Safety considerations for clinicians prescribing other medicines to patients who are on the Opioid Treatment Program
People with opioid dependency often have other coexisting conditions, including chronic pain, mental health conditions, and sleep disorders. Prescribers managing these patients must be aware of the high risk of prescribing sedating medicines for patients on opioid agonist treatment (OAT).
Methadone and buprenorphine are safe and effective medicines for treating opioid dependence. However, there is an increased risk of harm from combining methadone or buprenorphine with other sedating medicines, including unintentional overdose and death from multiple drug intoxication. The combination of methadone or buprenorphine with alcohol or other pharmaceuticals such as opioid pain relievers, benzodiazepines, antidepressants, anticonvulsants and antipsychotics increases the risk of opioid-induced unintentional deaths.
In NSW in 2020, pathology data of deaths referred for toxicology testing showed that where methadone or buprenorphine were detected, there was a high proportion of deaths co-detected with sedating medicines
Health care practitioners should consider the risks when patients on OAT are prescribed or using other medicines resulting in potentially harmful combinations.