Prescription drug dependence

All general practices should develop and implement a prescribing policy for drugs of dependence.
Register with the Prescription Shopping Information Service (PSIS) to monitor patient prescribing behaviour.
- Note: PSIS does not track non-PBS or private scripts.

Primarily opioids and benzodiazepines.
High-risk for misuse, dependence, and overdose.
Deaths often due to polypharmacy, especially with alcohol (↑ risk of respiratory depression).
Opioid dose >50 mg morphine equivalent/day associated with increased unintentional overdose risk.

Conduct a biopsychosocial assessment.
Obtain records or contact previous treating doctors.
Evaluate:
- Pain condition or indication
- Mental health status
- Substance use history
- Risk of misuse or diversion
Identify risk factors for dependence:
- Drug availability
- Concurrent mental illness
- Social isolation or unemployment
- History of trauma or adverse life events
- Peer group substance use

Establish goals beyond symptom relief (e.g. functional improvement, quality of life).
Provide frequent review appointments.
Document:
- Clinical rationale
- Risk assessment
- Informed consent
- Monitoring and review processes

Set time-limited prescribing goals — make it clear this is not indefinite.
Control:
- Quantity prescribed
- Dispensing intervals
- Avoid private or early repeats
Request patient to:
- Use a single GP for all reviews
- Fill scripts at a designated pharmacy
No phone extensions or replacements for lost scripts

Use a written opioid contract/agreement.
Consider a trial of controlled prescribing before committing to longer-term supply.
Offer opioid substitution therapy (e.g. methadone, buprenorphine) if dependence develops.
Consider provision of naloxone (especially for high-risk or household exposure).
- Naloxone
  - rapidly reverses opioid overdose.
  - Mechanism: Blocks opioid receptors in the brain (competitive antagonist).
  - Effective against: Heroin, morphine, oxycodone, fentanyl, codeine, etc.
  - Forms: Intramuscular injection or nasal spray.
  - Duration of action: Short (30–90 minutes) — repeat doses may be required.
  - Safety: Cannot be misused, does not cause overdose.

Provides free naloxone to:
- People at risk of opioid overdose
- Carers, family, friends of people at risk
Funded by the Australian Government Department of Health and Aged Care

Who Can Access Naloxone?

Individuals who:
- Use opioids (illicit or prescribed)
- Are on opioid substitution therapy (e.g. methadone, buprenorphine)
- Are prescribed high-dose opioids for chronic pain
- Have a history of overdose
Family/carers of individuals using opioids

How is Naloxone Supplied?

Two types of organisations can distribute it: