GP Program - Medication assisted treatment for opioid dependence
Prescribing medications for opioid dependence
South Australia has approximately 3000 people prescribed methadone liquid or buprenorphine with naloxone in film form (Suboxone®) to assist with the management of their opioid dependence.
Approximately two thirds of these patients are managed by community prescribers - the majority of these are general practitioners (GPs).
Prescribing medications for opioid dependence is not complicated, however, there are some specific issues around the medications themselves, and about caring for people with opioid dependence that need to be considered when prescribing this treatment.
Prescribing buprenorphine with naloxone in film form (Suboxone®) for opioid dependence (non-accredited prescribing)
In South Australia a medical practitioner does NOT need to be accredited to prescribe buprenorphine with naloxone in film form for up to ten patients for opioid dependence.
Medical practitioners need to obtain a Section 18A Controlled Substances Act 1984 (SA) authority (PDF 185KB) from the SA Health Drugs of Dependence Unit prior to prescribing a drug of dependence for the treatment of opioid dependence. This authority must be obtained before treatment commences.
The Drugs of Dependence Unit can be contacted on 1300 652 584 Monday to Friday 9.00 am to 5.00 pm.
The following resources provide further information about prescribing this drug.
Telephone 7087 1742 DACAS provides a telephone and email service for South Australian health professionals seeking clinical information and clarification around clinical procedures, guidelines and evidence-based practice.
The National Guidelines for Medication-Assisted Treatment of Opioid Dependence covers the use of methadone, buprenorphine, buprenorphine/naloxone and naltrexone. Information on the assessment of opioid withdrawal, including the Subjective Opiate Withdrawal Scale (SOWS), the Objective Opiate Withdrawal Scale (OOWS) and the Clinical Opiate Withdrawal Scale (COWS) is included in Appendix 2.
Methadone and Buprenorphine Programs - Patient Agreement (DOC 29KB) The ‘Essential information for patients commencing or recommencing on maintenance pharmacotherapy’ section must not be altered. Your practice details need to be inserted and the details on the lower half of the form can be modified to fit with your practice requirement.
Community pharmacy vacancy list To obtain information about which community pharmacies have vacancies for patients and other details of community pharmacies involved in the program, please ring the Alcohol and Drug Information Service (ADIS) on 1300 13 1340.
Maintenance Pharmacotherapies - Identification Form This form can be used for making up an ID card for patients going to a community pharmacy.
To be used by both accredited and non-accredited prescribers. To obtain the legally required Section 18A Controlled Substance Act 1984 (SA) authority to prescribe a drug of dependence for the treatment of opioid dependence, an initial application form must be filled in on both sides, signed by the prescriber and patient and faxed to the Drugs of Dependence Unit (DDU) at 1300 658 447. Then telephone DDU on 1300 652 584 (office hours) who will provide the authority number which can be written on the prescription.
Opioid dose Equivalence: Calculation of oral Morphine Equivalent Daily Dose (oMEDD). Please note the caveats that accompany the table. Table and full reference is available at the Faculty of Pain Medicine ANZCA.
Monitoring of patient prescriptions from other doctors (PDF 42KB) It is important to be aware of other drugs the patient may be using when prescribing methadone or buprenorphine due to possible drug interactions. Patients may provide information about their other drug use along with Urine Drug Screens (UDS). There are systems in place that may provide you with additional sources of information about your patient. Patients may provide more accurate information if they know that you can check the information they give you.
The systems listed in the attached document above appear to be extensive, however, once the initial paperwork has been completed, accessing the information is relatively straightforward. The GP Program Project Officer has put together packs with all the relevant forms and additional information that you may require. Please contact the GP Program Project Officer for a copy of this pack on (08) 7425 5045 or email: HealthDASSAGPProgram@sa.gov.au.
Insomnia Management Kit The Insomnia Management Kit is designed to be used by GPs with patients who report sleep problems. The information in the Insomnia Management Kit will assist GPs in the assessment, diagnosis and management of patients presenting for the first time with a sleep problem. The Kit is composed of a series of fact sheets that can be downloaded for use with patients.
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