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Queensland Medication-Assisted Treatment of Opioid …

Queensland Medication-Assisted Treatment of Opioid dependence : Clinical Guidelines 2018 Treatment of Opioid dependence : Clinical Guidelines 2018 - 2 - MATOD Clinical Guidelines 2018 - 2 Queensland Medication-Assisted Treatment of Opioid dependence : Clinical Guidelines 2018 Published by the State of Queensland ( Queensland Health), June 2018. This document is licensed under a Creative Commons Attribution Australia licence. To view a copy of this licence, visit State of Queensland ( Queensland Health) 2018 You are free to copy, communicate and adapt the work as long as you attribute the State of Queensland ( Queensland Health). For more information contact: Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Division, Department of Health, GPO Box 48, Brisbane QLD 4001, email phone 07 3328 9538.

Treatment of Opioid Dependence: ... procedures for the use of methadone and buprenorphine in the treatment of opioid dependence (2014) They seek to give clinicians the information they require to give optimal care to our client population. ... Tobacco and Other Drugs Unit, Cooktown.

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1 Queensland Medication-Assisted Treatment of Opioid dependence : Clinical Guidelines 2018 Treatment of Opioid dependence : Clinical Guidelines 2018 - 2 - MATOD Clinical Guidelines 2018 - 2 Queensland Medication-Assisted Treatment of Opioid dependence : Clinical Guidelines 2018 Published by the State of Queensland ( Queensland Health), June 2018. This document is licensed under a Creative Commons Attribution Australia licence. To view a copy of this licence, visit State of Queensland ( Queensland Health) 2018 You are free to copy, communicate and adapt the work as long as you attribute the State of Queensland ( Queensland Health). For more information contact: Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Division, Department of Health, GPO Box 48, Brisbane QLD 4001, email phone 07 3328 9538.

2 An electronic version of this document is available at Disclaimer: The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information. Treatment of Opioid dependence : Clinical Guidelines 2018 - 3 - MATOD Clinical Guidelines 2018 - 3 Acknowledgements These clinical guidelines have been based on evidence derived from research literature, consultation with clinicians, national policies and clinical guidelines and other jurisdictional consultation and Opioid Treatment policy documents.)

3 It is acknowledged that these guidelines draw on: National Guidelines for Medication-Assisted Treatment of Opioid dependence (Commonwealth of Australia, 2014) Consultation with the New South Wales Ministry of Health Policy for maintenance pharmacotherapy for Opioid dependence (Victorian Department of Health and Human Services, 2016) The West Australian Community Program for Opioid Pharmacotherapy (CPOP) Clinical policies and procedures for the use of methadone and buprenorphine in the Treatment of Opioid dependence (2014) They seek to give clinicians the information they require to give optimal care to our client population. Many clinicians have contributed to these guidelines. While not all have been individually named below, the input of each is equally appreciated.

4 In particular, preparation of these guidelines was undertaken by the MATOD Reference Group as follows: Isabel Chan Senior Pharmacist, Metro South Addiction and Mental Health Services Dr Geraldine Chew Addiction Medicine Specialist, Metro South Addiction and Mental Health Services, Persistent Pain Service, Private Prescriber Cameron Foote Pharmacist, Proprietor, Foote s Pharmacies Mary-Anne Goldsbrough Chairperson of MATOD Reference Group, A/Principal Project Officer, MATOD Guidelines, Mental Health Alcohol and Other Drugs Branch Alan Gude Psychologist, Metro South Addiction and Mental Health Services, Dr Jeremy Hayllar Addiction Medicine Specialist, Clinical Director, Metro North Mental Health, Alcohol and Drug Service Margo Hickman Clinical Nurse Consultant, Senior Advisor, Medicines, Regulation and Quality Cheng Huntley Nurse Unit Manager.

5 Alcohol and Other Drug Service, Mental Health and Addiction Services, Sunshine Coast Hospital and Health Service Mushtaq Mohiuddin Consultant Psychiatrist, Townsville Community Forensic Mental Health Service Dr Joss O Loan General Practitioner, Private OTP Prescriber, Inala Medico Niki Parry Treatment Support Worker, Queensland Pharmacotherapy Advice and Mediation Service (QPAMS) Co-ordinator, Queensland Injectors Health Network (QuIHN) Scott Patterson Nurse Unit Manager, Bundaberg Alcohol and Other Drugs Service Kate Podevin Principal Policy Officer, Mental Health Alcohol and Other Drugs Branch Dr Donald Spencer Clinical Director, Alcohol and Other Drug Service, Mental Health and Addiction Services, Sunshine Coast Hospital and Health Service Kathryn Williams Clinical Nurse Consultant, Mental Health and Alcohol, tobacco and Other Drugs Unit, Cooktown.

6 Treatment of Opioid dependence : Clinical Guidelines 2018 - 4 - MATOD Clinical Guidelines 2018 - 4 Foreword The Queensland Medication-Assisted Treatment of Opioid dependence : Clinical Guidelines 2018 ( Queensland Health) represents a revision of the Queensland Opioid Treatment Program: Clinical Guidelines 2012. The term Medication-Assisted Treatment of Opioid dependence (MATOD) used in the title signifies a more encompassing approach, indicating the use of medication and psychosocial support in combination for Treatment of people who are Opioid dependent. These guidelines align with national directions and recommendations, and incorporate the latest clinical evidence for Treatment of Opioid dependence . The clinical guidelines cannot provide detailed direction for managing every client in every situation.

7 In some circumstances, clinicians may need to vary their clinical practices from what is suggested in this document. It is essential that, under such circumstances, clinicians clearly document the reasons for going outside the guidelines in the client s clinical file. Individual medical practitioners, nurse practitioners, pharmacists and other clinical staff are responsible for decisions about the safety and effectiveness of Treatment for each client. The guidelines are not intended to replace professional judgement in individual cases. This document may also be referred to as a Health Management Protocol (as required by the Drug Therapy Protocol Opioid Treatment Program). Alcohol and Other Drug Services and private practitioners offering OTP should operate in a manner that is consistent with the Queensland Medication-Assisted Treatment of Opioid dependence : Clinical Guidelines 2018 ( Queensland Health).

8 Individual services should develop workplace instructions and procedures that remain consistent with both the national and state guidelines while reflecting local needs and circumstances. Disclaimers In these guidelines, Opioid Treatment program (OTP) refers specifically to Medication-Assisted Treatment of Opioid dependence using Opioid agonists (methadone, buprenorphine), while Queensland Opioid Treatment Program (QOTP) relates to the associated Queensland legislative and regulatory processes. The term OTP service provider refers to a private prescriber or Queensland Health OTP Clinic holding an approval to treat a client on OTP. This has been adopted to delineate the process of communication between OTP providers and agencies. It acknowledges that in an OTP Clinic, clinicians within the multi-disciplinary team represent the prescriber/treating team when communicating with agencies.

9 Prescriber is inclusive of medical and nurse practitioners, while delegate covers clinicians functioning within their scope of practice in an OTP Clinic. Medical addiction specialist includes addiction psychiatrists and addiction medicine specialists. Where mention is made of OTP service provider and GP concurrently, this relates to when the GP is not the private OTP prescriber for the client. In this document the term client is used to refer to people seeking assistance with Opioid dependence issues and engaged with OTP service providers. The terms patient, service user, consumer, person who uses drugs or person who injects drugs are used in various other settings. For the purpose of this document, buprenorphine refers to both buprenorphine-mono (Subutex ) and buprenorphine/naloxone (Suboxone ) unless specifically stated.

10 Treatment of Opioid dependence : Clinical Guidelines 2018 - 5 - MATOD Clinical Guidelines 2018 - 5 Executive summary The Queensland Opioid Treatment Program began in 1977 with the opening of the first Queensland Drug dependence Clinic. The policy and procedures manuals and clinical guidelines have each gone through several editions, up to the current 6th edition - The Queensland Medication-Assisted Treatment of Opioid dependence : Clinical Guidelines 2018 ( Queensland Health). Changes made in the 2018 Guidelines include: increased focus on combination of medication and psychosocial support for clients combined chapters previously titled managing Treatment -related issues and clients with particular needs into a single chapter titled issues affecting Treatment categorisation of clinical needs for clients, with varying frequency of reviews according to clinical parameters ( a case acuity approach) inclusion of OTP Clinic case reviews risk assessment to determine suitability for take-away and unsupervised doses with attribution of lower, moderate or higher risk rating.


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