PSY13 Opioid Substitution Treatment/Methadone

Aims of OST​ - Opioid Substitution Treatment (OST) (formerly known as: Methadone Maintenance Treatment (MMT) ​
-reduce or cease ❌ opioid use​
- reduce risk of ❌ transmitted by injecting​
- reduce risk of ❌​
- reduce rates of substance-related ❌​
- support the client, family and whānau through recovery and ❌ to support systems​

Methadone:
- A ❌ opioid agonist​
- In NZ, Controlled Drug class ❌ ​
- Commonly prescribed for moderate to severe pain and treatment of opioid dependence​
- Long elimination half-life of ❌ hours has been reported (Medsafe), therefore with repeated administration, doses have to be ❌ carefully​
- Takes ❌ to reach steady state and thereafter may still need dose adjusting​
- Common side effects include a ❌ mouth, constipation, ❌ dental problems..​

Misuse of Drugs Act 1975 Section 24​:
Who can rx methadone:
- Prescribers in an authorised methadone maintenance treatment clinic (e.g. Specialist Addiction Services SAS)​
- Individual GPs authorised in ❌ by a specific prescriber in a gazetted treatment service
- Emergency treatment for dependence in ❌ and not exceeding ❌​

❌ - a combination of buprenorphine and naloxone​. Class ❌ Controlled Drug​.
Buprenorphine is an ❌: µ (mu) opioid receptor partial agonist, and (kappa) opioid receptor antagonist.
Naloxone is an ❌:t µ (mu), δ (delta) and ĸ (kappa) opioid receptors​
Naloxone is a deterrent.

- Does not -need- ❌ form (unlike methadone)
- No Controlled Drugs ❌​ (unlike methadone)
- Must be kept in a locked safe at all times​.

Suboxone and methodone combo = ❌ ​.
- 3 strengths – 2mg/ml, 5mg/ml (Forte) ​and 10mg/ml (Extra Forte)​
- Orange, clear and pink​.

Pharmacists’ responsibilities​
❌ service reducing stigma​
Comply with all ❌ requirements for OST dispensing, recording and storage of medicines​
❌ and auditable systems to minimise risk and errors​
Ensure adequate ❌ of the consumption of OST doses​
Liaise with OST providers on a regular basis​

When would a pharmacist liase with the OST provider?​
Missed collecting more than ❌ dose​
Presented ❌​
Abusive or ❌ behaviour​
Diversion of dose (refers to the ❌ of prescribed opioid substitution medication)​
❌ symptoms​
Deteriorates in physical, emotional and mental state (potentially increased injecting behaviour)​
Pregnant?​

Needle Exchange programme:
- IVDU is a ❌ issue not criminal
- Harm reduction; reduce ❌ disease spread
- Needle Exchanges do ❌ cause increase drug use​