Emergency Plan for Opioid Agonist Treatment Patients
Dear Pharmacy/Clinical Service
This is important information regarding our shared opioid agonist treatment clients, especially if you have high numbers of clients at your service
Since 2015 when the Lismore floods inundated three pharmacies and over 100 of my clients were without a dosing point for over a week, I have developed an emergency plan – and this is certainly a good time to invoke that.
Apart from Covid-19, there is a greater than usual likelihood of flooding in the next 12 months and this information is relevant for those pharmacies that are flood prone.
Involuntary opioid withdrawal is associated with a high number of serious physical, psychological and social consequences, ranging from suicide, crime, unsafe and unhygienic injecting in poorly controlled & dangerous environments, overdose and death. As one of the largest prescribers of opioid agonist treatment in the Northern Rivers, civic emergencies are a priority for me.
If I am sick or if I have to quarantine myself due to exposure I will still be able to work from home and will continue my clients opioid prescriptions with new appointments. I can perform reviews by phone. For clinicians or pharmacists I will be available directly on 0428 890 021 and my availability will be kept up to date via my clinic website opioid.com.au
If I am too unwell, then logical clinical governance would be to contact the public service, Riverlands who have doctors on call 365 days per year and their own emergency plan for civic disaster situations. They can be contacted on 6620 7600. Obviously I do not speak for them and they should be contacted directly for a copy of their Emergency Plan.
In 2015 when three high-dosing pharmacies closed during rapidly rising flood waters, Riverlands declined to dose any of the 120 clients who dosed at those pharmacies. The reason senior medical and management gave me for this was that those pharmacies had failed to send client dosing information off-site to them and therefore they could not dose any opioid treatment patients. Fortunately SES and a few community pharmacies assisted these clients during the Emergency and apart from several dozen patients, most were able to avoid serious withdrawal and the consequences listed above.
Based on information Riverlands gave me following the flood, if any pharmacy is to close they should send their dosing records to either Riverlands or an alternative pharmacy so there is an off-site confirmation of last dose and TA. In an Emergency situation clients can then be dosed from that information. Copies of current prescriptions can also be provided by my clinical staff, or myself.
The several dozen clients who were declined dosing by the public clinical services in 2015, and went without medication for over a week, suffered a great deal. These clients remain traumatised from that event and they have been very vocal in prompting me to communicate with pharmacies to prevent this happening again.
For clients who are over 60 yo or have risk factors for ARDS then I am allowing 6 – 13 TA at a time based on their stability for the short term. Based on stability assessments and risk review, it is sensible and safe for these clients to reduce time spent in the community, especially in pharmacies so they can delay onset of illness and hopefully avoid the peak infection times when ICU bed access may be limited. Clients can contact me directly or if any pharmacist believes that a person meets that criterion then please contact me. I am reviewing notes and identifying clients who have respiratory or cardiac conditions to initiate that process.
The anxiety amongst our clients about chain of supply interruptions is exceptionally high as is understandable.
However if any client requires to be swapped from Biodone to Methadone or vice versa due to supply then that can be done without a prescription. Also, in this situation I believe a swap between suboxone and subutex is appropriate as well if supply is low. Obviously please contact me for a prescription adjustment – I state this here in case I am unavailable or overwhelmed by messages or requests.
Presentations of unwell clients
For clinical services, I will post updated information regarding suggested medication management of mild to moderately unwell clients who are taking opioid treatment on opioid.com.au
Obviously this situation is evolving and if any pharmacist has suggestions as to how we can more adequately address the risks to our clients please do not hesitate to contact me.
Thank you for taking the time to read this.
Dr Paul McGeown
Lismore Base Hospital Emergency Department.
Tweed, Nimbin and Byron Emergency Departments