Peer Group Learning activity, and clinicians who attended all FIVE meetings in a block session will be eligible for FIVE Reviewing Performance hours (see the Victorian Opioid Management ECHO for further details)
If this is something you think might interest you, we’d love to see you there! You can register at the Victorian Opioid Management ECHO website, after which you will be contacted with the link to the Zoom meeting.
PBS changes to Opioid Dependence Treatment July 2023
From 1 July 2023, patients on Opioid Replacement Pharmacotherapy are no longer required to pay pharmacy service fees of upwards of $30/week to remain on the program, and instead will pay a monthly co-payment, such as is contributed when collecting any medicine listed on the Pharmaceutical Benefits Scheme. This is an exciting change which has brought this area of medical treatment to a point where there is finally a degree of equity, especially when compared with the majority of medicines used to treat health conditions in Australia. Alongside this change, there has also been a cementing of pharmacist-led administration of long-acting injectable buprenorphine (LAIB). This service is now subsidised so that patients need pay no fees, with the pharmacist instead claiming a service fee through the PPA portal.
Clinics which have been ordering in LAIB directly for administration to patients will have to partner with a local pharmacy should they wish to continue offering this service as they had previously, which may introduce a few logistical challenges
Like so many policy changes, aspects which may work wonders for one group can cause great consternation for another. Should you encounter any difficulties in accessing or offering services as a result of these changes, we encourage you to contact the Area 4 Pharmacotherapy Network at A4PN@semphn.org.au or reach out to our support team:
For prescribers: Dr Vivian Praeger - 03 8514 6680 (mobile divert)
For pharmacists: Adrian May – 0420 970 942