What GPs need to know about opioid dependency changes

Saturday 1 July will bring historic changes for the 55,000 or more people accessing treatment for opioid dependency in Australia.
 
Up until now, those accessing methadone and buprenorphine for opioid dependency through community pharmacies and other private settings were paying up to $240 a month for their treatment.
 
This cost is not due to the medication itself, but rather the administrative burden of providing dosing/administration for Schedule 8 medications that need frequent supervised dosing or administration by subcutaneous injection.
 
From 1 July, these medicines will be on the PBS, which means people will instead only pay the PBS co-payment ($7.30, or $30 for those without a Health Care Card).
 
As a patient recently said, ‘these changes mean I can buy my kids new school shoes’.
 
Pharmacists will be reimbursed for their time by the PBS for the cost of the medicine and their time managing, dispensing or administering the medications. The actual amount is a bit complex, but it is likely to be similar to what most pharmacies are currently charging patients. 
 
Methadone and buprenorphine are highly evidence-based treatments. They assist people to get their opioid dependence, a chronic relapsing medical condition, under control. And just like diabetes, hypertension or asthma, they require long term care.
 
They help people to improve their physical and mental health, their relationships, get people back to work, study, parent well – live the lives they want. They are a very good thing.
 
The changes are historic but unfortunately, due to legislative issues, they start on 1 July, and we only have a small window to implement them. So, there are few things GPs prescribing or considering prescribing these medications need to know.
 
First up, there is a transition period where if we don’t quite get the prescriptions right etcetera, its ok. Regulatory authorities won’t come down on us like a tonne of bricks. Your dispensing pharmacist might ring and ask for an amendment and while I know this is annoying, we’re all learning about these changes together.
 
Secondly, any scripts written before 1 July are still valid for up to 84 days, depending on the existing script length. If the existing script length is outside the new PBS rules, you don’t have resolve all these by the cut off. A number of solutions are available, including script extension, new appointments, and new prescriptions.
 
Patients will start to pay the co-payment from 1 July and pharmacies are not allowed to charge private fees for the PBS scripts from this date.
 
Under the new system, prescriptions will be authority streamlined and can only be written for up to three months – 28 days plus two repeats. This means you will need to see your patients at least every three months.
 
Maximum daily doses are 150 mg for methadone and 32 mg for sublingual buprenorphine. Doses higher than this will need a phone call to authority PBS line.
 
Some patients’ opioid dependence therapy is currently being provided by non-PBS pharmacies and private clinics, while others are receiving their long-acting injectable buprenorphine at their general practice.
 
While the current arrangements can continue until November, it looks like these will change. The Federal Government PBS program is looking at how these settings may be accommodated; it is not clear yet how this will be addressed.
 
Currently the changes do not cover CTG (Close the Gap) or people who are not eligible for Medicare and therefore cannot access PBS medicines. Once again, this is being investigated to see how these important issues can be addressed.
 
GPs can find more information about this process via the PBS website and a Department of Health and Aged care fact sheet.
 
It is vital that all prescriptions are not only PBS compliant, but also in line with existing state or territory regulations so I would encourage all GPs to check those resources out as well.
 
Why is all of this important?
 
This is about equity and access, allowing a group of people with a potentially life-threatening chronic health condition to access treatment. As well as those already receiving opioid dependence therapy, we know that there is a group – estimated at around 50,000 people – who find it difficult to access treatment. This number may even be more, particularly when you consider people with chronic pain prescribed opioids who can develop this condition.
 
Nationally, nearly 80% of opioid dependence therapy prescribers are GPs, but only around 6% of us do this important work. We have an invaluable role to play in this space and I encourage all my colleagues to consider it as part of your general practice care.
 
If you don’t know where to start or would like to find out more or access collegiate support, I’d encourage you to join RACGP Specific Interests Addiction Medicine. Your state and territory also have information and training and would be very happy to assist you.
 
It is rewarding work and you know you’re having positive impact on people’s lives.
 
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