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Opioid dependence treatment

There are a number of reasons for seeking treatment for opioid dependence. Sometimes you may have used illegal substances such as heroin or illicit prescriptions (for example oxycodone). Other times you may have misused over-the-counter medications or prescribed pain relieving medication (for example morphine) in a way that presents a risk to you or other peoples’ health and safety. In these circumstances treatment via the Opioid Dependence Substitution Program (ODSP) or Suboxone® Opioid Substitution Program (SOSP) may be the safest way forward for you.

Where to start

It is recommended that you speak to your doctor about what options are best for you. You may also like to discuss your concerns with an Alcohol & Drug Information Service (ADIS) counsellor or seek an assessment at Eastern Drug and Alcohol Services South Australia to formulate a treatment plan that is best for you.

For information and details on finding a prescriber and dispensing pharmacy to provide treatment, please contact the Alcohol and Drug Information Service (1300 131 340) or the Drugs of Dependence Unit.

Your doctor will need to review you, confirm opioid dependence and obtain an authority from the Drugs of Dependence Unit before they can provide you any medication.

Started, what happens next?

It is important you:

  • see your doctor regularly and discuss any concerns with them to make sure you achieve positive outcomes from the program.
  • Let your doctor know straight away if you:
    • become unwell on these medications
    • taking any other medications
    • become pregnant

This is because opioids can be dangerous if taken incorrectly.

Treatment rules

If methadone or buprenorphine is taken incorrectly or by the wrong person there are rules about treatment to help ensure your safety and other peoples safety.

Dosing in the pharmacy and take-home doses

Initially you must attend your pharmacy for daily supervised dosing. As you progress through treatment and you make positive changes your doctor may provide you with limited unsuperivsed or take-home doses.

To see if you are ready for unsupervised or take-home doses your doctor may :

  • request urine or blood samples from you,
  • conduct physical assessment to make sure you are managing with your current dose and not using other substances,
  • check that you are attending all your medical appointments regularly,
  • check with your pharmacist to make sure you are not missing any of your doses, that you attend your pharmacy at the allocated time for dosing and in a sober manner. Please note: your pharmacist may not dose you if they are concerned about your presentation or consumption of these medications.

You must tell any doctor or pharmacist you see that you are on methadone or buprenorphine because other medications can interact with these drugs and put you at risk of overdose or other harms.

The Unsupervised Doses (Takeaways) Policy (PDF 190KB) outlines when and how many unsupervised or take-home doses you will be allowed.

It is really important that your unsupervised or take-home doses are always locked away and stored in a safe place. If another adult, child or pet was to consume your medication they are at risk of serious harm and immediate action must be taken to get them help by ringing an ambulance on 000. The Methadone not for kid’s brochure outlines how to safely store your medication.

You must never give your methadone or buprenorphine to another person.

Diversion or misuse of prescribed medication

You must remember to always take your medication as instructed by your doctor and pharmacist. The Guidelines for Action in Response to Serious Breaches (PDF 205KB) outlines action which may be taken in response to episodes of drug diversion, misuse of your medication or other serious issues that place you and others at risk.

You must only take your methadone or buprenorphine as instructed by your doctor and pharmacist.

Buprenorphine

Buprenorphine with naloxone in film form is what will be prescribed if you receive treatment with buprenorphine. The Suboxone Film information sheet (PDF 495KB) provides information on Suboxone® sublingual film.

Holidays and travel

It is important that you discuss any travel arrangements with your doctor before you make bookings or spend money as treatment may not be available everywhere. It is important that you tell your doctor that you wish to travel at least two weeks before you wish to go. The Prescriptions in another state / territory for ODSP (PDF 157KB) provides information to your doctor on short term treatment in other States and Territories if you want to travel or visit friends and family.

ODSP

The Opioid Dependence Substitution Program (ODSP) is a treatment program in South Australia where specially trained medical or nurse practitioners can offer pharmacotherapy for opioid dependence methadone liquid or sublingual buprenorphine (with or without naloxone).

There are four public clinics offering treatment that are operated by Drug and Alcohol Services South Australia (DASSA):

  • Central DASSA
  • Northern DASSA
  • Southern DASSA.

Treatment services are also offered by Prison Health and community prescribers (largely general practitioners).

Medications prescribed

The use of buprenorphine in tablet form is restricted to the ODSP and only in specially approved circumstances. Buprenorphine with naloxone in film form is what will be prescribed if you receive treatment with buprenorphine.

 

SOSP

The Suboxone® Opioid Substitution Program (SOSP) is a treatment program in South Australia that permits any medical practitioner, without special accreditation, to prescribe sublingual buprenorphine with naloxone in film form for up to five clients. The prescription of methadone liquid or sublingual buprenorphine without naloxone is not permitted through the SOSP.

If you are pregnant or cannot tolerate Suboxone® you will need to find an Opioid Dependence Substitution Program (ODSP) prescriber or clinic.

Suboxone Film

Suboxone® Film is taken under your tongue much like Suboxone® or Subutex® tablets. The film sticks to the lining of your mouth within seconds, reducing the time needed for supervised dosing. The film generally takes several minutes to dissolve, but usually requires supervision for less than one minute.

  • Avoid eating food for several minutes before and after taking the film, as this may reduce the absorption and effects of the buprenorphine.
  • Wash and dry your hands before handling the film (wet fingers can make it difficult to place the film correctly). If you take more than one film at a time, try to avoid overlapping the film in your mouth, as this slows down how quickly it is absorbed. The film can also be placed against your cheek if there is not enough room under your tongue.

Further information on this film, including how to use it is available in the Suboxone Film information sheet.

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