Pharmacotherapy for Opioid Use Disorder
Safer treatment and better recovery from opioid dependence
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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 known as opioid dependence) is a chronic, relapsing condition that affects people from all walks of life. Although commonly associated with street drugs, such as heroin, the misuse of prescribed opioids has been growing steadily over the last two decades.
ODT medicines have recently (since July 2023) been included on the PBS, significantly lowering the barrier to access for patients. Given the expected increase in demand for treatment, now is an excellent time for health professionals to improve their knowledge of, and their confidence in this treatment space.
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.
The policy changes rolled out in July 2023 have facilitated pharmacist administration of long-acting injectable buprenorphine, a newer formulation of Opioid Dependence Treatment which has seen a significant growth in use since 2020.
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 to assist health professionals in their work with patients who are living with an opioid use disorder.
This initiative is funded by the Victorian Department of Health. South Eastern Melbourne PHN is the lead agency, working in partnership with Eastern Melbourne PHN.
Visit www.PABN.org.au to access an excellent page of useful resources and a list of other services offered by A4PN.
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 Department of Health’s Policy for Maintenance Pharmacotherapy for Opioid Dependence was amended in April 2021 to provide all medical practitioners the scope to prescribe selected buprenorphine formulations for up to TEN (10) patients without undertaking the formal RACGP pharmacotherapy training. This is an important change which helps 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 or monthly injection)
- Sublocade® — buprenorphine subcutaneous depot (monthly injection)
The Brief clinical guidelines for long-acting injectable buprenorphine have been updated, and are available at the Department of Health Pharmacotherapy hub.
An even more concise primer for buprenorphine prescribing can be found in this six-page guide which outlines the step-by-step process for prescribing sublingual buprenorphine.
Royal Australian College of General Practitioners (RACGP) Training
The free MATOD modules described below may be accessed here:
- Module 1: Implement safe and effective opioid prescribing. Recognise, prevent and respond to problematic opioid use.
- Module 2: Become an accredited MATOD prescriber. Provides prescribers with the skills and confidence to assess, manage and initiate patients on Opioid Replacement Therapy.
- Module 3: Improve knowledge and confidence in prescribing and administering LAIB.
- Search the RACGP Victoria events page
A4PN prescriber supports
A4PN offers a variety of supports for clinicians 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 supports.
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. 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 for pharmacists
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
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. This meeting focuses on aspects of opioid management in Primary Care, which include:
- 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
From July 1st 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 – 0429 808 317