Medication Assisted Treatment for Opioid Dependence (MATOD)
The RACGP > Faculties > RACGP Victoria > Medication Assisted Treatment for Opioid Dependence (MATOD)

Opioids such as heroin are the third most commonly used illegal drugs in the world, after cannabis and amphetamine-type stimulants. Heroin dependence can lead to serious health, social and economic consequences for users, their families and society. However, heroin or opioid dependence can be treated with medication and psychosocial support. This form of treatment is called medication-assisted treatment of opioid dependence (MATOD). The most common medicines used in Australia are methadone, buprenorphine and naltrexone. There is a strong body of research that underpins the use of these and other medicines; however, some people are uncertain about the role of MATOD in treating heroin or opioid use and dependence.

The opportunity

RACGP and the Victorian Department of Health (DoH) provide fully funded MATOD training to general practitioners, specialists, and nurse practitioners throughout the state of Victoria, so that they are equipped to practise opioid pharmacotherapy in Victoria.

Training outline

Self-directed Pathway

This course is comprised of three modules:


CPD code: 179335
 

Learning Outcomes

  1. Implement safe and effective opioid prescribing as part of a broader pain management plan.
  2. Summarise the potential benefits and risks associated with opioid prescribing
  3. Recognise, prevent and respond to problematic pharmaceutical opioid use.
  4. Assess the appropriateness of and commence induction of a patient on one of the Opioid Replacement Therapies - Buprenorphine.

 


CPD Code: 204937
 

Learning Outcomes

  1. Assess patients presenting with problematic opioid use.
  2. Outline the criteria for the diagnosis of Opioid Use Disorder
  3. Address the legislative requirements relating to prescribing of buprenorphine and methadone.
  4. Implement opioid and methadone prescribing as part of a broader Opioid Use Disorder management plan.
  5. Describe MATOD-related referral and support pathways

 


CPD code:244688

 

Learning Outcomes

  1. Correctly interpret legislative frameworks and evidence-based clinical guidelines for the use of Long-Acting Injection Buprenorphine.
  2. Describe the options available for opioid dependent people who are considering Long-Acting Injection Buprenorphine.
  3. Apply pharmaceutical knowledge and rationale to the prescribing principles for Long-Acting Injection Buprenorphine.

 

Access to the MATOD program

Module 1

Please contact MATOD Program Coordinator, Kerrianne Singleton on 03 8699 0468 or via email at vic.MATOD@racgp.org.au if you don't have a RACGP number.

Module 1 Safer Opioid Prescribing is available online and can be access at any time

Module 2

You will automatically receive access to module 2 Opioid Use Disorder, Pharmacology & dosing on completion of module 1

Module 3

You will automatically receive access to module 3 Long-acting injectable buprenorphine on completion of module 2

Register your interest

Face to face workshops have been postponed due to COVID
Virtual workshops are available on request (minimum participating numbers apply)

  Register your interest  

Outcomes and CPD

Modules 1,2 and 3 are all CPD Accredited Activities under the RACGP CPD 2020-22 Triennium Program.
On completion of modules 1 and 2 you’ll be trained and recognised as a prescriber for methadone and buprenorphine based assisted treatment of opioid dependence.

Dr Paul Grinzi, MBBS FRACGP

Dr Paul Grinzi proudly received his medical degree from the Monash University in 1998 and has since gained broad experience in many areas of health, which led to being awarded his Fellowship in General Practice.

As a specialist general practitioner, Paul firmly believes that taking the time to communicate well achieves real and long-term change for his valued patients. His special interests include alcohol and other drug treatment, sports injuries, hepatitis C treatment and skin disorders. Paul is a Q fever vaccination provider and can offer PrEP to eligible patients. Paul has experience in providing health care to other health professionals.

Paul is also a medical educator with MCCC GP Training, holds a clinical lecturer position at the University of Melbourne and is a keen photographer, and barracks for Carlton.

