During the COVID-19 pandemic it is vital to maintain the continuity of medication assisted treatment for opioid dependence (MATOD).
The Victorian Department of Health and Human Services (DHHS), in partnership with the North West Melbourne Pharmacotherapy Network, have produced a range of guidance documents and tools to ensure that MATOD can continue during this period. This is essential to protect the health of people receiving MATOD, many of whom may be at increased risk during the pandemic, as well as the health of medical staff, pharmacists, counsellors and administration staff involved in MATOD programs.
Resources and guidelines
This fact sheet was prepared by DHHS and covers pharmacotherapy service provision during the COVID-19 response. Covering issues such as:
This guideline was developed by the Pharmacotherapy Area Based Networks and outlines the steps to ensure continued access to MATOD in the event of:
- Prescriber self-isolation/temporary practice closure
- Prescriber unable to continue care for patients/permanent practice closure
Key points covered:
- Use of COVID-19 MBS telehealth items
- Summary of the current policy for maintenance pharmacotherapy for opioid dependence relating to prescription duration and verbal orders
- Policy guidance regarding arrangements to cover absence from practice including arranging an alternative prescriber at usual clinic or another clinic
- Referrals to, and support from, local Addiction Medicine Specialist or Specialist Pharmacotherapy Services
- List of resources to assist with
- Finding new prescribers
- Clinic support
- Resources and online training
Some patients may have additional need for unsupervised dosing because of self-isolation or quarantine. This guidance document is to support the assessment of suitability for later quantities of surprised or ‘takeaway’ dosing.
In the ordinary course of dispensing methadone and buprenorphine pharmacists are required to dispense directly to the patient. This is reflected in existing MATOD policy.
However, it is likely that during the COVID-19 response a number of patients will be unable to attend a pharmacy in person, for reasons of illness or isolation. This guidance provides advice to pharmacists to follow in an event where it is likely that an agent may be required to collect pharmacotherapy on behalf of the patient.
Long acting injectable buprenorphine (LAIB) has been approved for release by the TGA. Buvidal® is available from April 3 2020; Sublocade® from 21 April 2020. These pharmaceuticals exist in multiple subcutaneous formulations, to be injected either weekly or monthly, depending on the clinical assessment of patient need. LAIB is an additional pharmaceutical for opioid-replacement therapy (ORT).
The current skills requirements for GPs to prescribe ORT remain in place. Clinicians are required to complete 95513 – Medication Assisted Treatment for Opioid Dependence (MATOD) Module 1 – Safer Opioid Prescribing and 179438 – Medication Assisted Treatment for Opioid Dependence (MATOD) – Module 2.
The release of LAIB – how it is prescribed and administered to patients – needs to be considered in the context of Victorian policy and regulation of Schedule 8 medicines. A range of supports are available to support GPs to better understand opioid dependence, to improve skills for conducting difficult conversations with patients about transition between medications, opioid dependence and pain management.
This fact sheet covers several considerations related to LAIB release including:
- Safety issues
- Financial considerations
- Skills requirements
- Schedule 8 storage requirements
- LAIB delivery system(s)
This document outlines strategies developed by the Pharmacotherapy Area-Based Networks to assist MATOD-dispensing pharmacies to prepare for a potential pharmacy closure.