Opioid management support
Medication assisted treatment for opioid dependence or Opioid Replacement Therapy (ORT) represents an important part of the Government’s community response to the treatment of drug and alcohol problems in Victoria. The Victorian opioid management system is described as a ‘Community-based’ model and was implemented in the 1990s. This model was chosen in order to normalise and de-stigmatise the treatment of drug dependence while making medication assisted treatment for opioid dependence readily available in the community. Access to medication assisted treatment for opioid dependence treatment is via community-based general practitioners (GPs) and pharmacies allowing the integration of ORT with primary health care. This results in greater client choice of practitioner and also maintains the client’s privacy.
To support this ‘community based’ model five pharmacotherapy networks (three regional and two metropolitan) have been established across Victoria. The networks aim to ensure there is an integrated, coordinated and accessible pharmacotherapy system available for people addicted to opioids, whether they live in metropolitan Melbourne or regional Victoria. The networks are there to provide support, education and information for general practice staff, pharmacists, and allied health professionals.
Western Victoria Primary Health Network's (PHN) opioid management support aims to;
- Drive service system reform to develop a strong and sustainable community Opioid replacement therapy (ORT) workforce that is supported by an adaptive, responsive and outcome focused opioid management support.
- Enhance service integration, coordination, referral pathways and collaboration between community based, specialist ORT providers and the broader Alcohol and Other Drugs (AOD) sector.
- Reduce the vulnerability of the community based ORT system by adopting and maintaining a whole of system approach, linked to AOD treatment sector reform.
Medication assisted treatment for opioid dependence
The use of medication assisted treatment for opioid dependence, also known as Opioid Replacement Therapy (ORT), has become established in Australia as an effective treatment for opioid dependence. It aims to reduce the health, social and economic harms caused by dependence on both illicit and licit drugs. ORT is used as part of a comprehensive treatment program including counselling, as well as, physical and mental health monitoring and support. Melbourne Pharmacist, Angelo Pricolo has created a video "Fighting the Dragon with Luck" illustrating the effectiveness of ORT.
Opioid replacement therapy: methadone and buprenorphine
Methadone and buprenorphine are the most widely and effectively used opioid replacement therapies substitution treatments for opioid dependence. They are used in long-term maintenance programs that aim to reduce the harms associated with the dependent drug use and to improve the person’s quality of life. They are also used in withdrawal to ease the discomfort of withdrawing from opioids. There is reasonable evidence that longer duration of ORT maintenance treatment is associated with reducing the individual and social harms associated with opioid dependence. Methadone treatment has been shown to significantly reduce the risk of death from overdose. The effectiveness of methadone maintenance programs in reducing HIV infections has also been well-demonstrated.
Incorporating naloxone into practice
There has been an unprecedented increase in unintentional overdose events involving opioids over the past two decades involving both illicit and pharmaceutical opioids. Recognising that many fatal opioid overdoses are preventable, Victoria’s “Whole of Government Drug and Alcohol Strategy 2013-2015”, included a commitment to widen the availability of naloxone as an emergency opioid overdose response, and to encourage prescribing for use by peers and family members within current rules. From this the Naloxone “Community Overdose Prevention and Education” (COPE) program was born. COPE is actively encouraging health professionals to routinely screen patients to identify those who are at high risk of opioid overdose. COPE recommends routine screening for overdose risk be incorporated into care planning processes for individuals being prescribed opioids for conditions such as chronic pain and those on opioid pharmacotherapies. It is highly recommended that any patient identified as at high risk for opioid overdose be offered a naloxone prescription. The Penington Institute, and partner agencies have developed two videos, which highlight the importance of this life saving program, they can be viewed here:
Naloxone: saving lives - is for people who are at risk of opioid overdose and their friends and families. It explains how to recognise the signs of overdose and safely administer naloxone.
Naloxone: experience and perspectives - is for frontline workers and people who are at risk of overdose. In the video, police, ambulance officers, doctors and health workers speak about the lifesaving capacity of naloxone, and their support for its use in a community setting.
For more information about naloxone prescribing and access to training for patients see the COPE website.
GPs can prescribe for up to five buprenorphine patients without having to undergo training. Medical practitioners may refer to the following guide for advice on the key regulatory and policy requirements for prescribing buprenorphine/naloxone. An online video, produced by Networking Health Victoria, is also available.
