Prescribers should call or email DDU to obtain the authority number before prescribing.
Prescribers are encouraged to access the online Privileged Circular which provides information about persons who are believed to abuse or obtain drugs by false pretences or unlawful means.
The broad goal of the MATOD program is to reduce the health, social and economic harms to individuals and the community from non-medical use of opioids, rather than expecting abstinence from use. While abstinence can be an important long-term goal, it is acknowledged that despite efforts, many people will continue to have access to unsanctioned drugs and will use them in a way that puts them and society at risk of harm. Patients taking action to modify their drug use behaviour do not usually successfully achieve abstinence on their first attempt; relapses occur frequently.
In general, treatment of opioid dependence via the MATOD program is based on daily supervised dosing at a pharmacy or clinic. Supervised daily supply of methadone or buprenorphine (+/- naloxone) by a pharmacist or nurse allows patients to be assessed before dosing to maximise their safety and that of the community, and to minimise the risk of drug overdose, abuse and diversion.
In South Australia, all medical practitioners and nurse practitioners (within their scope of practice) can prescribe sublingual buprenorphine with naloxone film (Suboxone®) to treat opioid drug dependence for up to ten patients, without completing specialised MATOD training. With the recognised greater safety of buprenorphine/naloxone use in the treatment of opioid dependence, this may provide better access for patients to receive both MATOD and other medical treatment from their usual prescriber.
A medical practitioner must become accredited to:
prescribe methadone liquid or buprenorphine as a single agent
MATOD prescribers must notify the DDU in writing prior to prescribing buprenorphine as Subutex® for patients who are:
allergic to naloxone
on a low dose short-term withdrawal regime
MATOD prescribers can apply to the DDU to prescribe buprenorphine for patients:
if treatment has been initiated and stabilised by an accredited prescriber
on a low dose (≤2mg) short term withdrawal regime
Non-accredited MATOD prescribers with patients who become pregnant are recommended to seek advice regarding management from an accredited prescriber or Drug and Alcohol Services South Australia (DASSA).
For patients being prescribed buprenorphine, in most circumstances it is appropriate to continue any existing take away regimen.
From September 2019 buprenorphine depot injections will be listed on the PBS as a Section 100 drug for the treatment of opioid dependence (MATOD); this is the same as for methadone liquid, sublingual buprenorphine/naloxone film and buprenorphine tablets.
From a regulatory perspective this formulation will be treated like any other schedule 8 drug used for the treatment of opioid dependence. Prescribers will need to apply for, and be granted an authority before being able to lawfully prescribe buprenorphine depot. Applications for buprenorphine depot may require relevant specialist medical practitioner (e.g. Addiction Medicine) oversight and support.
Prescribers considering the buprenorphine depot formulation are encouraged and recommended to familiarise themselves with the product information and relevant education material around its supply and administration, as well as consider their professional obligations.
Pharmacists dispensing prescriptions for buprenorphine depot should exercise appropriate clinical and professional judgement. As this product is indicated for opioid dependence it is reasonable to expect that the risk of diversion or misuse be taken into account when dispensing prescriptions, and that direct supply to patients does not occur.
For Clinical advice about buprenorphine depot, please contact Drug and Alcohol Clinical Advisory Service 7087 1742.
Split dosing | Methadone only
Twice per day dosing (split dosing) of methadone may be considered for:
patients who rapidly metabolise methadone
vomiting and/or rapid metabolising during pregnancy
patients with acute pain (short term treatment with split dosing)
Accredited prescribers must notify the DDU in writing prior to prescribing split dosing of methadone.
Neonatal abstinence syndrome
Neonatal abstinence syndrome (also called NAS) is a syndrome of withdrawal in a baby following exposure to drugs in-utero. NAS is most often caused when a woman takes opioids during pregnancy and can be managed with morphine to treat neonatal withdrawal symptoms. In accordance with Regulation 22(2) of the Controlled Substances
[Poisons] Regulations 2011 (SA), an authority is required when treatment exceeds 14 days of inpatient treatment or discharge medication. Authority to prescribe requires written application to the DDU, by a prescriber of a Local Health Network, generally a paediatrician in a neonatal unit.
Actions that may result in authority restrictions or termination of treatment
These may include:
suspected, attempted or confirmed diversion
unsanctioned drug use, intravenous drug use
continued drug seeking, prescription forgery/tampering
inappropriate storage of take away doses potentially resulting in theft or accidental death
The prescriber should clinically assess the patient and provide written notification to the DDU of the incident and the proposed management plan. Prescribers should use their clinical judgement to assess the benefits of continuing treatment and the risks of harm to the patient and community. MATOD provides an opportunity for patients to manage problematic use of opioids; forcing withdrawal from treatment may result in return to unsanctioned opioid use and drug related problems. It may be more appropriate to maintain treatment and seek support and clinical advice from DASSA and/or management.
Due to risks of overdose and death associated with methadone and buprenorphine, it is important to appropriately counsel patients regarding the safe and secure storage of any prescribed take away doses. The methadone and buprenorphine not for kid's brochure (PDF 185KB) helps outline how to safely store medication and should be provided to all MATOD patients.
Drug and Alcohol Clinical
Advisory Service (DACAS) (08) 7087 1742 Provides 24-hour clinical advice from senior medical staff, regarding opioid dependent patients and patients with other drug and alcohol related issues
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