Enhancing Pharmacist Involvement in Care - Medication Assisted Treatment for Opioid Dependence (EPIC-MATOD) Implementation Study

Participants currently receiving medication assisted treatment for opioid dependence (MATOD, with either methadone or buprenorphine) will be enrolled to receive 26 weeks of collaborative care with a pharmacist and prescriber. Following informed consent, a 30min-1hr induction meeting will occur with the pharmacist. prescriber and patient. Tasks to be delegated to the pharmacist will be initially agreed upon by the patient and prescriber, with parameters of the treatment to be defined within a collaborative care treatment agreement. Following induction to the model of care, a baseline research assessment will occur documenting demographic, substance use, treatment history, overdose history, health service utilisation, treatment perceptions and satisfaction with other health measures. Treatment: MATOD (with either methadone or buprenorphine) will be provided within the collaborative care model over 26 weeks. During the treatment period, all onsite MATOD dosing and unsupervised doses (doses dispensed to be taken as a later date, provided as per the Victorian Policy) will be provided from the pharmacy-site. Treatment will occur according the current State and National Policies with a study specific protocol for procedures that fall outside the current policy (e.g. treatment review and medication reinduction by pharmacists). As part of the model of care, prescribers will delegate ongoing monitoring of patient progress to pharmacists, in addition to optional delegation of three key clinical domains: 1) Adjusting patient’s methadone or buprenorphine dose, within a pre-specified range 2) Adjusting the number of unsupervised doses, within a pre-specified range 3) Reinduction back onto the same pharmacotherapy (i.e. back onto methadone or buprenorphine) after a pre-specified number of missed doses. Additional clinical monitoring of physical or mental health comorbidities and ancillary medication adherence (e.g. monitoring adherence with antidepressant, antipsychotic or antiretroviral medicines) may also be included in the treatment plan, with specific flags for referral back to the prescriber. The frequency of pharmacist assessments will be defined by the prescriber in the treatment agreement, and will vary depending on the patient the minimum frequency as per the Victorian opioid policy (e.g. monthly in the first 2 years of treatment). Pharmacist assessments will occur face to face, and will be guided by a structured review form. A baseline research assessment will occur within 7 days of the induction meeting, and then at 3- and 6- months post the baseline research assessment. The first 60 patients that meet eligibility criteria will be enrolled in the active treatment arm.