Dr Paul MacCartney MBBS, FRACGP

Dr Paul MacCartney has been working as a GP with special interests in Addiction Medicine, mental illness and homelessness medicine for the past twenty years in Fitzroy and in Shepparton. He has been involved in training many colleagues in the treatment of patients with opiate use disorder. Paul is keen to point out that contrary to initial expectations,  providing non judgemental treatment to our patients  struggling with substance use issues can be a very rewarding experience. 

Dr Christine Longman MBBS, DRACOG, FRACGP

Chris graduated with MB.BS from Monash University in 1979 and has been working in general practice in Yarraville for 37 years. She has also worked in GP training for many years with both the VMA and MCCC GP Training. She has an interest in addiction medicine and in training health professionals in MATOD. In 2010, she completed a Master of Medicine by research in the Department of General Practice University of Melbourne. Her thesis, entitled "Influences on Opioid Pharmacotherapy Prescribing in General Practice in Victoria" explored the reasons why GPs were reluctant to train for and prescribe Methadone and Buprenorphine to those with opioid dependence.

Dr Mark Davies, MBBS, MRCGP

Dr Mark Davies has been working with clients dependent on opioids since 1995. He was instrumental in setting up the Barwon Health Opioid Management Clinic and is passionate about helping people with dependence issues. He believe no one chooses to be dependent on heroin. He is a General Practitioner working in the town of Lara outside Geelong and tutors local GPs, medical students and registrars in the art of opioid replacement prescribing.

In his other life he has grown up children, enjoys mountain biking, reading and thinks he is not too old to start kitesurfing.

Dr Ferghal Armstong MBBch, BAO

Dr Ferghal Armstrong is a Director of Nyora Medical Centre and Black Fish Medical Clinic in Koo Wee Rup.

Graduating from Queens University in Belfast, Dr Ferghal is a fellow of the Australian College of General Practitioners. He has a special interest in Addition and Pain medicine and is currently continuing his studies to become a specialist in this area of medicine. He continues to consult part time as a GP at both Nyora Medical Centre and Black Fish Medical Clinic where he sees patients for chronic disease management. Dr Ferghal also has a special interest and further qualifications in dermatology and skin cancer.

Dr Dean Membrey, MBBS (Hons), FRACGP, DCH

Dr Dean Membrey graduated from Monash University and completed his hospital based training at the Austin Hospital. He gained experience working with patients suffering from substance use disorders during his general practice training program and currently works in a general practice centre for injecting drug users in the inner suburbs of Melbourne. Dean is also on the clinical council of the Eastern Melbourne PHN and is involved in providing the MATOD training through the RACGP.

Dr Belinda McDonald MBBS, FRACGP

 

Dr Erin Hatherell MBBS, FRACGP

Dr Erin Hatherell graduated from the University of Flinders in 2004 and has been working in General Practice for 11 years. Erin has a very relaxed and approachable manner. She believes in delivering a high level of care with a holistic approach to achieve the best outcomes for her patients. Erin also has a love of Cats and Coffee! Erin is looking forward to meeting you and being able to provide a valuable healthcare service to the families of the Bayswater Community and surrounding suburbs.

Dr Thileepan Naren, MBBS DCH PGDipSurgAnat MHM MPH FRACGP

Dr Thileepan Naren graduated from Monash University in 2006 and completed his Fellowship from the Royal Australian College of General Practitioners in 2014. He has also completed a Diploma in Child Health, Postgraduate Diploma in Surgical Anatomy and Masters of Health Management and Public Health.

He is a practicing General Practitioner at the Bendigo & District Aboriginal Co-operative. 

