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.


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.

Informed consent and treatment decision-making can be complicated in the field of addiction medicine where at times ‘desperate’ patients and/or their carers are attracted to treatment approaches that may not be supported by available evidence. In considering treatment options, it is our responsibility to present patients and carers with the available evidence regarding safety and effectiveness and to clearly identify where a proposed medication is not licensed for an indication.

There are several medications in the field of addiction medicine for which the evidence is still emerging, such as the use of baclofen or topiramate in the treatment of alcohol dependence, amphetamine-based medications in the treatment of methamphetamine dependence, flumazenil for benzodiazepine withdrawal, or nabiximols in treating cannabis dependence. Other products (e.g. long acting naltrexone implants, medical cannabis products) may not be licensed by local regulatory bodies (the Therapeutic Goods Administration in Australia and Medicines Control in NZ).

In these circumstances, clinicians should
a) Follow RACP guidance regarding off-label prescribing or relevant therapeutic advisory bodies such as the Council of Australian Therapeutic Advisory Groups, the TGA and Medicines Control’s medicine safety updates and procedures for unlicensed medications,
b) Provide clear and written information to patients and carers, and
c) Consider such treatment approaches as ‘second line’ options for those not responding to conventional treatment approaches. A second opinion from another Addiction Medicine specialist is often advised.

Supporting evidence

Baandrup L, Ebdrup BH, Rasmussen JØ, Lindschou J, Gluud C, Glenthøj BY. Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users. Cochrane Database Syst Rev. 2018;3(3):CD01148.

Council of Australian Therapeutic Advisory Groups, Rethinking medicines decision-making in Australian Hospitals: Guiding Principles for the quality use of off-label medicines, 2013. S, Saulle R, Rösner S. Baclofen for alcohol use disorder. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD012557.

Naloxone implants are unlicensed in either Australia or overseas; they should not be confused with depots, which are licensed in the US and Europe.

Nielsen S, Gowing L, Sabioni P, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev. 2019;1(1):CD008940. 2019 Jan 28.

Pani PP, Trogu E, Pacini M, Maremmani I. Anticonvulsants for alcohol dependence. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD008544.

Royal Australasian College of Physicians, Guidelines for ethical relationships between health professionals and industry. Sydney:, 2018 KJ, Acheson LS, Lintzeris N, Ezard N. Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review. CNS Drugs. 2020 Mar 17. doi: 10.1007/s40263-020-00711-x. PMID: 32185696.

How this list was made 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.

Download AChAM Recommendations