Essential guides, files and forms for pharmacotherapy service providers.
Note: links may be either web links or direct download links .
Victorian Department of Health (DoH) web resources
Guidelines
- Victorian DoH Policy for maintenance pharmacotherapy for opioid dependence.
Primary guidelines for Victoria. Updated July 2023
- Policy addendum – long-acting injectable buprenorphine.
Read in conjunction with the state guidelines.
- National Medication Assisted Treatment of Opioid Dependence (MATOD) Guidelines 2014
Secondary, supporting National guidelines.
- Brief guide to buprenorphine-naloxone prescribing
- Long-acting injectable buprenorphine – brief clinical guidelines.
- Levels of supervised dosing (takeaways) checklist
See also, COVID-19 moderated guidelines below.
- Guide to prescribing buprenorphine/naloxone and long-acting injectable buprenorphine.
For prescribers who have not undertaken Medication Assisted Treatment for Opioid Dependence (MATOD) training.
- Pharmacotherapy transfers out of Victoria
- Pharmacotherapy transfers into Victoria
COVID-19 resources
Forms for medical and nurse practitioners
- Application for a permit to treat with methadone or buprenorphine – online form
Online Smart Forms usually elicit a faster response.
- Application for a permit, print or fax
- Notification of a drug dependent person.
Notification is mandatory
“Section 33 of the Act requires a medical or nurse practitioner who has reason to believe that a patient is a drug-dependent person to notify the Department, using this form, where:
the patient seeks prescription of a schedule 8 or schedule 9 poison, or a schedule 4 poison which is also a drug of dependence, or
the practitioner intends to treat or is treating the patient with a schedule 8 or schedule 9 poison, or a schedule 4 poison which is also a drug of dependence”- Notification of termination of patient from methadone or buprenorphine program
Forms for pharmacists
- Application for permission to supply pharmacotherapies in Victoria.
- ORT self-assessment form.
- Pharmacotherapy Support Program tax invoice.
- Notification of temporary transfer into Victoria.
Other useful documents
- Methadone patient information booklet
suitable for emailing. - ‘Starting methadone or buprenorphine’
patient leaflet. - Patient/GP agreement — buprenorphine.
- Patient/GP takeaway agreement — methadone.
- DHHS printed resources order form