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.
- ***Fact Sheet: Buprenorphine/naloxone for opioid dependence: Important points to know about buprenorphine/naloxone (Suboxone®) (PDF 199KB)
- ***Buprenorphine/naloxone (Suboxone®) Prescriber Initial Medical Assessment Checklist (PDF 612KB)
This document can be used as a checklist of steps to be taken when patients are being initiated into medication assisted treatment with buprenorphine/naloxone (Suboxone®)
Additional clinical resources are provided below.
A medical practitioner must become ACCREDITED if they wish to:
- treat more than ten patients at one time with buprenorphine with naloxone in film form
- prescribe methadone liquid or buprenorphine as a single agent (Subutex®).
For more information go to GP Program - SA - MATOD Prescriber training and annual education event page or contact the GP Program Project Co-ordinator: (08) 7425 5045.
Further information and advice
- Drug and Alcohol Clinical Advisory Service (DACAS) telephone (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
- Drugs of Dependence Unit telephone 1300 652 584 (office hours)
Provides advice on prescribing from a regulatory view point.
- Alcohol and Drug Information Service (ADIS) telephone 1300 13 1340
any day between 8.30am and 10pm for information, counselling and referral (South Australian callers - local call fee).
National Clinical Guidelines
- 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.
- National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn. Maintaining or initiating MATOD is the preferred approach to management of opioid dependence in pregnancy. DASSA should be contacted for advice and/or management if your opioid dependent patient is pregnant.
Assessment & induction onto MATOD
MATOD — Medical Assessment (PDF 58KB)
This clinical form enables the recording of the assessment of a patient for possible commencement of medication assisted treatment for opioid dependence.
MATOD Initial Medical Assessment Checklist — Accredited Prescriber of methadone and buprenorphine (PDF 480KB)
This document can be used as a checklist of steps to be taken when patients are inducted into medication-assisted treatment with methadone or buprenorphine formulations by accredited prescribers.
- Buprenorphine/naloxone (Suboxone®) Prescriber Initial Medical Assessment Checklist (PDF 612KB)
This document can be used as a checklist of steps to be taken when patients are being initiated into medication-assisted treatment with buprenorphine/naloxone (Suboxone®).
- 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.
Please contact the GP Program Project Officer for copies of this form on (08) 7425 5045 or email: HealthDASSAGPProgram@sa.gov.au
- Letter of Introduction of Patient to Pharmacist (PDF 17KB)
This letter can be used after you have telephoned the pharmacist about a new patient. It is best to give the pharmacist as much clinical information as possible.
- Patient handbooks — Prescribers can obtain copies of the following handbooks by contacting the GP Program Project Officer on (08) 7425 5045 or e-mail: firstname.lastname@example.org.
- Suboxone Sublingual film buprenorphine hydrochloride/naloxone hydrochloride: A Guide to Treatment.
Accredited prescribers only:
- The Methadone Handbook (Fourth Edition)
- Subutex: A Guide to Treatment.
- Methadone Buprenorphine Not for Kids (PDF 67KB)
This brochure outlines what should be done if Methadone or Buprenorphine is taken by someone not prescribed the medication. Free copies of the brochure are available to prescriber holding authorities from the Alcohol and Drug Information Service (ADIS) on 1300 13 1340.
Drug of Dependence - MATOD forms and policy
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.
Management tool - related to MATOD
- Medications for Symptomatic Opiate Withdrawal (SOW) Management (PDF 52KB)
In many instances, withdrawal may need to be managed with symptomatic medication rather than with buprenorphine. This list outlines what is used currently at DASSA for symptomatic relief of opioid withdrawal. Of course, in most situations buprenorphine-assisted detox is preferable.
- Prescription Review (PDF 51KB)
This form is used for recording review consultations with patients established on opioid pharmacotherapy.
- Maintenance Pharmacotherapy - Stabilisation / Withdrawal (including cows - Clinical Opiate Withdrawal Scale) (PDF 97KB)
This form is used in the first days of stabilisation and includes a running sheet on one side, together with a COWS assessment tool for each day for recording the patient’s subjective assessment of withdrawal.
- Methadone — drug to drug interactions (including QTc Prolongation) (DOC 52KB)
This information sheet provides information about drug-to-drug interactions include QTc prolongation, for health practitioners involved in patient care where methadone is prescribed. Please insert your practice details into the document.
- Urine drug screening: its use in determining patient progress (PDF 88KB)
Provides information on your patients substance use related problems.
- Benzodiazepine Dose Equivalents (PDF 187KB)
This list allows the clinician to convert doses among benzodiazepines.
- 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.
- Contact information for MATOD patients
You may wish to include this in your patient’s file, put a copy in your practice policy folder, and/or laminate a copy for your consulting room.
- 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.