Supporting the update of the NSW Clinical Guidelines for Opioid Dependence Treatment (ODT)
Investigators: Prof Suzanne Nielsen, Prof Peter Bragge, Dr Ali Cheetham, Diki Tsering,Veronica Delafosse, Dr Tina Lam
The supervised administration of opioid dependence treatments such as methadone and buprenorphine remains a central feature of opioid dependence treatment models in Australia. Given significant changes in both clinical practice and the treatment landscape—particularly the expansion of long-acting injectable buprenorphine and increased attention to patient-centred care—a timely and systematic review of the evidence for supervised versus unsupervised dosing is warranted. The aim of this Evidence Check rapid review was to identify, appraise, and synthesise literature comparing supervised and unsupervised dosing of opioid dependence treatments with a focus on safety, effectiveness, retention, and treatment experience. The review was designed to prioritise evidence applicable to the Australian context and inform recommendations for the revision of clinical guidelines and support evidence-based decision-making regarding dosing supervision within NSW. A secondary aim was to identify best practice across recent (published since 2020) Australian and comparable international guidelines for opioid dependence treatment.
The evidence indicated that supervision requirements in pharmacotherapy treatment for opioid dependence can be most effective when increased take-aways are linked to indicators of patient stability and treatment progress, such as attendance, engagement, and substance use outcomes. Increased unsupervised dosing among patients who met stability criteria during the COVID-19 pandemic supports that increased flexibility can be offered without comprising safety or treatment outcomes. Take-away dosing and unsupervised induction with buprenorphine was found to achieve outcomes comparable to supervised dosing for safety, retention, and substance use, while improving patient satisfaction and quality of life. For methadone, outcomes appeared more sensitive to the degree of supervision, with better results observed when take-away dosing is linked to indicators of treatment progress. These findings support the importance of clinical assessment to determine the level of supervision required to maintain safety while maximising treatment flexibility, supporting patient autonomy, and strengthening the alignment of opioid dependence treatment with patient-centred practice.
Funder: Sax Institute
This project was a collaboration between Monash Addiction Research Centre and BehaviourWorks Australia.