Update – April 2024

The Pharmacotherapy Area-Based Networks have received a number of queries about which takeaway guidelines should be used when assessing the appropriateness of takeaways for an individual on Opioid Dependence Treatment.

The confusion is understandable. As of Friday 5 April 2024, on the Department of Health website:

• The Policy for maintenance pharmacotherapy for opioid dependence states a maximum of FOUR take-away doses per week for methadone and SIX take-away per week doses for buprenorphine
• The Checklist for assessing the appropriateness of take-away doses indicates a maximum of SIX take-away doses per week for methadone and up to THIRTEEN take-away doses per fortnight for buprenorphine.
  

  This particular document also states that the guidance provided is being made in the context of the COVID pandemic and the social distancing requirements that were in place at the time.

Without a clear indication from the Department of Health about which guideline should take precedence, the safest approach is to return to first principles. Take-away doses should ALWAYS be considered in the context of each individual, and both the prescribing clinician and the client’s regular pharmacist should work with the client to establish what is safe and appropriate.

An analysis by the Victorian coroner, published in 2022 stated there was no evidence of increased mortality from diverted methadone or methadone overall following changes to allow increased takeaways during the pandemic ¹. The most recent coroner’s report indicates a stable trend in methadone-related mortality in recent years ², however further monitoring of methadone related mortality will be needed. It is wise to be prudent, but also important to remember how impactful take-away doses can be to a patient’s quality of life.

1. Coroners Court of Victoria. 2021. Victorian overdose deaths, 2011–2020.
2. Coroners Court of Victoria. 2023. Overdose deaths in Victoria 2013-2022.

COVID-19 Response

The COVID-19 pandemic and ongoing risk has created new challenges for healthcare. The pharmacotherapy treatment system has been identified as a priority area. The Victorian Department of Health and Human Services (DHHS) and the Pharmacotherapy Area-Based Networks are providing advice on a range of strategies to ensure continuity of treatment for pharmacotherapy patients and associated supports for prescribers and dispensers.

These strategies include:

• Lowering the threshold for takeaway doses with reasonable management of risk and benefit
• Increasing the duration of prescriptions
• Collection of takeaways and/or stewardship by a responsible third party
• Roster of pharmacies and prescribers in local areas who are willing and able to deputise services
• Expanding access to long acting injectable buprenorphine as an alternative to daily Suboxone
• Prescriber and pharmacy service continuity and contingency planning

This is an evolving situation and this page will be regularly updated.

You local pharmacotherapy network managers are available to assist you. If you have any queries regarding these, or any other pharmacotherapy matter please feel free to contact your local network manager via the details found on our ‘About’ page.