Australasian Chapter of Addiction Medicine
The Australasian Chapter of Addiction Medicine (AChAM) is a Chapter of the Royal Australasian College of Physicians (RACP) Adult Internal Medicine Division that connects and represents Addiction Medicine Fellows and trainees in Australia and New Zealand. AChAM advances the study of addiction medicine in Australia and New Zealand through training, research and collaboration with health professionals and organisations. The Chapter provides training and continuing professional development to ensure excellence in skills, expertise, and ethical standards. AChAM advocates on behalf of its members and acts as an authoritative body for consultation in addiction medicine to ensure quality care for individuals with addiction disorders.
2.
Do not prescribe pharmacotherapies as stand-alone treatment for Substance Use Disorders (SUD) but rather as part of a broader treatment plan that identifies goals of treatment, incorporates psychosocial interventions and identifies how outcomes will be monitored
Do not prescribe pharmacotherapies as stand-alone treatment for Substance Use Disorders (SUD) but rather as part of a broader treatment plan that identifies goals of treatment, incorporates psychosocial interventions and identifies how outcomes will be monitored
Safe and effective pharmacotherapies exist for the management of substance use disorders (e.g. methadone, buprenorphine, naltrexone for opioid dependence; acamprosate, naltrexone, disulfiram for alcohol dependence; nicotine replacement, varenicline, bupropion for nicotine dependence; and benzodiazepines as part of benzodiazepine withdrawal). However, the vast majority of studies of these pharmacotherapies have either evaluated their effectiveness in combination with psychosocial interventions or demonstrated them to be more effective when prescribed in combination with psychosocial interventions. Therefore, practitioners should always ensure that patients have clinical pathways available to access psychosocial interventions and that these interventions are incorporated into treatment care plans.
Supporting evidence
Gowing, L, Ali, R, Dunlop, A, Farrell, M, & Lintzeris, N. National Guidelines for Medication-Assisted Treatment of Opioid Dependence. National Drug Strategy. Commonwealth of Australia; 2014; ISBN: 978-1-74241-945-9.
Gowing, L. Pharmacotherapies for relapse prevention in alcohol dependence. Monograph no. 26 2011.
Haber PS, Lintzeris N, Proude E, Lopatko O. Treatment of Alcohol Problems. Australian Commonwealth Department of Health and Aged Care: Canberra; 2010.
May Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.
Miller PM, Book SW, Stewart SH. Medical treatment of alcohol dependence: a systematic review. Int J Psychiatry Med. 2011;42(3):227-66.
Royal Australian College of General Practitioners, Prescribing drugs of dependence in general practice - Part B: Benzodiazepines. Melbourne:, 2015 https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/Guidelines/Drugs%20of%20dependence/Prescribing-drugs-of-dependence-in-general-practice-Part-B-Benzodiazepines.pdf
How this list was made
Through the RACP Evolve program, the Chapter Committee of the Australasian Chapter of Addiction developed a draft Evolve Top-5 Recommendations of low-value practices and interventions that pertain to the specialty. After several rounds of internal consultations and revisions, the list of recommendations was subject to an extensive review process that involved key College societies with an interest or professional engagement with addiction medicine.
The list was then consulted with other medical colleges including through Choosing Wisely Australia. The recommendations were also reviewed by the College’s Aboriginal and Torres Strait Islander Health Committee to ensure that the list adequately reflects the health needs of Indigenous Australians with substance use disorders.
Feedback received in the consultations led to further fine tuning of the list, which was then finalised and approved by the AChAM President and President-Elect.
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1
Do not undertake elective withdrawal management in the absence of a post-withdrawal treatment plan agreed with the patient that addresses their substance use and related health issues.
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2
Do not prescribe pharmacotherapies as stand-alone treatment for Substance Use Disorders (SUD) but rather as part of a broader treatment plan that identifies goals of treatment, incorporates psychosocial interventions and identifies how outcomes will be monitored
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3
Do not deprescribe or stop opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality from discontinuation of opioid medications
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4
While managing patients with Substance Use Disorder (SUD), exercise caution in the use of treatment approaches that are not supported by current evidence or involve unlicensed therapeutic products.
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5
Use a 'universal precautions' approach for all psychoactive medications that have known potential or liability for abuse including opioids, benzodiazepines, antipsychotic medications, gabapentinoids, cannabinoids and psychostimulants.