Pharmacotherapy for problematic opiate use
What is pharmacotherapy?
In Australia, when we refer to pharmacotherapy, we generally mean replacement of problematic (often illegal) opiate use with a legally prescribed and dispensed substitute like methadone.
Pharmacotherapy for opioid users is sometimes referred to as:
- Methadone or Done Program
- Opioid Replacement Therapy/Treatment (ORT)
- Opioid Substitution Therapy/Treatment (OST)
The reason why opiate substitution is provided to people with a problematic drug use is that it has been proven to be very successful in assisting people to stabilise their drug use and their lives. Once stabilised, people on opiate substitution may decide abstinence is their goal and they can slowly focus on reducing their dose. They may also decide to stabilise and continue on a maintenance program.
Pharmacotherapy is at present one of the most the most effective programs on offer, available to people with opioid dependence.
Each state has different rules governing the administration of pharmacotherapy programs. You can go online and check the guidelines for each state.
What drugs are provided through pharmacotherapy?
Methadone is one of the most successful, well-researched and cost-effective treatments for opiate dependence. It is available in both liquid and tablet forms, although most Australian pharmacotherapy programs use the liquid form alone. There are two brands of methadone liquid: Methadone Syrup and Biodone Forte. Their contents and strength are the same.
Methadone is a full opiate agonist: the higher the dose, the greater the opiate effect will be. This is why most prescribing doctors will start new pharmacotherapy clients on low dose, in NSW no more than 40mg (8 mL). The dose can be adjusted as required until the pharmacotherapy client no longer is experiencing opiate withdrawals for the full 24 hours between doses. If doses are missed or other opiates are used, it can take longer for pharmacotherapy consumers to stabilise on a daily dose.
If you find methadone doesn’t work for you, you might find buprenorphine might be a better fit for you.
Buprenorphine is a relative new drug used in pharmacotherapy treatment. It comes in tablet or sub-lingual form. The names used are Subutex and Suboxone.
Subutex is the less widely used of two buprenorphine formulations available to opiate pharmacotherapy consumers. Subutex is a mono-formulation of buprenorphine available in 0.4, 2 & 8mg sub-lingual tablets. It has been largely superseded by Suboxone (a buprenorphine/naloxone formulation.) The presence of the opiate antagonist naloxone in Suboxone makes it less attractive than Subutex for pharmacotherapy consumers. Subutex tablets are placed beneath the tongue, where they are absorbed directly into the blood-stream through the mucous membrane.
Suboxone contains a 4:1 ratio of buprenorphine/naloxone. Naloxone, is an opiate antagonist, and it reverses the effects of opiates. Under the brand name Narcan, it is used intravenously to assist overdose victims and is only present in Suboxone as a deterrent to diverting and misusing of the drug, especially through injection. When Suboxone is taken sub-lingually (beneath the tongue), the naloxone has a pharmacological effect on the client. Only 1-4% of the Naloxone is absorbed by the persons system, and after an hour this small amount has left the body.
Suboxone is available in in 2mg and 8mg strengths, comes in a sub-lingual film (similar to a Listerine strip). It is placed beneath the tongue, where it is absorbed directly into the blood-stream through the mucous membrane. (It can also be placed inside of the cheek.)
How do I access pharmacotherapy?
In NSW, there are three options for accessing pharmacotherapy treatment. You can access a public clinic, private clinic or GP/chemist. To find the closet service, you can ring ADISon (02) 9361 8000 or freecall 1800 422 599 24 hours a day, 7 days a week.
The main differences are that public clinics are free, but usually have a waiting list, whilst private clinics don’t have waiting lists but can cost up to $8.00 per day. Seeing a private doctor and collecting your dose from a chemist can also cost if the GP doesn’t bulk bill. Most chemists normally charge around $35.00 per week for dispensing methadone or buprenorphine.
To get a prescription an application will be made to the Ministry of Health for you to receive a script for a regulated medication. This can take up to a day for approval, so before your first appointment with the clinic or doctor, make sure you ask what documentation you need to bring so all paperwork can be completed on the same day. You will definitely need a current Medicare card and some form of photo ID. If there is no waiting list, you can be receiving your first dose within 24 hours of your application being submitted.
Getting the most out of treatment
It is important to find a prescriber or clinic that you trust and can be open with. Together with your doctor, you can develop a care plan that meets your needs to ensure you get the most out of your treatment.
For more information about other treatment options, check out NUAA information on other treatment options.
If you would like to know more about pharmacotherapy, we have collected some resources that may assist you.