The Opioid Treatment Program (OTP) is considered an essential treatment and drug and alcohol services are responding to changing needs during the COVID-19 outbreak.
The changes include the recent
temporary easing of the numerical limits on takeaway doses outlined in the
OTP Clinical Guidelines, based on individual risk assessment. The
Interim Guidance for the delivery of medication assisted treatment of opioid dependence in response to COVID-19: a national response is a useful reference.
The following procedures are to manage continuation of service for patients in self-isolation from COVID -19 and should be read together with the
Community Pharmacy OTP dosing point - Contingency planning for the potential impacts of COVID-19.
It is critical that pharmacists and prescribers work together to ensure continuing treatment and establish the ongoing safety for patients to receive doses in the absence of regular observed dosing at the clinic or pharmacy. Arrangements should be documented and reviewed as required.
Services that may be considered in collaboration with prescribers to continue OTP for patients in isolation:
Confirm with the prescriber that self-isolation is clinically required for the patient.
Discuss and document the individual plan for the patient, e.g. How long will the special arrangements be required? On what date will the plan be reviewed? Confirm and document last dose details if the patient is not an existing client at the pharmacy. Discuss secure storage of takeaway doses with the patient, especially if there are children or others at home.
All patients should be given advice on how to respond to an overdose and provided take home naloxone, currently available free for patients in NSW as part of an Australian Government Pilot.
Note that each takeaway dose must be individually packed and labelled in accordance with the NSW Opioid Treatment Program Community Pharmacy Dosing Point Protocol (TG201-5).
Ensure patients know how to contact the community pharmacist for advice and information if required – provide any written information together with takeaway doses prepared.
Payment for doses and delivery may be arranged via EFTPOS,
Centrepay or direct debit in preference to cash on delivery.
Only a responsible adult (18 years and above), nominated by the pharmacist may deliver takeaway doses of OTP medicines. The delivery person does not have to be a pharmacist, however should have the skills, experience and knowledge to support the pharmacist in their duty of care. Contact the Pharmacy Guild if you require support for delivery services.
Ensure processes and protocols are in place to ensure safety and security of delivery staff, given the risks of theft.
Delivery staff should be familiar with the
COVID-19 infection control and contactless delivery protocol. The contact number for the patient and the pharmacy should be provided to delivery staff to help manage delivery.
Supervised dosing at the patient’s home may be considered where patients must be isolated and have been clinically assessed as requiring supervised dosing to continue treatment safely. If indicated, supervised dosing at home should be a time-limited arrangement made in collaboration with the public OTP clinic, for example:
Correct use of a surgical face mask is recommended if a distance of 1.5 metres cannot be maintained. Longer times of exposure and the potential requirement to provide clinical care should be taken into account when considering safety protocols.
Some NSW public health facilities may require additional capacity to prepare takeaway doses during the COVID-19 outbreak and may reach out to community pharmacies to assist with this service.
Consider if your community pharmacy is able to support public clinics on a temporary basis by either:
Dispensing and delivery fees should be discussed and agreed to with clinics. The Pharmacy Guild of Australia’s guide to
home delivery of medicines may be a useful resource.
Ensure regulatory requirements are met, including a separate valid prescription specifying the takeaways doses for each patient, accurate dispensing records, safe storage of doses and maintenance of Schedule 8 drug registers. If delivery is required, refer to procedures outlined above.
There is increased risk of diversion with this option – consider for a strictly limited time if other options are unavailable, with careful monitoring.
The agent must be an adult, agreed to by both the prescriber and the patient. When deciding on suitability, consider risks of diversion, concerns for patient (or family) safety, and secure storage and transport etc. The clinic must discuss the strict procedures to be followed, documenting the discussion and the agent’s agreement to adhere to this.
Pharmacists should request this documentation from the clinic together with a validated copy of the agent’s photo ID (forwarded by the prescriber), details and timeframe for the arrangement to include in the patient’s file before commencing. The pharmacist on duty must verify the agent’s identity against photo ID in the patient records before any doses are given.
Regular phone / telehealth contact with the patient must be maintained by the clinic or pharmacist to document any adverse outcomes and assess the safety of continuing the arrangement.