Curriculum standards

Knowledge guides

LG 16: Prescribing for opioid dependence

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

View

Eligibility considerations

Advanced Trainees will assess the patient’s current condition and plan the next steps.

View

Less common or more complex patient considerations

Advanced Trainees will understand the resources that should be used to help manage patients.

View

Undertaking therapy

Advanced Trainees will monitor the progress of patients during the therapy.

View

Post therapy

Advanced Trainees will know how to monitor and manage patients post-therapy.

View

Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management, and integrate these into care.

View

Evidence supporting opioid agonist treatment (OAT) as a harm reduction measure
Key quality use of medicines (QUM) principles:
- prescribing for patients at higher risk for adverse drug events
- safety and continuity of care in transfer of prescribing
Low threshold, low treatment engagement versus high threshold, high treatment engagement – tailoring for the patient
Overview toxicology and approaches to:
- a poisoned patient
- liaison with emergency department (ED) and psychiatry in overdose (OD) cases
- management of common toxidromes (intoxication)
- OD of substances commonly used
Pharmacology and toxicology of opioids commonly consumed in Australia and Aotearoa New Zealand
Pharmacology of medications used in OAT
Underlying harm-reduction role of OAT
Rapid induction onto buprenorphine (sublingual) and induction onto long-acting depot buprenorphine

Determination of risks associated with opioid use in each individual patient
Diagnosis of opioid dependence
Polydrug use and associate risks, particularly alcohol and sedatives

Buprenorphine (BUP) to methadone
Chronic pain and opioid use disorder
Complex presentations, such as mixed intoxications and withdrawals
High dose treatment considerations, and approach to suspected enhanced metaboliser problem
Management of OAT during acute hospital admissions
Medication interactions with methadone
Methadone to BUP transfers
OAT in patients with severe cardiac, hepatic, and kidney disease
Patients who insist on methadone only, despite history of problems with methadone treatment
Polydrug use and risks this may present for OAT
Post OD in ED, and Medication Assisted Treatment for Opioid Dependence (MATOD) induction
Pregnancy and OAT
Prescribed sedatives, such as:
- benzodiazepines
- gabapentinoids
- z-drugs
QT prolongation with methadone
Role of opioid antagonists
Specific risk considerations, including:
- adolescents
- occupational risks, such as pilot, bus driver, or surgeon
- parenting and child safety
- people with disability
Treatment in people with impaired capacity / cognitive impairment
Treatment in young adults and older people
Treatment provision for remote patients

Cautious induction with methadone
Culturally safe treatment services for Aboriginal and Torres Strait Islander people and Māori
Microinductions from full opioid agonists onto BUP
Monitoring treatment, including:
- hospital presentations
- liaison with pharmacy
- treatment outcome measures
- urine toxicology
Other approaches with BUP; rapid induction while avoiding precipitated withdrawal
Take home naloxone discussion
Therapeutic implications for other special populations, such as:
- adolescents
- LGBTQIA+ peoples
- pregnant people
- prisoners
- rural and remote
Treatment with long-acting BUP injection

Long-term trajectories of patients who have engaged in OAT, and relapse risk
Optimising transitions between specialist services and primary care or custodial services
Planned cessation of OAT
Unplanned cessation of treatment

Designing and operating services and service systems to meet the needs of Aboriginal and Torres Strait Islander people and Māori
Differentiating between physiological opioid and sedative / hypnotic dependence and opioid use disorder and sedative / hypnotic use disorder
Ensuring hospitals have guidelines for ongoing management of OAT for admitted patients
Ensuring transitions are as smooth as possible between services, including specialist services, primary care, and custodial services
High-priority patients for OAT
Legal aspects of opioid prescribing in relevant jurisdictions and administrative requirements
Management of benzodiazepine withdrawal
Managing patients with chronic pain and opioid dependence, and advising other prescribers regarding de-prescribing, formal OAT, and the various risks
Medications in stimulant use disorder
Naltrexone, disulfiram, and acamprosate (Australia only) for alcohol relapsed prevention
Newer medications in addiction medicine, such as baclofen, gabapentin, and topiramate
Ongoing advocacy and actual supporting structures for OAT in primary care