Dispensing opioid substitution therapy

Community pharmacies must be approved by the Department of Health to dispense opioid substitution therapy (OST). OST includes methadone syrup/solution and buprenorphine as Subutex or Suboxone for the treatment of dependency.

Approval requirements

Pharmacies

Pharmacies must apply to the Department using the Application for a pharmacy to participate in the CPOP form (Word 814KB).

Pharmacists

Any pharmacist dispensing OST at an approved pharmacy must have first successfully completed the on-line Pharmacist Training Program (external site).

Procedures

Approved pharmacies and trained pharmacists must adhere to the Clinical Policies and Procedures for the Use of Methadone and Buprenorphine in the Treatment of Dependence (the Policies) (external site).
New patients

Numbers

Pharmacies are approved to dose a maximum of 50 patients daily. The dosing of greater numbers requires additional approval and will be is considered on a case by case basis. Pharmacies should contact the Department for more information.

Client Agreements

Pharmacies are encouraged to interview prospective clients prior to acceptance. If accepted, clients should be asked to sign a Client Agreement. A suggested Agreement can be found in Appendix 11 of the Policies. The Agreement sets out the expectations for the patient when attending for daily dosing.

Initial steps

Valid prescriptions

Pharmacists must ensure that all OST prescriptions are complete, legal and valid Schedule 8 prescriptions. Prescriptions must also adhere to the standard CPOP format and include:

  • specific dates to start and finish dosing;
  • next appointment date;
  • nominated pharmacy;
  • exact daily dose (in milligrams: mg);
  • number of unsupervised doses allowed each week (if applicable).

Patient identification

Pharmacists must positively identify the client before each dose.Prescribers are to provide an endorsed photograph of the client with the first prescription. The relevant contact client addresses and phone numbers should be kept up to date.

Before Dosing

Prior to each dose the original prescription and the client’s dosing record should be reviewed in person.

Missed doses may not be replaced and clients should be referred back to their prescriber. Vomited doses are not replaced unless authorised in writing by the prescriber.

Patients should not be dosed if intoxicated.

Dosing

Methadone should be measured and provided in a disposable cup, with water for after dosing as required. Dosing is to be personally supervised to ensure the dose has been swallowed.

Suboxone and Subutex should be removed from packaging and provided in a disposable cup or spoon for sublingual administration. Suboxone clients must be observed for at least one minute supervision to ensure the film has adhered. Subutex should be crushed to the size of coarse coffee grounds and clients supervised for a minimum of two minutes after dosing.

Unsupervised doses must only be provided on the day a patient attends for scheduled dosing. Unsupervised doses are to be packaged and labelled according to the Polices.

Recording

An individual daily dosing record is to be kept for each client. A template dosing record is available from the Department. A record of each dose taken or each unsupervised dose supplied is to be made at the time of client dosing.

Approved electronic systems may be used to record client dosing (hyperlink approved registers).

At the end of each month a summary report of clients dosing for the month must be provided to the Department of Health.

More information

Medicines and Poisons Regulation Branch
Mailing address: PO Box 8172, Perth Business Centre, WA 6849
Phone: 9222 6883
Email: poisons@health.wa.gov.au