The following are strategies provided for your consideration and implementation as appropriate.

Consider ways to ensure continuity of service for the opioid treatment program:

  • Ensure adequate stock and storage of opioid agonist treatment (methadone and buprenorphine).
  • Review all current prescriptions for opioid agonist treatment and for those prescriptions that are due to expire soon, advise the patient to make contact with their doctor or practice by telephone initially to organise a new prescription. The doctor may determine if a clinical review is necessary, or if a new prescription will be sent directly to the pharmacy.
  • Ensure patient records are up to date, e.g. contact information / address and current prescriber.
  • Ensure that you have contact details for prescribers, any nominated locum prescribers, and drug and alcohol services in the local health district to help you plan in case of service disruption at short notice.
  • Some prescribers may increase the number of take away doses temporarily as a strategy to reduce contact by the patient with others. Guidelines around the number of takeaway doses doctors may prescribe will be relaxed during this time. Ensure instructions are in writing and a new prescription is issued where necessary. Maintain good communication with prescribers and discuss any concerns you have to ensure ongoing patient safety.
  • Consider extending or staggering dosing times if necessary to reduce congregation or overcrowding of patients. Advise patients to keep a distance of 1.5m from others.
  • Work together with prescribers to ensure patients can continue to receive doses if they are diagnosed with COVID-19 or are symptomatic and awaiting results. The Ministry is working closely with prescribers, local health districts and service providers around strategies to prioritise continued access to opioid treatment medications for patients.
  • Where observed dosing is not possible due to self-isolation, discuss treatment options and interim measures with the prescriber to enable safe treatment, which may include changes to the patient’s treatment, e.g. switching to unsupervised sublingual buprenorphine/naloxone, switching to depot buprenorphine, or agreeing on whether a nominated person could pick up (and sign for) doses on the patient’s behalf during the isolation period.

For temporary transfers of dosing sites as a result of COVID-19 service disruption, ensure that transfer of care notes are clearly documented, including last dose details. Long term transfers must be reported to the NSW Health Pharmaceutical Regulatory Unit by the prescriber.

Other contingency planning considerations

Harm minimisation initiatives

  • The Australian Government pilot providing free take home naloxone to patients who are at risk of an overdose, without a PBS prescription. Register for the Pilot.
  • Provide take home naloxone to all patients on OTP, providing advice on how to respond to an opioid overdose. This is especially important for patients who may be accessing increased numbers of take away doses.
  • If you do not offer the needle syringe program, ensure you have list of local providers.
  • Recommend influenza vaccination and refer vulnerable populations to their GP where indicated.

Strengthen infection control strategies

Important infection prevention and control strategies include:

  • Providing alcohol-based hand sanitiser for patient use in the pharmacy
  • Encouraging good hand hygiene, cough and respiratory etiquette
  • Asking patients receiving supervised doses to remain 1.5m from staff and other customers
  • Implementing systems to screen patients for symptoms of COVID-19 when they attend and support them to seek testing if they are unwell – in this case, contact the prescriber to discuss dosing arrangements in case self-isolation is required. See current advice on testing
  • Disposable cups must be used and discarded immediately directly into a waste bin.
  • Increase the frequency of environmental cleaning, e.g. clean the counters, pens and other high-touch surfaces more regularly. Guidance is available from NSW Health.

Workforce

Keep your patients informed of any changes to service provision, and reassure them that you are communicating with their medical team to continue to provide safe treatment.

24 hour telephone clinical support regarding drug and alcohol treatment is available for health care professionals through the Drug and Alcohol Specialist Advisory Service (DASAS): (02) 9361 8006 (Sydney) or 1800 023 687 (rural)​​​​​​. 



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Current as at: Friday 12 June 2020