The NSW Opioid Treatment Program (OTP), also known as opioid dependence treatment, 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, other specialist settings, general practitioners (GPs), community pharmacies and correctional facilities. OTP may be provided alongside other treatments such as counselling or residential rehabilitation. In NSW, the treatment options available for OTP include medicines like methadone and buprenorphine (including combinations with naloxone). In recent years, long-acting injectable buprenorphine has also become available providing a weekly or monthly alternative to traditional daily dosing. The available opioid dependence treatment options are equally effective but can be taken in various ways based on your preference and clinical need.
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What is opioid dependence?
- What is opioid dependence treatment?
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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
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 cut down or stop using because of the physical and psychological withdrawal symptoms. Stopping opioid use abruptly can lead to both physical and psychological withdrawal symptoms, these can begin to occur within only a few minutes to several days after last use.
Withdrawal symptoms can include:
- Excess sweating, chills and goosebumps
- Sleeplessness and broken sleep
- Uneasiness/anxiety
- Feeling restless
- Diarrhoea
- Restless legs and tremors
- Stomach and leg cramps
- Nausea and vomiting
- Runny nose and eyes
- Joint and muscular pain
- Fever
- Increased heart rate and blood pressure
- Cravings (wanting opioids very badly)
Some people may experience withdrawal symptoms after they have been on strong pain-relieving 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 is opioid dependence treatment?
The medicines used for OTP are opioids that can bind to the opioid receptors in the brain to prevent withdrawal symptoms. These medicines include methadone, buprenorphine and buprenorphine-naloxone available as oral, sublingual (under the tongue) or long-acting depot injections (weekly or monthly). Both methadone and buprenorphine are long-acting opioids which can prevent withdrawal symptoms for 24 hours or even longer.
Methadone and buprenorphine may also be prescribed by clinicians to patients to treat severe or chronic pain and are also used 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 dental health, male reproductive health, libido and cause sweating and constipation.
Buprenorphine comes in three different forms, a tablet (Subutex) or film with naloxone (Suboxone) which is dissolved under the tongue, and a long-acting injection (depot- Buvidal® and Sublocade®). For depot buprenorphine, depending on the strength, the injections can last for either one week or one month. Buprenorphine long-acting injections are administered no more frequently than every 26 days or once a month, therefore, reducing the number of visits for dosing.
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, 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 and administered through community pharmacies. If you are living in NSW and would like to access OTP at a community pharmacy, there is a map available so you can find a location that is near you.
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 injectable 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.
Opioid overdose
Opioid overdose can happen to anyone and can be fatal and knowing the signs is important. Access to free overdose-reversing medicines is available through drug and alcohol services and many community pharmacies, allowing anyone in NSW to save a life. For more information about identifying the signs of an overdose visit recognising an opioid overdose. Naloxone is a drug that reverses the effects of an opioid overdose. It is available in a very easy to use nasal spray, and as a pre-filled injection. Take Home Naloxone is now available from an increasing number of community pharmacies, public alcohol and other drugs services and some non-government health and welfare services across NSW. More information about Naloxone and participating pharmacies is available on the Take Home Naloxone page.
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, 7 days a week 9.30am to 5.00pm (excluding public holiday).
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.
