PSY13 Opioid Substitution Treatment/Methadone

Aims of OST​ - Opioid Substitution Treatment (OST) (formerly known as: Methadone Maintenance Treatment (MMT) ​ -reduce or cease [blank_start]illicit[blank_end] opioid use​ - reduce risk of [blank_start]blood-borne diseases[blank_end] transmitted by injecting​ - reduce risk of [blank_start]overdose[blank_end]​ - reduce rates of substance-related [blank_start]crime[blank_end]​ - support the client, family and whānau through recovery and [blank_start]access[blank_end] to support systems​

Methadone: - A [blank_start]synthetic[blank_end] opioid agonist​ - In NZ, Controlled Drug class [blank_start]B3[blank_end] ​ - Commonly prescribed for moderate to severe pain and treatment of opioid dependence​ - Long elimination half-life of [blank_start]15 – 60[blank_end] hours has been reported (Medsafe), therefore with repeated administration, doses have to be [blank_start]adjusted[blank_end] carefully​ - Takes [blank_start]5 - 6 days[blank_end] to reach steady state and thereafter may still need dose adjusting​ - Common side effects include a [blank_start]dry[blank_end] mouth, constipation, [blank_start]drowsiness, dizziness, nausea, vomiting,[blank_end] dental problems..​

Methadone is the fifth most dispensed drug.

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 [blank_start]writing[blank_end] by a specific prescriber in a gazetted treatment service - Emergency treatment for dependence in [blank_start]hospital[blank_end] and not exceeding [blank_start]3 days[blank_end]​

When dispensing methadone, it needs to be prescribed on a Controlled drug H572/H572M prescription form.​

It is recommended that methadone be kept in a locked safe at all times, but not required.

[blank_start]Suboxone[blank_end] - a combination of buprenorphine and naloxone​. Class [blank_start]C4[blank_end] Controlled Drug​. Buprenorphine is an [blank_start]agoinist at 2 opioid receptors[blank_end]: µ (mu) opioid receptor partial agonist, and (kappa) opioid receptor antagonist. Naloxone is an [blank_start]antagonist at opioid receptors[blank_end]:t µ (mu), δ (delta) and ĸ (kappa) opioid receptors​ Naloxone is a deterrent. - Does not -need- [blank_start]triplicate[blank_end] form (unlike methadone) - No Controlled Drugs [blank_start]register[blank_end]​ (unlike methadone) - Must be kept in a locked safe at all times​.

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

Pharmacists’ responsibilities​ [blank_start]Confidential[blank_end] service reducing stigma​ Comply with all [blank_start]legislative[blank_end] requirements for OST dispensing, recording and storage of medicines​ [blank_start]SOP[blank_end] and auditable systems to minimise risk and errors​ Ensure adequate [blank_start]supervision[blank_end] 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 [blank_start]one[blank_end] dose​ Presented [blank_start]intoxicated[blank_end]​ Abusive or [blank_start]threatening[blank_end] behaviour​ Diversion of dose (refers to the [blank_start]selling or exchanging[blank_end] of prescribed opioid substitution medication)​ [blank_start]Withdrawal[blank_end] symptoms​ Deteriorates in physical, emotional and mental state (potentially increased injecting behaviour)​ Pregnant?​

Needle Exchange programme: - IVDU is a [blank_start]health[blank_end] issue not criminal - Harm reduction; reduce [blank_start]HIV, HEP C[blank_end] disease spread - Needle Exchanges do [blank_start]not[blank_end] cause increase drug use​