April 27, 2020

Accessing pharmacotherapy (opioid replacement therapy) during COVID-19

Pharmacist browsing medication shelves

Pharmacotherapy, in the form of opioid replacement therapy (ORT), is the replacement of a drug of dependence, such as heroin, codeine and OxyContin, with a legally prescribed substitute.

Replacing a drug of dependence with a prescribed drug helps to stabilise the lives of people who are dependent on heroin and other opioids, and reduce the harms related to drug use.1

In 2019, approximately 50,000 people received pharmacotherapy treatment for their opioid dependence at 2,940 dosing points across Australia.2

Opioid pharmacotherapy treatments (such as methadone or buprenorphine) are beneficial and can:

  • reduce drug cravings and withdrawal symptoms
  • improve the physical and mental health of opioid dependent people
  • decrease substance-related criminal activity
  • increase patients’ ability to gain and maintain employment3,4

Impacts of COVID-19 on pharmacotherapy

There are now new challenges for people who access ORT due to the COVID-19 (coronavirus) pandemic. Many may be experiencing anxiety and fear due to COVID-19 and trying to reduce and mitigate these feelings is vital.5,6

In most cases, people who are on ORT are required to visit their health clinic or pharmacy on a daily basis. This can be more difficult for people right now, due to restrictions on movement and the social distancing regulations imposed to curtail COVID-19.

In recognition of this new barrier, some regulations and restrictions around takeaway doses are being changed so that people can reduce how often they need to visit their ORT clinic. The length of some prescriptions may also be increased by up to three months.

For people who are experiencing symptoms of COVID-19, or who are living with someone who is unwell, home delivery of essential medication, including pharmacotherapy medication may also be available.

Helpful tips for people who are on ORT can be found here.

For people who are accessing ORT, it is important to have a safe and regular supply of medication to prevent withdrawal and minimise the risk of relapse. 

How pharmacies and other services can help

Pharmacies and alcohol and other drug services are helping to ensure that people can continue to access their medications by:

  • having adequate supplies of methadone and buprenorphine in stock
  • reviewing prescriptions that are due to expire and contacting pharmacotherapy clients to advise them to contact their doctor or practice by phone firstly to renew their prescription
  • temporarily increasing the number of takeaway doses to reduce contact by clients with others
  • staggering dosage times to prevent congestion and advising people to maintain a 1.5 metre distance
  • recognising and mitigating the fear and anxiety many people are feeling now due to COVID-19
  • providing access to naloxone
  • advising clients about alternative medications, such as unsupervised sublingual buprenorphine/naloxone or depot buprenorphine
  • enabling a nominated person to pick up (and sign for) doses on behalf of someone who is in isolation.7,8

For support and information related to pharmacotherapy please see the following:

Support options 

State and territory peer-based organisations of people who use drugs:

Harm Reduction Victoria

NUAA (NSW)

CAHMA (ACT)

NTAHC (NT)

QuIHN (QLD)

Harm Reduction WA

Other organisations 

Hepatitis SA

Tasmanian Users Health and Support League (currently no website, email info@aivl.org for contact details).

Resources

  1. Brands B., Sproule B, Marshman J. Drugs and Drug Abuse. 3rd ed. Ontario: Addiction Research Foundation; 1998.
  2. Australian Institute of Health and Welfare. National Opioid Pharmacotherapy Statistics Annual Data collection 2019. Canberra 2020.
  3. Chalmer J, Ritter A. Polygon the many sides to the Australian opioid pharmacotherapy maintenance system Canberra: Australian National Council on Drugs 2009.
  4. Recovery Research Institute. Pharmacotherapy – Medications; n.d [cited 2020 April 17].
  5. Harm Reduction Victoria. Some Helpful Tips for People on Pharmacotherapy - Methadone and Buprenorphine (Suboxone and Subutex); 2020 [cited 2020 April 17].
  6. NUAA. COVID-19 and OTP; 2020 [cited 2020 April 17].
  7. NSW Health. Considerations for business continuity; 2020 [cited 2020 April 17].
  8. NSW Health. Suggested action plan for Community Pharmacy OTP dosing points – Contingency planning for the potential impacts of COVID-19; 2020 [cited 2020 April 17].

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