Guidelines for South Australian Pharmacists Dispensing Medication Assisted Treatment for Opioid Dependence (MATOD)
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Intended to provide the background knowledge needed by a pharmacist involved in dispensing methadone and buprenorphine
Medication Assisted Treatment for Opioid Dependence (MATOD) is prescribed by doctors and some nurse practitioners for people with illicit and other opioid problems. MATOD helps to reduce withdrawal symptoms, control cravings, and block or change the effects of opioids. As medication alone is often not enough to achieve lasting recovery from dependence, it is often used in conjunction with counselling and other forms of psychosocial therapy.
The broad goal of the MATOD program is to reduce the health, social and economic harms to individuals and the community from illicit or overprescribed use of opioids.
Pharmacists are an essential component of the MATOD program as treatment of opioid dependence via the program is largely based on daily supervised dosing at a pharmacy or clinic.
Supply of methadone or buprenorphine (+/- naloxone) under supervision of the pharmacist maximises the safety of patients and that of the community.
Stigmatisation and discrimination against someone on the basis of their use of alcohol or drugs can impact the individual, their families and can be a barrier to getting help.
The following videos show how discrimination and stigmatisation can affect people with drug and alcohol problems:
The Controlled Substances Act 1984 and regulations control the manufacture, sale, supply, possession and use of controlled substances in South Australia. The controls aim to protect public health and safety.
The legal responsibilities of pharmacists are outlined under the Controlled Substances Act 1984. This includes dispensing of medications such as methadone or buprenorphine for the treatment or maintenance of drug dependence.
The Act provides pharmacists with certain privileges and responsibilities. It is expected that pharmacists will be aware of their obligations under the Act, and ensure they act lawfully and responsibly at all times.
The Guidelines for South Australian Pharmacists Dispensing Medication Assisted Treatment for Opioid Dependence (MATOD) is intended to provide the practical knowledge needed by a pharmacist to dispense MATOD.
The guidelines cover:
They also include useful templates for community pharmacies such as:
The MATOD Community Pharmacy Program Manager can provide education and support to SA MATOD community pharmacies. MATOD training can be arranged for pharmacists, intern pharmacists and others in the pharmacy industry in the form of:
Training can also be arranged for pharmacists in country areas unable to attend training in Adelaide.
For further information on training sessions please email: HealthDASSAPharmacyEnquiries@sa.gov.au
Buprenorphine Long Acting Depot Injections (BPN Depot) are the latest treatment option for MATOD clients in Australia.
Buvidal® and Sublocade® are available in a range of strengths which will enable clients to have either a MONTHLY or a WEEKLY depot injection.
This treatment can be offered to stable MATOD clients and may be suitable for:
With the advantages of:
BPN Depot is to be administered by subcutaneous injection only and should never be supplied directly to the client or other third party as there is the risk of serious harm or death if injected intravenously.
Pharmacists are to make arrangements with prescribers to supply the product directly to the healthcare practitioner who will be administering the injection.
For clinical advice about BPN Depot, please contact Drug and Alcohol Clinical Advisory Service on (08) 7087 1742 (8.30 am to 10.00 pm 7 days/week including public holidays) or email your enquiry to email: HealthDACASEnquiries@sa.gov.au
Community pharmacists wanting support regarding BPN Depot (including help setting up an account to access these products) can email: HealthDASSAPharmacyEnquiries@sa.gov.au.
Disruption to MATOD dosing or temporary closure of community pharmacies (due to COVID-19 or other reasons) poses a serious risk to continuity of MATOD client dosing.
All pharmacies should have contingency plans which include a viable MATOD continuity of care plan in place at their site.
Specifically all MATOD pharmacies are expected to ensure:
In the event of a community pharmacy unable to dose they are to contact DASSA immediately through the Alcohol and Drug Information Service (ADIS) on 1300 13 1340 (8.30 am to 10.00 pm every day).
As a result of changing COVID-19 restrictions in SA, the DDU may at times approve temporary changes to MATOD prescribing and dosing.
These changes will be routinely communicated to all SA MATOD community pharmacies via email from DASSA.
If a MATOD client (DASSA or private prescriber) dosing at a community pharmacy is required to genuinely home isolate due to COVID-19, pharmacists are to contact DASSA to discuss solutions for continuity of dosing.
