Opioid dependence in general practice
Pharmacotherapy for opioid dependence is usually prescribed in the community by trained general practitioners (GPs) or nurse practitioners. GPs play a key role in preventing, identifying and managing patients with opioid dependence.
The Victorian DHHS Policy for Maintenance Pharmacotherapy for Opioid Dependence outlines that any GP is able to prescribe buprenorphine/naloxone (Suboxone®) for a limited number of patients for the treatment of opioid dependence, without completing formal training. The patient limit is currently 10 patients.
A 16 minute video and 4 page guide are available to support GPs with prescribing buprenorphine/naloxone.
Supports for GPs
RACGP Victoria provides free accredited pharmacotherapy training for GPs, and the Area 4 Pharmacotherapy Network offers an array of free support to GPs and Nurse Practitioners who manage patients with opioid dependence.
- Accredited training for GPs
- GP mentoring (peer-based support for GPs)
- Addiction Medicine Specialist support and secondary consultation
- Paid Clinical Placements
- Peer Group Learning meetings
- GP education at your clinic or virtually
- Whole-of-practice education at your clinic or virtually
- Meducate Opioid Stewardship online modules
- Community of Practice events
Contact us at A4PN@semphn.org.au or 03 8514 6600 for a brochure outlining the available supports.
Prescriber training for Medication Assisted Treatment of Opioid Dependence (MATOD)
MATOD prescriber training (for GPs and Nurse Practitioners) consists of three parts:
- MATOD Module 1 – Safer Opioid Prescribing
- MATOD Module 2 – Opioid Use Disorder, Pharmacology & Dosing
- MATOD Module 3 – Long-acting Injectable Buprenorphine
On completion of Modules 1 and 2, prescribers will be trained and recognised as an authorised prescriber for methadone and buprenorphine based assisted treatment of opioid dependence. Futher details about each Module are outlined below.
MATOD Module 1 – Safer Opioid Prescribing
An introduction to implement safe and effective opioid prescribing and to recognise, prevent and respond to problematic opioid abuse. This training is a prerequisite for prescribers who want to attend MATOD Module 2.
MATOD Module 1: Access here
Learning outcomes
- Implement safe and effective opioid prescribing as part of a broader pain management plan.
- Summarise the potential benefits and risks associated with opioid prescribing
- Recognise, prevent and respond to problematic pharmaceutical opioid use.
- Assess the appropriateness of and commence induction of a patient on one of the Opioid Replacement Therapies – Buprenorphine
This event attracts 4 RACGP CPD points.
MATOD Module 2 – Opioid Use Disorder, Pharmacology & Dosing
A comprehensive series of modules with videos and interviews with MATOD experts. It includes live zoom session that will allow participants to ask questions of the experts.
On completion of modules 1 and 2 prescribers will be trained and recognised as an authorised prescriber for methadone and buprenorphine based assisted treatment of opioid dependence.
Learning outcomes
- Assess patients presenting with problematic opioid use
- Outline the criteria for the diagnosis of Opioid Use Disorder
- Address the legislative requirements relating to prescribing of buprenorphine and methadone
- Implement opioid and methadone prescribing as part of a broader Opioid Use Disorder management plan
- Describe MATOD-related referral and support pathways
This event attracts 40 RACGP CPD points.
MATOD Module 3 – Long-acting Injectable Buprenorphine
Builds on knowledge of prescribing and administering long-acting injection buprenorphine, including how to select, initiate and manage patients who are using these new opioid substitutions.
Learning outcomes
- Correctly interpret legislative frameworks and evidence-based clinical guidelines for the use of Long-Acting Injection Buprenorphine
- Describe the options available for opioid dependent people who are considering Long-Acting Injection Buprenorphine
- Apply pharmaceutical knowledge and rationale to the prescribing principles for Long-Acting Injection Buprenorphine
This event attracts 4 RACGP CPD points.
Please contact MATOD Program Coordinator, Hannah Lack on 03 8699 0957 or via email at vic.MATOD@racgp.org.au if you don’t have a RACGP number.
GP Mentoring
Peer-based support and mentoring is available for GPs via phone, email or face-to-face. This may include advice about:
- How to diagnose opioid dependence and initiate a patient on pharmacotherapy
- Writing a buprenorphine/naloxone script and applying for a permit
- How to prepare management plans, making the most of medicare billing
Contact us to connect with your local GP mentor.
Addiction Medicine Specialist support & referral
In addition to the specialist support available 24 hours a day-7 days a week through the Drug and Alcohol Clinical Advisory Service (DACAS), GPs can contact local Addiction Medicine Specialists for access to:
- Mentoring and support
- Secondary consultation
- Shared care
- Telehealth
GPs can also attend free specialist-led Peer Group Learning meetings (see below for more details).
Contact us to connect with your local Addiction Medicine Specialist for support.