Kerrianne Singleton
RACGP MATOD Program Coordinator

Department of Health and Human Services. 
Maureen Chesler
Pharmacotherapy Development Officer
m: 0418 221 452
e: maureen.chesler@dhhs.vic.gov.au  

Area 1 - Western Victoria PHN Opioid Management Team
Cindy Holzer
Pharmacotherapy Project Officer - Geelong
0403 594 299
cindy.holzer@westvicphn.com.au 

Area 2 - Grampians and Loddon Mallee
Pauline Molloy
Manager Orticare & Harm Minimisation Coordinator
03 5338 9142
paulinemo@bchc.org.au 

Area 3A - Gippsland and Hume – Gippsland
Sean Taylor-Lyons
Manager
0458 693 094
sean.taylor-lyons@lchs.com.au 

Area 3B - Gippsland and Hume – Hume
Tim Griffiths
Manager
0418 910 200
tgriffiths@primarycareconnect.com.au 

Area 4 -Southern and Eastern Metropolitan Melbourne
Michael Abelman
Pharmacotherapy Liaison Coordinator
0436 031 887
Michael.Abelman@semphn.org.au 

Adrian May
Pharmacotherapy Liaison Coordinator
0429 808 317
adrian.may@semphn.org.au 

Area 5 - North West Melbourne
Cohealth
Marcelle Kayrooz
Pharmacotherapy Leader
0439 436 772
Marcelle.Kayrooz@cohealth.org.au 

National Guidelines for Medication-Assisted Treatment for Opioid Dependence
The principle clinical resource for all prescribers.

DirectLine
The main State-based directory of Alcohol and Other Drug services. Directline also offers telephone AOD counselling direct to patients.

Pharmacotherapy, Advocacy, Mediation and Support (PAMS)
A free service for MATOD patients – who can assist with mediating potential problems and supporting patients commence and continue with treatment
Call 1800 443 844 

The Drug and Alcohol Clinical Advisory Service (DACAS)
A free 24-hour call-back clinical advisory service for challenging issues requiring the assistance of an Addiction Medicine Specialist.
Call 1800 812 804 

Victorian Opioid Management ECHO
This online small-group professional development runs weekly and incudes a weekly topic presentation and GP case-based discussions

MATOD/ORT Updates

The COVID-19 pandemic has had a significant impact upon individuals, health care systems and societies in Australia and elsewhere. Health services have had to adapt rapidly to the changing conditions for patients and health workers to reduce the spread of COVID-19, and to respond to individuals with (suspected) infection.  

Measures to support physical distancing were introduced in March 2020, to protect the health of those in MATOD who may be at increased risk during the COVID-19 pandemic.  Changes to minimise face-to-face requirements for MATOD, by providing longer prescription durations, allowing for more takeaway doses and third-party collection of doses were all introduced where clinically appropriate.  

It is important to note that these measures remain in place for the duration of Victoria’s public health emergency directives.  

The maintenance of these contingencies is important as the state and federal governments work to complete the vaccination program for the Victorian population, in combination with the possibility of further snap lockdowns in the short- to medium-term. While there are plans to review these policy changes when safe enough to do so, they will remain in place as long as COVID-19 poses an ongoing risk to the Victorian public.  

Please refer to the “Revised Policy for maintenance of opioid dependence”, available at the Department of Health Pharmacotherapy policy page for specific details of the policy changes put in place last year.   

For advice around pharmacotherapy scenarios which may fall outside these revised guidelines, please contact your local Pharmacotherapy Area-Based Network or, outside of regular working hours, the Drug and Alcohol Clinical Advisory Service.  

Helpful advice for pharmacotherapy clients can be accessed through the Pharmacotherapy Advocacy, Mediation and Support service and at Harm Reduction Victoria’s website  

Your pharmacy will be notified when the pharmacotherapy COVID-19 guidelines are no longer active. A transition period will likely be required to support any long-term policy changes to the physical distancing currently in place for pharmacotherapy.  

Kind regards, 
 
AOD Policy and Commissioning team 
Mental Health Division 
Department of Health 

Suggested actions for MATOD prescribers in COVID-19 pandemic

As MATOD/ORT prescribers we are in a position to help reduce community spread by the way we work. 

