Opioid maintenance treatment
Opioid maintenance treatment (methadone or buprenorphine**) aims to minimise the harms related to opioid use.
Methadone comes in the form of a syrup and is used to treat opioid dependent people. Buprenorphine/naloxone comes in a wafer that is dissolved in the mouth.
Starting opioid treatment
People wanting to start on opioid treatment are assessed to determine suitability for treatment. This involves taking a history and conducting a physical examination.
If suitable, an induction process will be started, usually on the day of assessment. Clients continue to be reviewed by members of the treating team while receiving opioid maintenance treatment.
The treating team enquires about drug use, health and other psychological and social factors, and will discuss other assessments as well, including screening for Blood Borne Virus’.
Prescriptions for opioid maintenance treatment are reviewed at least every three months.
In Australia, methadone and buprenorphine** are only legal within a treatment program.
Specialist Medical Services
The Alcohol & Drug Services Medical Service provides consultation and provision of medical services to clients who have an alcohol and drug issue.
This service provides:
- Comprehensive client drug and alcohol management
- Induction and ongoing care for clients with complex needs who are prescribed Opiate Replacement Therapy (Pharmacotherapy)
- Medicated withdrawal (Inpatient and Outpatient)
- Referral for other medical services as appropriate
- Liaison and provision of medical advice and care to inpatients at The Canberra Hospital and advice to GP's and health care practitioners
- Education to other health care professionals and the general public
The Medical Service is a team of dedicated doctors who are experts in the field of alcohol and drug medicine. The Medical Service doctors accept referrals from GP's and other health professionals.
Methadone is a potent synthetic opioid agonist which is well absorbed orally and has a long, although variable plasma half life. The effects of methadone are qualitatively similar to morphine and other opioids.
Buprenorphine is a derivative of the morphine alkaloid, thebaine, and is a partial opioid agonist. Buprenorphine diminishes cravings for heroin, and prevents or alleviates opioid withdrawal in dependent heroin users.
Buprenorphine has a higher affinity for opioid receptors than full opioid agonists. Because of this, buprenorphine can block the effects of other opioid agonists in a dose dependent fashion. By its dual effects of reducing craving and reducing the response to administered heroin, buprenorphine reduces the self-administration of heroin.
Prescribing and dosing
In the ACT, a prescriber may prescribe a controlled medicine (methadone or buprenorphine**) for opioid maintenance treatment. Prescribers are required to prescribe methadone or buprenorphine** in accordance with the National Guidelines for Medication Assisted Treatment of Opioid Dependence (2014). Prescribers should also endeavour to comply with the Opioid Maintenance Treatment in the ACT: Local Policies and Procedures wherever possible.
A prescriber needs to obtain an approval from the Chief Health Officer prior to prescribing these medicines. Detailed requirements to prescribe a controlled medicine for opioid maintenance treatment can be accessed from the Controlled Medicines webpage. A prescriber must also hold an endorsement to treat drug-dependency if they wish to be approved initiate clients onto treatment or to prescribe for more than five stable patients at a time, unless the prescriber is working at a defined ACT institution.
Most clients will commence dosing at either the Alcohol and Drug Service or a community pharmacy. The prescriber must confirm arrangements with the pharmacy that the client wishes to attend for supervised dosing. This confirmation will involve a client visit to the pharmacy to allow the client and pharmacist to agree on dosing arrangements.
**buprenorphine is taken to include buprenorphine or buprenorphine/naloxone.
Who can use this service?
People who have an opioid dependency are suitable to be assessed for opioid maintenance treatment.
How can I access it?
By contacting the 24 Hour Helpline (02) 6207 9977 for initial information and assessment, or by contacting your medical practitioner.
The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection provides national data on clients being treated with medication (pharmacotherapy) for their dependence on opioid drugs such as heroin. It also provides statistics on those prescribing the medication and where it was dispensed. The latest bulletin may be sourced from the Australian Institute of Health and Welfare website (see AOD Links - National) and search for 'NOPSAD'.
- National Guidelines for Medication Assisted Treatment of Opioid Dependence (2014)
- Opioid Maintenance Treatment in the ACT: Local Policies and Procedures