Referral to Specialist Pharmacotherapy Services or Addiction Medicine Specialist outpatient services may need to be considered for some complex clients. Referral pathways to these services in southern and eastern metropolitan Melbourne are outlined below.
| Provider | GP referral process | Addiction Medicine Specialist |
| Monash Health – Addiction Medicine Unit | Fax referral letter to 9554 8693 OR Phone 9554 8201 |
Dr David Jacka |
| Alfred Health – SouthCity Clinic | Fax 9525 7369 OR Phone 9525 7399 |
Dr Benny Monheit |
| Eastern Health – Turning Point (Box Hill & Richmond) | Fax referral letter or referral form to 9416 3420 OR Phone 8413 8413 |
Dr Matthew Frei |
| Peninsula Health – Consultation Liaison Addiction Medicine Service | Phone 9784 8326 (Central Intake) | Dr Helen Sweeting |
Paid Clinical Placements
Observe an experienced MATOD prescriber for 3.5 hours while being reimbursed for your time! Placements are available on any day of the week and are located throughout our catchment. Contact us to find out more.
Peer Group Learning meetings
Peer Group Learning meetings are RACGP-accredited peer-based educational sessions facilitated by local Addiction Medicine Specialists and address the specific learning needs of participants. They are designed to support pharmacotherapy prescribers in their practice.
Previous sessions have covered topics such as:
- Long Acting Injectable Buprenorphine (LAIB)
- Codeine rescheduling and SafeScript
- Review of pharmacotherapy best practice (doses, initiating a patient, length of treatment)
- Takeaway doses (recent changes to guidelines, assessing stability, communication between prescriber and pharmacist)
- Complex pharmacotherapy patients (when and where to refer, comorbidities, drug interactions)
- Pain management in pharmacotherapy patients (acute and chronic)
Meetings are held bi-monthly virtually or face-to-face in Box Hill, Bayside and Frankston-Mornington. Contact us at 03 8514 6600 or A4PN@semphn.org.au for more information or to book a session.
GP education at your clinic: Opioids – The Next Steps
Designed for GPs, this session can be delivered to any of your practice staff to increase their understanding of opioid dependence and its management in the general practice setting.
- Do you look after patients with chronic pain and/or mental health issues?
- Do you prescribe opioids, benzodiazepines, sedative anti-depressants or gabapentinoids?
- Do you ever co-prescribe? (i.e. share clinical care with other prescribers)
- How much do you know about the alcohol consumption patterns of your patients?
Between 2015 and 2020, 43% of deaths caused by overdose were associated with either pharmaceutical drugs alone (~31%), or a combination of pharmaceutical drugs and alcohol (~12%). The introduction of mandatory use of SafeScript in 2019 may have marginally reduced these numbers, but they remain persistently high (1).
Developed by a multi-disciplinary team including a GP, an Addiction Medicine Specialist, and an award-winning Quality Use of Medicine pharmacist, “Opioids – the next steps” (OTNS) is a three-part education series designed to address:
- The socio-medical context of overdose
- The assessment and management of overdose risk
- The diagnostic criteria utilised to identify patients with opioid use disorder
- Appropriate evidence-based treatments for opioid use disorder and the regulations governing their prescription
- Peer-based support, specialist advice and the mentoring and training modalities available to support general practitioners in the management of opioid use disorder
This event consists of THREE 30-minute units, which address the most commonly-applied approaches to reducing overdose risk in patients:
- “Why?” – available to complete online, or for live delivery (face-to-face or via Zoom/Teams)
- “How?” – available to complete online, or for live delivery (face-to-face or via Zoom/Teams)
- “Q&A” – by its nature this unit must be delivered live (face-to-face or via Zoom/Teams)
Accredited for 3 Category 2 RACGP QI&CPD Points.
Contact us at 03 8514 6600 or A4PN@semphn.org.au for more information or to book a session.
Whole-of-practice education: Management of Opioid Dependence – Best Practice, Business Model
Upskill your practice team and develop a strategic, efficient and viable business model. In-house training customised to your availability and needs.
Learning Outcomes:
- Management of opioid dependence using a chronic disease framework
- Understanding challenging presentations
- Responding to codeine rescheduling and SafeScript (real-time prescription monitoring)
- Implementing effective systems, policies and practice environment
- Building a treatment team and collaborative partnerships
Presenter
Anastasia Dimitriou, a Practice Manager experienced in managing general practice pharmacotherapy programs.
Accreditation/points
This training has been allocated 4 AAPM CPD points by the Australian Association of Practice Management Ltd (AAPM).
Click here to view the flyer and to book your session.
Contact us at 03 8514 6600 or A4PN@semphn.org.au for more information or to book a session.
Meducate Opioid Stewardship online modules
Prescription medicines kill more people than the road toll. This statistic reminds us of how opioid stewardship is now as relevant and as necessary as antibiotic stewardship. This online training identifies three stages in patient care during which opioid prescribing can be an issue:
-Initiation of opioids in acute pain
-Initiation of opioids in chronic pain
-Management of patients already prescribed high dose opioids
Click here to access the free online Meducate Opioid Stewardship modules.
This training module is funded by the Victorian Pharmacotherapy Area-Based Networks.
Community of Practice events
A4PN Community of Practice events are multi-disciplinary educational events with expert speakers, including local Addiction Medicine Specialists, presenting on current topics. These events are a fantastic opportunity for cross-sector networking and continuing professional development.
See the Training & Events page for upcoming Community of Practice events.
Contact A4PN@semphn.org.au for more information or sign up to the SEMPHN and EMPHN newsletters to receive details of upcoming events.
(1) Coroners Court of Victoria. “Victorian Overdose Deaths, 2011-2020,” July 29, 2021. https://www.coronerscourt.vic.gov.au/victorian-overdose-deaths-2011-2020