2 relevant legislations to methadone supply
Misuse of Drugs (Supervision of Prescription and Supply of Methadone) Regulations, 1998.
Misuse of Drugs (Supervision of Prescription and Supply of Methadone and Medicinal Products containing Buprenorphine authorised for Opioid Substitution Treatment) Regulations 2017
Where must patients register prior to commencing treatment?
Central Treatment List - issued a PH number
Must have only one GP and one pharmacy
What is on the patient’s treatment card?
PH number, patient’s name, photograph, copy of signature, name of patient’s GP and pharmacy
How long are cards valid for?
One year
What 2 types of training must GPs undergo
Level 1 - can only treat stabilised patients
Level 2 - may initiate treatment and
can provide services to a greater number of opioid
dependant patients.
How long are methadone Rx valid
seven days (8 in exceptional circumstances)
What happens once full prescription has been dispensed?
- total amount supplied must be entered in the CD reg, with entry dated with date of final supply
- pharmacist must stamp and sign prescription and should also be signed by patient after final supply
- Prescriptions should be sent to HSE no later than 14 days after
the last day of the month in which the supply was completed.
what action should be taken if 48-72 hours have elapsed since last dose
usual dose can be prescribed
can be given as 2 divided doses over the first day as a precaution
what action should be taken if 72 hours - 5days have elapsed since last dose
Prescribe half of usual dose, which should not exceed 40mg
Aiming to return to usual dose within 5-7 days, usually in increments of up to 20mg/day
what action should be taken if >5days have elapsed since last dose
treat as new induction
What requirements exist for supplying methadone to medical practitioners?
- written requisition is required - on standard methadone prescription form
- requisitions must be forwarded to the HSE no later than 14 days after
the last day of the month in which the supply was completed. - pharmacist must satisfy themselves that the medication will be used appropriately, i.e. to treat patients under the practitioner’s care
What happens during the Supply of Methadone other than for Opioid Dependence
- must be on standard methadone prescription form
- pharmacy must be authorised by department of health to receive methadone from wholesaler
- rx must comply with CD rx requirements
- patient does not need to be on CTL, but must be prescribed by consultant first, not GP
- can be prescribed for one month
