Innovative clinical placement program to improve treatment for people living with Opioid Use Disorder
Building skills and confidence in GPs to deliver Medication Assisted Treatment of Opioid Dependence (MATOD).
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Patients living with opioid dependence (also known as Opioid Use Disorder) are among the most marginalised groups in south east Melbourne, and frequently struggle to find a doctor who is willing to prescribe treatment for them. Without access to appropriate opioid pharmacotherapy treatment, individuals are at an increased risk of significant health and social issues including mental illness, medical issues, crime and loss of life due to overdose.
What is opioid drug dependence?
Opioid drugs are substances that have a similar action to morphine in the brain (ADF 2021). They can be prescription pain medicines (such as codeine and oxycodone) or illicit drugs (such as heroin). Opioids are often prescribed for the management of strong pain. However, they can produce euphoria and are sometimes used for non-medical reasons. Long-term or non-medical use of opioids can lead to health issues such as drug dependence and overdose.
Since 1 February 2018, access to all opioid pain medicines has required a prescription in Australia.
What is opioid pharmacotherapy treatment?
Opioid pharmacotherapy treatment, also known as Medication Assisted Treatment of Opioid Dependence (MATOD), involves replacing the opioid drug of dependence with a longer-lasting, medically-prescribed and supervised opioid. Provided by a clinician, this can reduce cravings for other opioids, help clients to manage the effects of drug dependence and improve overall quality of life. While abstinence can be an important long-term goal, it is acknowledged that despite efforts, many people will continue to access opiods and will use them in a way that puts them and society at risk of harm.
SEMPHN has found that despite many general practitioners undertaking MATOD accreditation training, most were not prescribing MATOD for patients in the community. Many GPs reported that insufficient support soon after undertaking accreditation training contributed to their reluctance to engage in this area down the track. They identified barriers such as a lack of confidence and hands-on experience when a patient presents with opioid dependence.
Recognising the gap between patient need and professional capability, Area 4 Pharmacotherapy Network (funded by the State Government and managed by SEMPHN and Eastern Melbourne PHN) developed a first of its kind MATOD Clinical Placement Program designed to build the skills and confidence of GPs. This helps to provide MATOD services to patients living with opioid dependence while being reimbursed for the time involved in undertaking the coursework and placement.
Building on theoretical knowledge, the program provided an opportunity for MATOD-accredited GPs to gain ‘real world experience’ by observing the clinical work of an experienced prescriber (26 hours over 4 weeks), and then applying their skills at a high-volume MATOD GP practice under mentorship and supervision (32 hours over 8 weeks).
The inaugural 12-week program started on 23 February 2023 with 11 GPs. Data analysis predicted each GP may see between 10-20 patients with opioid dependence, resulting in improved capacity and more residents in south east Melbourne being supported to manage their condition and live well.
An evaluation of the first program round found:
of GPs felt more confident in prescribing all forms of Opioid Replacement Therapy
were willing to take on new patients
would recommend the program to their colleagues
Daniela took part in the placement program and was mentored by general practitioner Dr Praeger. She talks about how the program has improved her knowledge and ability to prescribe in clinic.
"I enjoyed my placement immensely. I am already prescribing at my usual clinic and was hoping that the experience I gained from the placement would improve my practice. I feel this has certainly been achieved - I am more than happy to prescribe methadone or buprenorphine, but would prefer where possible to prescribe Long-Acting Injectable Buprenorphine (LAIB), as it is the best option for those patients who are currently homeless. I have already been liaising with Dr Praeger who has assisted with transferring patients from methadone to LAIB. I’m very pleased with this relationship."
Daniela, Clinical Placement Program Participant
The MATOD Clinical Placement Program represents an innovative approach to overcoming the barriers to prescribing that are regularly reported by GPs in this area of practice. Increasing the number of active prescribers of MATOD is helping to reduce the stigma and inequities in accessing opioid dependence treatment, while also improving the health and social wellbeing of individuals and the wider community.
The MATOD clinical placement program has received funding for another two years, to support more people in our community.
For more information about the MATOD Clinical Placement Program and upcoming dates, visit our website.
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