Medication Assisted Treatment of Opioid Dependence (MATOD)

Question 1

In what time period does a maintenance programme start to have significant effects on drug use and psychosocial stability?

Answer 1

3 months minimum with majority of benefits gained after 1 year

Question 2

What is an ideal approach to initiating treatment in this demographic?

Answer 2

Stepped care; start simple and escalate or withdraw based on the client response

Question 3

What is the theory behind substitution therapy?

Answer 3

The substitution of a drug that exposes the client to fewer risks allows them to develop stability of their health and social functioning before addressing the physical dependence.

Question 4

how is MATOD a harm reducing strategy?

Answer 4

the medications used induce increased opioid tolerance so if they are used there is little to no effect from them

Question 5

Natural history of heroin withdrawal?

Answer 5

onset in 8 - 24hrs

peak severity of symptoms day 10

Question 6

Natural history of maintenance treatment withdrawal?

Answer 6

onset in 12 - 48hrs

peak severity of symptoms between 10 - 20 days (slow to dissipate)

Question 7

How many supervised doses are required per week?

Answer 7

3 for methadone and 2 for buprenorphine

Question 8

What is the DDU’s rules regarding supervision and takeaway dosing?

Answer 8

first month - 7 days pharmacy if possible (all supervised)

first 2 months - no takeaways (Non- supervised doses are allowed on Sundays and public holidays at 6 day pharmacies)

less than 9 months - ≤ 6 take-away per month at a 7day or 2 per month plus Sundays and public holidays at 6 day pharmacies.

9 - 18 months - ≤ 12 takeaways per month (three per week) at a 7 day pharmacy or 8 per month plus Sundays and public holidays at 6 day pharmacies.

≥ 18months - with evidence of lifestyle improvement and abstinence from unsanctioned drug use, take-away doses may be increased gradually. There must be a minimum of three supervised doses per week for methadone or two supervised doses per week for buprenorphine.

Question 9

When to initiate MATOD drugs after last opioid use?

Answer 9

short acting 12 - 18hrs

long acting 18 - 24hrs

Question 10

How much notice is required to arrange an interstate transfer of MATOD?

Answer 10

• 3 weeks notice required for interstate, more for overseas.

- If on program < 3 months; may not be accepted in other states.