Frequently asked questions on Medication Assisted Treatment for Opioid Dependence (MATOD) Program
- Who can prescribe MATOD if the authorised prescriber is unavailable?
- Is a MATOD prescription written interstate valid in South Australia?
- Is a MATOD prescription written in South Australia valid interstate?
- Does the Risk Assessment Tool need to be submitted to the DDU?
- How many take away doses can be prescribed for a patient?
- If 28 days of Suboxone take away doses of are prescribed, when does the patient need a supervised dose?
- If weekly supplies of Suboxone are prescribed, when does the patient need a supervised dose?
- Is an application required to increase the number of Subutex take away doses for a patient?
- How should Suboxone take away doses be packaged?
- What is required when applying for increased take away doses?
- If a patient is prescribed split dosing of
methadone, how many take away doses are permitted?
Who can prescribe MATOD if the authorised prescriber is unavailable?
In accordance with Regulation 22(1)(c) of the Controlled Substances (Poisons) Regulations 2011 (SA), a prescriber working in the same practice as the authority holder (authorised prescriber) can act as a locum and continue to prescribe treatment in the short term absence of the authorised prescriber. Prescribing must comply with the conditions of the authority.
Locums should continue treatment according to the plan and dosage regimen set out by the authorised prescriber. Significant changes should not be initiated by a locum and may require consultation and clinical support from Drug and Alcohol Clinical Advisory Service (DACAS) on (08) 7087 1742.
Is a MATOD prescription written interstate valid in South Australia?
A MATOD (or any other schedule 8) prescription written by an interstate prescriber is valid in South Australia if it complies with:
- that jurisdiction’s legal requirements for writing a Schedule 8 prescription, or
- Regulation 34 of the Controlled Substances (Poisons) Regulations 2011 (SA).
A pharmacist can dispense a valid interstate MATOD (or any other schedule 8) prescription if they:
- know the person for whom the drug has been prescribed, OR
- recognise the signature of the prescriber on the prescription, OR
- have verified the prescription by contacting the prescriber.
(Regulation 35(8) Controlled Substances (Poisons) Regulations 2011)
No authority from SA Health’s Drugs of Dependence Unit is required if the prescription is written by a prescriber interstate.
Pharmacists should use their professional judgement when deciding if it is safe and appropriate to dispense an interstate MATOD prescription.
Is a MATOD prescription written in South Australia valid interstate?
MATOD prescriptions written in South Australia may not be valid in another state or territory. The relevant state or territory authority should be contacted for further information. Refer to Dispensing of interstate prescriptions page for state/territory regulatory body contacts.
Does the Risk Assessment Tool need to be submitted to the DDU?
No, the risk assessment tool does not need to be submitted to the Unit; prescribers are encouraged to use this tool when reviewing patients to document the risk of, and to help decide if it is appropriate to provide take away doses.
How many take away doses can be prescribed for a patient?
The updated Drugs of Dependence Unit (DDU) MATOD Program Guidelines for prescribing take away doses provides more flexibility for very stable, low risk patients and clinical autonomy for prescribers when determining if it is appropriate to prescribe take away doses during the maintenance phase.
Application and approval from DDU is required only if take away doses are in excess of the following:
- 28 days of Suboxone®, or
- 4 consecutive days of methadone
- Any increase in current takeaway allowance for Subutex®.
If 28 days of Suboxone take away doses of are prescribed, when does the patient need a supervised dose?
If 28 days of Suboxone take away doses are prescribed, they must be immediately preceded and followed by a supervised dose (i.e. supervised doses must be provided on day 0 and day 29). No patient should be having more than 28 days’ unsupervised dosing without written approval from the DDU.
In other words: If 28 days of take away doses of Suboxone are prescribed, the patient would then need to present to the pharmacy to have a supervised dose on the 29th day.
If weekly supplies of Suboxone are prescribed, when does the patient need a supervised dose?
If weekly supplies of Suboxone are prescribed and the patient is attending the pharmacy once a week to collect take away doses, the patient should receive a supervised dose on the day they attend the pharmacy (for example, have a supervised dose in the pharmacy and collect 6 takeaway doses for the remainder of the week).
It is a requirement to annotate MATOD prescriptions with the supervised dosing requirements for example, include the number of supervised doses and take away doses.
Is an application required to increase the number of Subutex take away doses for a patient?
As per the DDU MATOD Program Information “For patients being prescribed buprenorphine, in most circumstances it is appropriate to continue any existing take away regimen”. Accordingly, any subsequent increase to a patient’s existing buprenorphine take away regimen, requires approval from the DDU.
How should Suboxone take away doses be packaged?
For smaller quantities of take away doses:
Each day’s take away dose should be packaged separately (for example, 4 take away doses – 4 individual packages).
For larger quantities of take away doses:
The recommendation is for single strengths to be packaged per box. If the patient is required to take different strengths of films (for example, a combination of 2mg and 8mg films), it is recommended that the different strengths of films be packaged separately.
For example: If the prescribed dose is 10mg Suboxone® daily with 28 take away doses; dispense one box containing 28 Suboxone® 2mg films, and one box containing 28 Suboxone® 8mg films.
Pharmacists are to ensure that the boxes are appropriately labelled, and that the patient is aware of the dosing instructions for both strengths of film to achieve the correct daily dose of Suboxone®. Note that in some circumstances, take away doses packed for each individual day’s treatment may still be appropriate.
For further clinical advice phone the Community Pharmacy Program Manager, Drug & Alcohol Services South Australia on (08) 7425 5160
What is required when applying for increased take away doses?
Application must be made in writing and signed by the authorised prescriber, providing detail of:
- the specific circumstances
- the results of a recent urine drug screen
- an itinerary, if the patient is travelling overseas
- patient’s stability and the appropriateness of take away doses
- secure storage of take away doses
As per the DDU Customer Service Standards, applications are reviewed within 14 days of receipt. Applications received less than 14 days prior do not allow adequate time for review and may not be approved.
If a patient is prescribed split dosing of methadone, how many take away doses are permitted?
For split dosing of methadone, one portion (or both portions) of the total daily dose may be given as a take away dose. Written approval from the DDU must be obtained before prescribing more than 4 consecutive days of take away doses per week, even when a patient is receiving split doses.
In other words: there must be a minimum of 3 split supervised doses (for example, 3 supervised morning doses) and up to a maximum of 11 split take away doses of methadone prescribed per week. Any increase to this take away regimen, requires approval from the DDU.