The NSW Opioid Treatment Program (OTP), also known as opioid agonist treatment or opioid substitution treatment, provides pharmacotherapy and support services to people with an opioid dependence. Treatment may be provided as a short term measure to assist people to stop using other opioids, or for long term maintenance.
The OTP is provided through public clinics, private clinics, general practitioners (GPs) and community pharmacies
(find a pharmacy near you), and correctional facilities, and may be provided alongside other treatments such as counselling or residential rehabilitation. The pharmacotherapy medicines used in the NSW OTP are methadone, buprenorphine – including depot buprenorphine, given in an injection under the skin weekly or monthly – and buprenorphine-naloxone.
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What is opioid dependence?
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What are pharmacotherapy medicines?
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NSW Opioid Treatment Program
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Mixing OTP medicines with other drugs
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Driving Safety
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Talk to someone about OTP
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FAQs for OTP patients during COVID-19 (PDF)
What is opioid dependence?
When some people experience pain, both physical and or psychological, they may rely on opioids to make their body and mind feel better. People who are dependent on opioids find it very hard to stop using or cut down because of withdrawal symptoms. Stopping opioid use abruptly can lead to withdrawal symptoms, these can begin to occur within only a few hours after last use.
Symptoms can include:
- Sweats and chills
- Sleeplessness and broken sleep
- Uneasiness/anxiety
- Feeling restless
- Diarrhoea
- Restless legs
- Stomach and leg cramps
- Nausea
- Runny nose and eyes
- Joint pain
- Cravings (wanting opioids very badly)
Some people may experience withdrawal after they have been on strong medicines prescribed by their doctor, such as oxycodone (Endone) or codeine. While others may experience it after using illicit drugs like heroin. Dependence is a medical condition, regardless of how people become dependent or what drug they use, everyone is entitled to treatment.
What are pharmacotherapy medicines?
Methadone, buprenorphine and buprenorphine-naloxone belong to a group of sedating and strong pain-killing drugs called opioids. Both methadone and buprenorphine are long-acting opioids, therefore only one dose per day is usually needed to prevent the uncomfortable symptoms of opioid withdrawal. Methadone and buprenorphine may also be prescribed by clinicians to patients to treat severe or chronic pain or in palliative care settings.
The effects of methadone and buprenorphine can include relief from pain and a feeling of wellbeing, but can also cause nausea, sleepiness and long term use can have effects on male reproductive health, libido and cause sweating and constipation.
Buprenorphine is effective at blocking the effect of other opioids, as it binds tightly to the opioid receptors in the brain. It comes in three different forms, a tablet (Subutex) or film (Suboxone) which are dissolved under the tongue, and a long acting injection (depot- Buvidal and Sublocade). For depot buprenorphine, injections last a week or a month.
Buprenorphine may also be mixed with naloxone (buprenorphine-naloxone) to discourage people injecting.
NSW Opioid Treatment Program
The purpose of the OTP is to provide patients with access to treatment for opioid dependency, with a focus on improving patients’ health, wellbeing and engagement with their families and community.
Patients can access treatment through public drug and alcohol services, private clinics, GPs and community pharmacies. The type of treatment they access will depend on the complexity of the care they need and their location.
Treatment through public clinics is free for patients with the most complex care needs or for those needing supervised dosing.
In many cases, patients can be treated in community settings such as private GP clinics with management of methadone or buprenorphine dispensed daily through community pharmacies.
Most patients are required to start the program with a nurse or a pharmacist watching them take the methadone or buprenorphine every day. After some time patients may be able to have some of the medication to take at home, but this is only after the patient and the doctor are comfortable with how the treatment is progressing, and it is safe to do so.
Long-acting depot buprenorphine does not require supervision because once the medication is injected it is slowly released over days or weeks, depending on the formulation.
Patients and doctors will decide together what treatment plan and medication is best. Some patients may want to take the medication for a short amount of time, other patients may feel they need the medications for longer, each patients’ needs are different.
Clinicians delivering the OTP are guided in practice by the
NSW Clinical Guidelines: Treatment of Opioid Dependence.
Only patients with opioid dependence are suitable for the OTP program. Similar opioid treatment programs are available in all states and territories.
Mixing OTP medicines with other drugs
Methadone and buprenorphine alone are not risky to take but it is necessary to understand how they interact with other sedating substances – particularly benzodiazepines and alcohol. There is a risk of over-sedation when taking sedating medications or alcohol while being treated with methadone.
It is important that patients discuss with their clinicians (doctor, nurse or pharmacist) about all their prescriptions and their other substance use. Doctors can choose a different combination of prescription medication to reduce the risks.
Driving Safety
It is not risky to drive when on a stable dose of methadone or buprenorphine, as long as you are not taking other sedating substances or drugs at the same time.
In the first two weeks of buprenorphine and first four weeks of methadone treatment, and any time where the dose is changed by 5mg or more, you are strongly advised NOT to drive or operate heavy machinery.
For more information, visit
drivingsafety.com.au
or
Download the
Driving Safety and Medicines Fact Sheet.
Pregnancy and child safety
Babies and children can die from taking methadone or buprenorphine. It is important that any takeaway doses are stored in a locked cupboard or drawer, and to never take the medicines in front of children. Depot buprenorphine is a good alternative for parents, as there are no takeaway doses and therefore no chance of exposing children to the medicines.
Methadone and buprenorphine must never be given to babies or children, unless prescribed to them. If a child has taken it call
000 (triple zero) immediately.
If you are dependent on opioids and pregnant, or planning to become pregnant, it is important you consider getting treatment for opioid dependency. Substance Use in Pregnancy and Parenting Service (SUPPS) can coordinate treatment, call
Alcohol and Drug Information Service (ADIS) on
1800 250 015, for counselling and referrals 24 hours a day, 7 days a week.
Talk to someone about OTP
The Opioid Treatment Line (OTL) is a phone based service that provides opioid pharmacotherapy information, referrals, advice and a forum for pharmacotherapy or treatment concerns. OTL assists people who want to know more about the system of opioid treatment in NSW, including how to get onto a program, and what they should expect from clinics and doctors providing the service.
For more information contact the
Opioid Treatment Line (OTL) on 1800 642 428, Monday to Friday 9.30am to 5.00pm with temporarily extended service hours to include 9:30am - 2:00pm on weekends and public holidays to support Covid-19 related queries.
For information from a consumer led organisation, contact
NSW Users and AIDS Association (NUAA).
NEW!
Consumer guideline series is available online through NUAA.
For free and confidential advice call the Alcohol and Drug Information Service (ADIS) on
1800 250 015. Counsellors are available 24/7 to provide information, referrals, crisis counselling and support. Or start a
Web Chat with an ADIS counsellor online Monday to Friday, 8.30am – 5pm.
