Prescribing Opioid Pharmacotherapies for Opioid Dependence

South Australia has approximately 3000 clients on methadone or buprenorphine or buprenorphine / naloxone for the management of their opioid dependence.

Approximately 50% of these clients are managed by community prescribers - the great majority of these are GPs.

The current available effective pharmacotherapies are not complicated to prescribe. 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 / Naloxone (Suboxone^®) for opioid dependence

Buprenorphine / Naloxone (Suboxone^®) has a lower risk profile than methadone or buprenorphine alone (Subutex^®). Therefore a prescriber does not need specific accreditation in order to prescribe this formulation for up to 5 patients for opioid dependence in South Australia. For further information regarding prescribing of Buprenorphine / Naloxone (Suboxone^®) film, click here

As for other S8 medications prescribers are required to obtain an authority from the Drugs of Dependence Unit. However for Buprenorphine/Naloxone (Suboxone^®), the authority must be granted before treatment commences. The Drugs of Dependence Unit operates during business hours and therefore authorities can not be issued on weekends or after hours.

A medical practitioner must become accredited to hold more than 5 authorities.

For more information about training to become an accredited prescriber of opioid pharmacotherapies, see below 'Training to become an accredited prescriber'.

Training to become an accredited prescriber

In order to be able to prescribe:

• Methadone and/or Buprenorphine (Subutex®) for people with opioid dependence, a medical practitioner needs to undergo training and then become accredited.

• Buprenorphine/Naloxone (Suboxone®) for more than five patients they will also need to become accredited.

Training is provided by Drug & Alcohol Services South Australia (DASSA) medical staff, in collaboration with the Drugs of Dependence Unit (DDU).

Training involves coverage of background information on opioid dependence and its treatment with agonist pharmacotherapies such as methadone and buprenorphine, practical problem solving and skills development. The current training options offered by DASSA reflect the National Learning Objectives and Assessment Procedures for the Pharmacological Management of Opioid Dependence.

 Further information on the National Learning Objectives and Assessment Procedures for the Pharmacological Management of Opioid Dependence

DASSA 2013 Training Program

Medication Assisted Treatment for Opioid Dependence (MATOD) Prescriber Training Course.

To apply for accreditation to prescribe methadone liquid or sublingual buprenorphine (with or without naloxone) to maintain/treat opioid drug dependence, medical or nurse practitioners must complete the Medication Assisted Treatment for Opioid Dependence (MATOD) Prescriber Training Course. Training involves:

• Submission of a pre-workshop assessment based on pre-reading provided to participants. The pre-reading covers the knowledge based component of the course. Detailed feedback is given to participants prior to the workshop. The pre-activity takes approximately 3 hrs

• Attendance at an interactive workshop (usually run on one day of a weekend) from 9am to 4pm. The workshop involves extensive role plays using a variety of scenarios that cover a wide range of relevant skills.

• A post activity is completed that covers the content of the course and again detailed feedback is given.

Continuing Medical Education (CME) points are available through the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). There is no cost for this course; however places are limited and registration is required.

On completion of this course an application is submitted to the Opioid Dependence Prescriber Review Committee (ODPRC) which in conjunction with the Drugs of Dependence Unit (DDU) considers the application and can confer accreditation.

Metropolitan Training

There are four regular training sessions per year:

>Term 1 - Saturday, February 2 at Norwood

>Term 2 - Sunday, May 5 at Norwood

>Term 3 - Saturday, August 3 at Norwood

>Term 4 - Sunday, November 3 at Norwood

Rural and remote areas

The workshop component can be provided on site in rural and remote areas. Times can be arranged with individual participants.

If you are interested in being involved in these training programs telephone the GP Program Project Officer on Tel: (08) 8274 3306 or email: dassa.gpprogram@health.sa.gov.au

There are a number of National Drug Strategy documents that are very useful in preparation for prescribing pharmacotherapies for opioid dependence:

 Clinical guidelines and procedures for the use of methadone in the maintenance treatment of opioid dependence

 Clinical Guidelines and Procedures for the use of Buprenorphine in the Treatment of Heroin Dependence

 Clinical Guidelines and Procedures for the Use of Naltrexone in the Management of Opioid Dependence

Abbreviated versions of these documents include:

 Clinical guidelines and procedures for the use of methadone in the maintenance treatment of opioid dependence - Abbreviated version

 National Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Dependence - Abbreviated version

 Clinical Guidelines and Procedures for the Use of Naltrexone in the Management of Opioid Dependence - Abbreviated version

If you are interested in being involved in these training programs telephone the GP Program Project Officer on Tel: (08) 8274 3306 or email: dassa.gpprogram@health.sa.gov.au

Support for prescribers

Educational support for community prescribers is available through:

• A quarterly newsletter for community prescribers of opioid substitution treatment. The focus is on providing practical clinical and administrative information that is relevant to your everyday practice. We welcome input from our readers and will try to make this as useful and be as responsive to your requests as possible. Past editions of these newsletters are available on the website from this link.

• Continuing Professional Development Seminars for community prescribers (available via teleconferencing for rural/remote participants).

2013 dates and topics are as follows:

• Rural and remote meetings are on an ad hoc basis as requested by Divisions of General Practice, Medicare locals etc.

• Rural and remote prescribers can arrange for a practice visit and audit to be undertaken by one of the DASSA medical staff. This will involve a DASSA doctor sitting in with the GP while seeing their opioid pharmacotherapy patients, with opportunities for discussion and feedback. The other half of the day will involve a case note audit and feedback.
  

All of these services are free of charge.

Further information and advice:

Alcohol & Drug Information Service (ADIS) Clinical Advisory Service

Tel: 8363 8633 or

Tel: 1300 13 1340

(South Australian callers - local call fee)

Alcohol & Drug Information Service

(24-hour information and counselling)

Tel: 1300 13 1340

(South Australian callers - local call fee)