Document NumberADS: 2.7.14

Alcohol and Drug Program

Standard Operating Procedure

Non adherence to Opioid Treatment Pharmacotherapy medication regime (dose diversion) -

Purpose

To ensure opioid treatment pharmacotherapy medication dispensed at the Opioid Treatment Service (OTS) is taken as prescribed.

Scope

This procedure applies to any staff member (nurse, pharmacist or doctor) dispensing opioid treatment pharmacotherapy medication.

Procedures

On admission the importance of adhering to correct dosing procedure and the possible scenarios that may lead to staff considering dose diversion will be provided to people accessing OTS.

1. Dosing procedures:

1.1 To ensure a dose of methadone has been taken as prescribed, dosing staff will:

  • Dispense personsdose into a disposable cup
  • Observe the person swallowing the dose
  • Observe the personswallowing water with or after the dose
  • Ensure the personspeaks to staff before leaving

1.2 To ensure a dose of buprenorphine has been taken as prescribed, dosing staff will:

  • Ask the personto drink some water prior to dosing to moisten the mouth
  • Break the buprenorphine tablets into ‘chunks’
  • Observe the personplacing the dose in the sublingual space
  • Ask the person to remain for observation for at least two minutes
  • Ask the person to open his or her mouth and show the sublingual space

The manufacturers of buprenorphine state that once the tablets have become moist, and resembles a paste like consistency, the active part of the tablet has been dissolved and what remains is the chalk like suspension. If a person waits for the designated time and the sublingual area is checked and still contains medication, provided it is in the paste like consistency described above, the dose can be considered as taken appropriately.

1.3 To ensure a dose of Suboxone Film has been taken as prescribed, dosing staff will:

  • Ask the personto drink some water prior to dosing to moisten the mouth
  • Ask the person to place the film correctly around the outside of the gums.
  • Observe the person placing the film in the correct space
  • Ask the personto remain for observation for at least two minutes
  • Ask the person to open his or her mouth and show the film has been absorbed.

2. Diversion

Diversion for the purposes of this document is any occasion where the staff observe the person not taking his or her dose as it is prescribed, eg:

  • Swallowing a dose of buprenorphine
  • Placing a dose of buprenorphine in an area of the mouth besides the sublingual pocket
  • Refusing to be observed after being administered a dose of buprenorphine
  • Not speaking to staff after swallowing a dose of methadone
  • Attempting to place medication in another receptacle with the intention of leaving the dosing area with it
  • Going immediately into the toilet after dosing

Where an instance of diversion is suspected, dosing staff will instruct the person on the correct way to take his or her pharmacotherapy. The incident and discussion is documented in the persons file.

The CNC is informed of the incident, and if appropriate also speaks with the personto reinforce the appropriate administration of his or her medication, and discuss any other issues which may have lead to the diversion episode.

The person is also reminded of the consequences of further diversion, which for peopleon buprenorphine means transfer to methadone maintenance.

People on methadone who divert will have the daily dose diluted with water prior to administration, and if continue to divert will need their place on the maintenance program reviewed by the multidisciplinary team.

They will also be offered and referred to counselling services provided by the clinic

Evaluation

  • Outcome Measures
    To be reviewed annually or as required

References

ACT Opioid Maintenance Treatment Guidelines

National Pharmacotherapy guidelines.

Disclaimer: This document has been developed by ACT Health, Alcohol & Drug Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and ACT Health assumes no responsibility whatsoever.

Document no / Version <Policy title> / Issue Date / Review Date / Area Responsible / Print Date
ADS:2.7.14 / 1.0 / July 2011 / Apr 2018 / ADS OTS
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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