Methadone and Buprenorphine Guidelines for Pharmacists in South Australia
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The role of the Community Pharmacy Program is to support the pharmacy profession and its involvement in medication assisted treatment for opioid dependence in South Australia. Its primary aim is to maintain and expand community pharmacy involvement in this program.
These documents outline the legal responsibilities of pharmacists under the Controlled Substances Act 1984. This includes dispensing of medications, such as methadone/buprenorphine for the treatment or maintenance of drug dependence.
The Controlled Substances Act 1984 and the Controlled Substances (Poisons) Regulations 1996 regulate the supply and prescribing of certain drugs in South Australia. 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.
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.
All doses should be supervised until the patient is stabilised on treatment. Take away doses may be gradually introduced for stable patients in recognition of treatment progress and to improve quality of life.
The provision of take away doses is a clinical decision made by a prescriber for an individual patient and should be based on a thorough risk/benefit assessment and not be solely on time in treatment.
The Guidelines for prescribing take away doses outlines the take away framework for methadone and buprenorphine in South Australia.
Suboxone® (buprenorphine/naloxone) tablets were listed on the PBS in 2006, but are no longer available in Australia because Suboxone® film has replaced it. The inclusion of an opioid antagonist (naloxone) with buprenorphine is intended to make the product less attractive for diversion and injection. Diversion of the single ingredient buprenorphine-only tablet Subutex® is much more common than diversion of Suboxone. Risks of such diversion include injecting related harm to the person on the program, or to a third party. Suboxone® film is available in two strengths: 2/0.5mg and 8/2mg. The MATOD program information outlines the guidelines for prescribing buprenorphine.
The MATOD program information outlines the guidelines for prescribing split doses of methadone.
See the Drugs of Dependence Unit policies and forms for further information on these and other drugs.
The MATOD program information outlines actions that may result in authority restrictions or termination of treatment.
Written notification of the incident must be provided to the DDU.
Pharmacists are encouraged to update their knowledge about the harm minimisation services offered at pharmacies. The Community Pharmacy Program provides training about medication assisted treatment for opioid dependence to pharmacists, intern pharmacists and others in the pharmacy industry.
The Community Pharmacy Program can arrange training in country areas, if it is difficult for pharmacists outside of Adelaide to attend training.
For further information on training sessions email: HealthDASSAPharmacyEnquiries@sa.gov.au
The SA Health Drugs of Dependence Unit maintains details of persons where the Minister's delegate believes the person is consuming drugs that represents a risk or obtaining drugs by false pretences (eg pseudoephedrine products, schedule 4 or schedule 8 medications). This information may be supplied to medical practitioners, pharmacists, managements of hospitals etc by delegates of the Minister for the purpose of preventing or restricting further supply of these drugs to the named people. It must not be used for any other purpose and it is an offence to communicate this information to other persons except so far as is necessary to prevent or restrict further supplies of drugs. National Privacy Principles require these circulars to be disposed of when no longer required.
Further information on Privileged circular access.
The monthly Schedule 8 report must be forwarded to the Drugs of Dependence Unit, by the seventh day of the following month.
Electronic reports should be emailed to Health.DDReturn@sa.gov.au
Alcohol and Drug Information Service (ADIS) is a telephone information, counselling and referral service for the general public, concerned family and friends, students and health professionals. ADIS is staffed by training professionals with experience in the alcohol and other drug field. ADIS also provides information about how to access other DASSA and community-based alcohol and other drug services, including information about available prescribers and pharmacies. A range of information pamphlets, posters and other resources are also available.
Telephone: 1300 13 1340 (South Australian callers only - local call fee)
Drug and Alcohol Services SA has a range of information resources, pamphlets, posters, professional and research publications available for download.
The Drug and Alcohol Clinical Advisory Service (DACAS) provides 24 hours per day 7 days per week clinical advice for South Australian clinicians including both hospital based and community pharmacists.
Telephone: (08) 7087 1742 (24 hours 7 days a week, South Australian callers only - local call fee)
The Drugs of Dependence Unit is responsible for administering those parts of the Controlled Substances Act 1984, relating to drugs of dependence. This includes the issue of authorisations to permit prescribing or supply of a drug of dependence to treat drug dependence or where treatment exceeds two months for other reasons. The Unit is responsible for the development of policies and guidelines in these areas to complement the functioning of the Act.
Telephone: 1300 652 584 (9.00 am to 5.00 pm Monday to Friday)
Fax: 1300 658 447
Pharmacists or pharmacy staff with queries relating to the Community Pharmacy Program can email: HealthDASSAPharmacyEnquiries@sa.gov.au