A group from RACGP, PHNs, PABNs, PAMS, Pharmacy Guild, VAADA and other experts in the field have been working with DoH to provide some urgent guidelines for prescribers and pharmacies. Please find these below or on the Victorian Alcohol and Drug Association (VAADA) websitePharmacotherapy services: Information for prescribers and dispensers

Some suggestions
Script duration
  • Give up to 6 month duration scripts (in the event you become unwell and to give time for a replacement to be found)

Take aways

  • After conducting a risk assessment, consider increasing take-away for stable patients:
    • up to 1 month for Suboxone
    • up to 1–2 weeks for Methadone
  • Above 2 measures taken in conjunction with discussion with pharmacists about risk and suitability
  • Take away dose guidance

Long Acting Injectable Buprenorphine

  • Move patients over to this as much as possible (if you can prescribe and administer this)
  • Refer to brief clinic guidelines and further information (below)

Buddy / Delegate

  • This is particularly important for solo practitioners to have a colleague who can cover them in the event that they become unwell. Please speak to your Pharmacotherapy Are-Based Network (PABN) co-ordinator, to share your contingency plan.

Naloxone

  • Provide all patients scripts for take-home naloxone (Nyxiod or Prenoxad) along with educational material regarding overdose identification, first aid and naloxone administration.

Telehealth

  • Try to conduct as many consultations via Telehealth as possible to reduce the occurrence of face-to-face presentations and lessen foot traffic in our clinics. (We are fortunate that RACGP, AMA and others got this off the ground so quickly).

MATOD refresher

  • MATOD module 2 part A is available online if you wish to refresh your knowledge about opioid use disorder and the pharmacology of buprenorphine and methadone

Third party arrangements

These actions can reduce patients congregating at clinics and pharmacies which in turn helps to protect:

  • patients and their families / friends
  • yourself and clinic staff
  • pharmacists and their staff

The TGA and PBS has recently approved Long Acting Injectable Buprenorphine (LAIB) for release outside of the Restricted Access Period. Buvidal® will be available from 3 April; and Sublocade® from 21 April, 2020. 

Across Victoria many pharmacotherapy prescribers and dispensers have been engaged in the TGA’s restricted access period/product familiarisation process for LAIB products. 

Attached is a discussion paper outlining key considerations in accessing and administering LAIB, including interactions with SafeScript, how to order and store LAIB, and other practical considerations. The discussion paper was informed by – and developed with the advice of – the Expert Advisory Committee on medical issues related to drugs of dependence, including representation from RACGP Victoria. 

To support clinicians to administer LAIB, DoH interviewed Dr David Jacka, Addiction Medicine Specialist at Monash Health, about his key pieces of practical tips:
  1. Have a cotton swab ready to put pressure on the injection site as soon as the needle has been removed.
  2. There may be some bleeding or product ooze following injection. Be prepared to quickly staunch the venous bleeding, it can be significant; this will also prevent the product leaking out of the injection site. Ask the patient to apply pressure to the injection site to minimise bruising; a small plaster over the injection site may be necessary to prevent ooze onto clothes.
  3. Advise your patients that there may be a small palpable lump in the fat.
  4. In some patients the drug crystalline matrix may be palpable for a number of months after the injection; this reportedly resolves over weeks to months.
  5. Refer to the product information if the initial dose is inadequate.

Many patients have reported a distinctive ‘wearing-off’ experience, with the onset of subtle withdrawal symptoms as the next dose approaches. Patients report after weeks of great ‘cover’, there is a subjective experience of the declining levels, resolved with an earlier or larger repeat dose. The pharmaceutical companies give guidance about subsequent doses being administered early.  

Following from Dr Jacka’s reminder that the different products have different injection sites, clinicians are reminded to review the information provided on injection sites and angles.

Additional information is provided in the updated clinical guidelines available at the health.vic website.