Dr Bronwyn Hudson is the founder and principal GP at the Yellow Gate Medical Clinic in Banaglow. She specialises in addiction medicine and runs an outpatient opioid treatment program.
In good news for the medication assisted treatment of opioid dependence (MATOD) in general practice, the recently updated NSW Clinical Guidelines: Treatment of Opioid Dependence 2018 provide a number of measures that make treating opioid dependence in the community more practical and flexible.
The new guidelines aim to increase access to MATOD by expanding the role that GPs play in opioid replacement therapy. The guidelines also place a greater reliance on non-government organisations as well as community pharmacies.
The guidelines allow for unaccredited prescribers to increase the number of patients they can support. For methadone, unaccredited medical practitioners can apply to the Pharmaceutical Regulatory Unit (PRU) to prescribe for up to 10 low risk patients (increased from 5) who are being transferred from an accredited prescriber. For buprenorphine and buprenorphine-naloxone, unaccredited prescribers may be authorised to prescribe for up to 20 patients.
The guidelines also allow for non-accredited prescribers to initiate non-high risk patients in primary care settings. This means that patients can not only bypass waiting lists but can be treated in their local community, negating the need to travel to their nearest public clinic for initiation.
The 2018 guidelines introduce a risk-based case management model that differentiates between low risk patients that can be effectively treated in the community and those who have complex treatment needs that are best cared for in the specialist treatment sector.
The use of buprenorphine in the treatment of opioid withdrawal and opioid dependence is evidence based and supported by a Cochrane review. General practitioners are uniquely placed to support patients in recovery from opiate dependence. This may, or may not, include replacement therapy. The new guidelines, make prescribing in a general practice setting easier.
For support in prescribing, please contact your nearest public Opioid Treatment Clinic. Other useful contacts include the Alcohol and Drug Information Service (1800 422 599) and the Drug and Alcohol Specialist Advisory Service (1800 023 687).
The new guidelines, along with all relevant information for prescribing can be found on the OTP in NSW website.
Dr Bronwyn Hudson spoke at the NoRDocs Unconference
in Lismore on 30 June, 2018