Information for pharmacists about OST

Pharmacies

Pharmacies must apply to the Department using the Application for a pharmacy to participate in the CPOP form (Word 814KB).

The Pharmacist with Overall Responsibility (PWOR) must complete the Pharmacist Accreditation Training and is responsible to ensure that all pharmacists participating in the Program have also completed the Pharmacist Accreditation.

Pharmacists

Any pharmacist dispensing OST at an approved pharmacy must have first successfully completed the on-line Pharmacist Training Program provided by the under the Community Pharmacotherapy Program (CPP) (external site). This training provides pharmacists with accreditation for both oral and injectable formulations of OST.

Procedures

Approved pharmacies and trained pharmacists must adhere to the Clinical Policies and Procedures for the Use of Methadone and Buprenorphine in the Treatment of Dependence (the Policies) (external site).

It also details how to apply for authorisation from the CEO.

Numbers

Pharmacies are approved to dose a maximum of 50 patients daily. The dosing of greater numbers requires additional approval and will be is considered on a case-by-case basis. Pharmacies should contact the Department for more information.

Client agreements

Pharmacies are encouraged to interview prospective clients prior to acceptance. If accepted, clients should be asked to sign a Client Agreement. A suggested Agreement can be found in Appendix 11 of the Policies. The Agreement sets out the expectations for the patient when attending for daily dosing.

Valid prescriptions

Pharmacists must ensure that all OST prescriptions are complete, legal and valid S8 prescriptions. Prescriptions must also adhere to the standard CPOP format and include:

• specific dates to start and finish dosing
• next appointment date
• name of nominated pharmacy dosing or supply site
• exact daily dose (in milligrams: mg)
• precise details of dosing increases/decreases and minimum intervals
• number of unsupervised doses allowed each week (if applicable)
• HDWA authorisation number
• All patients are required to be authorised prior to receiving OST in WA including visitors from other states. Authorisations are visible on ScriptCheckWA within 24 hours of approval

Patient identification

Pharmacists must positively identify the client before each dose. Prescribers are to provide an endorsed photograph of the client with the first prescription. The relevant contact client addresses and phone numbers should be kept up to date.

Before dosing

Prior to each dose the original prescription and the client’s dosing record should be reviewed in person.

Missed doses may not be replaced and clients should be referred back to their prescriber. Vomited doses are not replaced unless authorised in writing by the prescriber.

Patients should not be dosed if intoxicated.

Methadone should be measured and provided in a disposable cup, with water for after dosing as required. Dosing is to be personally supervised to ensure the dose has been swallowed.

Suboxone and Subutex should be removed from packaging and provided in a disposable cup or spoon for sublingual administration. Suboxone clients must be supervised and observed for at least one minute to ensure the film has adhered. Subutex should be crushed to the size of coarse coffee grounds and clients supervised for a minimum of two minutes after dosing.

Unsupervised doses must only be provided on the day a patient attends for scheduled dosing. Unsupervised doses are to be packaged and labelled according to the polices.

Dispensed depot buprenorphine must never be handled by, be accessible to, or dispensed directly to the patient or carers. Administration of depot buprenorphine must be done by registered health practitioners. If administration of the depot is not done by the pharmacist, the medication should be delivered to the medical centre/clinic where administration is to occur and handed directly to the authorised health professional.

An individual daily dosing record is to be kept for each client. A template dosing record (Word 244KB) is available from the Department. A record of each dose taken or each unsupervised dose supplied is to be made at the time of client dosing.

Approved electronic systems may be used to record client dosing.

At the end of each month a summary report (Word 877KB) of clients dosing for the month must be provided to the Department of Health by no later than 7 days after the end of the month during which the transactions occurred.

All records of supply and administration of CPOP, including daily dosing records and pharmacy monthly reports must be kept for a period of 5 years.