Alternatively please contact Alcohol and Drug Information Service (ADIS) on 1300 131 340 (7 days a week, 8.30am to 10.00 pm).
Pharmacists, MATOD prescribers and DASSA clinicians are strongly encouraged to be proactive and communicate regularly. This collaboration and sharing of information between dosing pharmacists and clinicians will help to identify potential risks to clients and contribute to best patient care.
It is important that pharmacists contact the prescriber to work together and discuss solutions when there is evidence of poor compliance, illicit drug use or drug seeking and other inappropriate or unacceptable behaviours. This includes:
DASSA is also available to provide support and guidance to community pharmacists including but not limited to difficult client behaviour, attendance issues, and dosing errors.
Pharmacists should immediately report MATOD prescribing errors, dosing errors or dosing incidents to the prescriber/DASSA clinician and follow all recommendations for actions to be taken in the case of MATOD dosing errors.
Please contact ADIS on 1300 13 1340 or DASSA community Pharmacy MATOD Program Manager/DASSA Senior Pharmacist on (08) 7425 5000. Alternatively non-urgent queries can be emailed to HealthDASSAPharmacyEnquiries@sa.gov.au
DASSA medical staff wish to relay information to community pharmacists to further develop a shared-care approach to management. Until now DASSA has always sent patient sensitive correspondence such as prescriptions to community pharmacies via fax or via email as a password protected PDF.
DASSA has implemented a system to encrypt and password protect all emails containing patient sensitive information being sent to community pharmacies using 7-Zip software. This will provide an extra level of security to the data to minimise it being accessed by unintended recipients and reduce the requirement to use faxes.
Passwords will be generated at DASSA and sent via a separate communication to the intended recipient before sending out the file. The password will be updated every three months.
Pharmacists are encouraged to discuss preferred means of communication (phone calls, email etc.) with DASSA staff. Community pharmacists wanting to discuss these options can also email HealthDASSAPharmacyEnquiries@sa.gov.au
In all cases of suspected, attempted or confirmed diversion, the pharmacist should report the incident to the prescriber and written notification of the incident must be provided to the Drugs of Dependence Unit (DDU).
Diversion includes not consuming the dose to the complete satisfaction of the dispensing pharmacist, as well as supplying a take-away dose to another person. Clients are required to consume their medication as prescribed.
Fraudulently changing the prescription is a serious breach. It is considered confirmed diversion and must be reported to the Police in addition to the prescriber and the DDU.
These actions may result in authority restrictions or termination of treatment by the DDU.
It is a requirement under the Controlled Substances Act 1984 that theft or loss of drugs or substances subject to abuse/diversion be reported by pharmacists. This includes unaccounted losses.
DASSA Community Pharmacy MATOD Program Manager maintains details of all SA MATOD community pharmacies.
Having up to date community pharmacy details provides DASSA staff (including clinicians, case workers and phone support staff) access to accurate information.
It also supports General Practitioners by having timely access to a comprehensive MATOD community pharmacy list in order to refer MATOD clients.
If your pharmacy wishes to participate in the MATOD program please email HealthDASSAPharmacyEnquiries@sa.gov.au
to have your pharmacies details added to our database and to discuss education, training and support for staff at your site.
If your pharmacy details change (name, address, contact information, phone number, fax number or email address) please advise HealthDASSAPharmacyEnquiries@sa.gov.au to have your details updated.
Pharmacists or pharmacy staff with queries relating to the Community Pharmacy MATOD Program can contact Gary Altobelli (Community Pharmacy MATOD Program Manager) or Sona Samadian (Senior Pharmacist) on (08) 7425 5000 or email HealthDASSAPharmacyEnquiries@sa.gov.au.
Alcohol and Drug Information Service (ADIS) is a confidential telephone information, counselling and referral service for the general public, concerned family and friends, students and health professionals.
The Drug and Alcohol Clinical Advisory Service (DACAS) provides clinical advice for South Australian clinicians, both hospital based and community pharmacists.
The Drugs of Dependence Unit is responsible for administering those parts of the Controlled Substances Act 1984 relating to drugs of dependence.
Pharmacists should contact the DDU for queries relating to legislation, MATOD prescribers, authorities for MATOD clients or client take away entitlements if there are concerns.
Drug and Alcohol Services SA has a range of information resources, pamphlets, posters, professional and research publications available for download.