Please watch the video from local GP, Dr Mark Davies on the benefits of becoming an ORT prescriber.
If you want more information on becoming a prescriber or undergoing training, please contact the team.
Any pharmacy/pharmacist can dispense ORT, but will need to fill out an application form for permission to supply ORT treatment to eligible clients in Victoria. The Pharmaceutical Society of Australia (Victorian Branch) provides online and face-to-face ORT training for pharmacists.
Please watch the video from local Pharmacist, Greg Porte on the benefits of becoming an ORT dispenser.
If you want more information on becoming a dispenser of ORT or undergoing training, please contact the team.
Western Victoria PHN's opioid support*
*Please note that these support services cover the Barwon and South West regions. For services for the Grampians region please see Ballarat Community Health Orticare.
As part of the opioid support commitment to providing support for ORT prescribing and dispensing, a range of resources, clinical tools, education and support mechanisms have been developed. These include clinical advice, mentoring and support from the opioid support team and referral options for complex prescribing of ORT.
This chart can also be downloaded.
Information and resources
A number of HealthPathways have been developed to assist in pain management, diagnosis of opioid dependence and medication assisted treatment for opioid dependence. For HealthPathways access or for further information please access the HealthPathways fact sheet . Opioid Management Pathways include;
To stay up to date on the latest guidelines and service information save HealthPathways on your desktop as a favourite and shortcut.
Contact HealthPathways if you need password details or more information.
Drug and Alcohol Clinical Advisory Service (DACAS)
DACAS is a specialist 24 hour telephone consultancy service that is free of charge for health and welfare professionals. Call 1800 812 804.
DirectLine provides 24 hour assistance for clinicians and patients. DirectLine provides confidential alcohol and drug counselling and referral across Victoria. DirectLine locate a local intake and assessment service to plan treatment for your client. Call 1800 888 236.
Pharmacotherapy Advocacy Mediation and Support Service (PAMS)
PAMS is a state-wide telephone service that provides confidential telephone-based information, support, advocacy, referral and mediation for opiate pharmacotherapy consumers and their direct service providers on any pharmacotherapy client related issue in Victoria. Call 1800 443 844.
Department of Health and Human Services
For more information, legislative requirements and permits go to the Drugs and Poisons website.
Prescription Shopping Service
A service to help prescribers make informed prescribing decisions and better manage the health outcomes of their patients. For more information go to the Department of Human Services.
Clinical support and advice
Rural Addiction Medicine Specialist (RAMPS)
The RAMPS service provides access to an Addiction Medicine Specialist. The main focus of RAMPS is to assist local ORT providers to enhance treatment skills and better manage more complex patients.
Opioid management forum
Join our discussion forum to discuss your opioid and ORT based issues and to learn about issues your peers and colleagues may also be experiencing. It is open to all health professionals and can be accessed at http://portal.healthcloud.org.au/ . You will need to register to join.
Training and mentoring
The team is dedicated to supporting GPs and pharmacists in the community to provide medication assisted treatment for opioid dependence. These support options include:
- GP, pharmacist and outreach clinical advisors
- Mentoring by experienced GP prescribers
- Pharmacist mentoring
- Communities of practice
- Shared care model
- Ongoing CPD addressing dependence and chronic pain topics
- General practice staff training and support.
Education and scholarships
Keep an eye out in the Westvic News for the latest information about scholarships.
Online training and CPD
- Victorian pharmacy ORT training module
- Dr Malcolm Hogg, head of pain services at the Royal Melbourne Hospital, alongside the National Prescribing Service have developed education modules to address the important aspects of managing chronic pain.
- The RACP have developed a resource that addresses strategies in using opioids to approach the management of pain, managing side effects and monitoring progress
- Pharmacists can play a role in the management of chronic pain. Evidence suggests that a multimodal, biopsychosocial approach is needed for the management of chronic pain and pharmacists are ideally placed to support this management approach.
Upcoming CPD and training events
- Pharmaceutical Society of Australia
- Western Victoria PHN CPD
To find out more information or to provide feedback, organise a practice visit or access support please contact the Western Victoria Primary Health opioid management team*;
Aneill Kamath, Coordinator or p: 5564 5888. For the Warrnambool and Geelong region.
Not sure who to contact? All opioid management team members will be able to assist or connect you to the most appropriate team member.
*Please note that Western Victoria PHN Pharmacotherapy Network covers the Geelong Otway and Great South Coast regions.