Hello, my name is Gary Altobelli, and I'm the Community Pharmacy MATOD Program Manager
at DASSA.
My role is to provide education, training, and ongoing support, including issue resolution,
to all South Australian community pharmacists who provide MATOD dosing services.
As a Suboxone prescriber, most of your patients will dose at a community pharmacy, so I'd
like to share some important tips and information with you today from a pharmacy perspective
to help ensure the best outcomes for all of our patients and clients.
Firstly, I'd like to talk to you about the importance of communication between prescribers
and pharmacists.
Pharmacists are often the last step in this process and may, at times, require real time
support while issues are occurring in their pharmacy.
It's important that prescribers are accessible and available to help resolve these issues
as they're occurring, as small issues can often escalate in the pharmacy.
It is also important that your practice has covered doctors when you're on leave to help
make decisions while you are not present.
Pharmacists can also help provide important details to you regarding patients' physical
and mental health and any changes as they often see these clients every single day for
daily dosing, while you, as the prescriber, may often only see them once every few months
for medical reviews and new prescriptions.
Some common issues which pharmacists may contact Suboxone prescribers about for help and resolution
include missed doses as per the guidelines, intoxication, challenging behaviors, issues
with payment or pharmacy debt, presentation or prescriptions from other prescribers for
monitored drugs, either identified via script check assay or by presentation of the prescription,
decisions on lost, stolen, or broken takeaway doses, and most recently, if a client is required
to home isolate as a result of COVID, collection by a third party or home delivery will need
to be arranged.
DASSA can provide support in this context.
As community pharmacists will have different levels of expertise and MATOD practice, there
are also some common pharmacist errors and issues which you may encounter.
These include pharmacists continuing to provide dosing on an expired prescription.
Sometimes, specific instructions such as scheduled dose reductions may be missed, as well as
attendance issues or self-cessation of treatment not being reported to the prescriber.
Dosing errors may also occur and will need to be handled accordingly.
Specifically as a non-accredited MATOD prescriber, there are certain issues that are commonly
reported by pharmacist to DASSA and clarification sought.
These include not obtaining an S18A authority from the DDU, incomplete MATOD prescriptions
or prescriptions not valid.
It is important that Suboxone prescribers familiarize themselves with the requirements
of MATOD scripts, including specific information, which should be included on all MATOD scripts
as per the DDU.
Prescribing outside of guidelines is common, including high initiation doses, which can
be a very high risk, and prescribing unsupervised doses outside of the takeaway framework are
also common.
In these cases, you can refer to the DDU risk assessment tool.
Another issue, which is not quite as common, but has been seen, includes nonaccredited
prescribers, prescribing Subutex and, to a lesser extent, methadone.
So in conclusion, non-accredited Suboxone GPs are an important part of MATOD treatment
in South Australia.
They increase accessibility for clients, especially in areas where there are limited, accredited
MATOD prescribers.
Hopefully, this information today will help raise awareness of potential issues to consider,
and please keep in mind that extensive support is always available from DASSA, including
DACAS and ADIS.
Thank you.