State’s health department has been forced to reassess policy after concerns about numbers of methadone-related deaths were raised by the Coroner

Key changes in the revised ‘Policy for maintenance pharmacotherapy for opioid dependence’, which comes into effect on 1 September, reduce the amount of take-away doses allowed for opioid replacement therapy (see Key changes below).

The department says it was forced to evaluate the guidelines due to concerns raised by the Coroner’s Court of Victoria following a number of methadone-related deaths.

Revisions were conducted by an expert advisory committee comprising GPs, pharmacists, addiction medicine specialists, a consumer advocate and departmental representatives.

“Pharmacotherapy providers are encouraged to read the revised policy and understand that the tightened guidelines deliver stronger, clearer, safer and additional advice on the provision of pharmacotherapies throughout Victoria,” says the department.

“There is a significant focus in the revised policy on pharmacotherapy take-away doses, which can be fatal if diverted, shared or ingested incorrectly.”

Key changes:

  • Maximum number of methadone take-away doses per week is four (down from five).
  • No single methadone supply should exceed three consecutive take-away doses (down from five).
  • Minimum period of stability in treatment before take-away methadone doses may be considered is three months.
  • Reiteration that unsupervised take-away pharmacotherapy doses are highly dangerous and should be restricted to “very stable and continuous dosing” clients.
  • Time in treatment should not be the only consideration when it comes to assessing eligibility for a client to receive unsupervised take-away doses.

The department points out that prescribers are entitled to operate outside of the policy’s guidelines in “exceptional circumstances, at their professional discretion”.

A number of additional resources have been created to complement the revised policy, and are available on the department’s website. They include a:

  • checklist for assessing appropriateness of take-away doses;
  • patient agreement form: methadone take-away doses;
  • patient agreement form: buprenorphine take-away doses;
  • starting methadone or buprenorphine information sheet; and
  • a methadone treatment in Victoria user information booklet.

See the Vic Health website for more information and to download the revised policy.