Information For People On Opioid Treatment: Methadone, Suboxone, Subutex, & Buprenorphine Injections

Opioids describe all the drugs in the opioid family, meaning drugs that stimulate or excite the parts of our brains that feel these substances.  

• The word includes drugs that come from the opium poppy, and the ones that are created from chemicals in labs.  

• Opioid drugs include: heroin, methadone, oxycodone, fentanyl, morphine and nitazines. 

This is a term we use to refer to a dependence on opioid drugs.  

• The word dependence is a medical or clinical term, but is thought to be less stigmatising than words like addiction.

People with an opioid dependence will have experienced some of these: 

• Tolerance, meaning they need more opioids to feel the same effects.  

• Withdrawal if they stop using opioids. 

• Continued use of opioids even if they have problems that come from using them, or want to try to stop or reduce their use of opioids.  

This term is about the medications that are used to treat opioid dependence.

• The medications are usually used long term and are sometimes known as maintenance, substitution, replacement or pharmacotherapy.  

• the main role of these medications is to give people a chance to “stabilise” parts of their lives by using a cheaper, legal drug that will allow the person to avoid the effects of withdrawal.  

• The medications used in ODT in Australia are – methadone and buprenorphine.  

• There are a few different types and formulations of both methadone and buprenorphine. There is more information about the different medications in other sections.  

This term is about all the regulations and practices that make up how we are prescribed and dosed the ODT medications.

• There are different names and terms that describe the ODTP.  

• Most of the names and terms aren’t used by anyone who is on the medications.  

• In this guide, we have tried to use the same terms as much as possible, and will refer to the Opioid dependence treatment program as ODTP or we call it ‘The Program’.  

Most people who are picking up methadone, Subutex or Suboxone, or getting long-acting injectable buprenorphine (LAIB), will pay a standard, one-off fee every 28 days.  

For most people, the cost every 28 days will be:   

• $7.30 for concession or pension card holders
• $30 for those without a concession card
• This is called a PBS co-payment and is the same as for other medications on the PBS.

If you are getting two different strengths of Subutex or Suboxone, both the 8mg and 2mg strength, will be charged for both. This means:

• You will be charged a 28-day fee for the 8mg and a 28-day fee for the 2mg strength
• $14.60 for concession or pension card holders
• $60 for those without a concession card.

If you are on a strength of Subutex or Suboxone that requires paying the double medication cost, it is worth knowing:

• This requirement is because of the PBS system requirements with your pharmacist having to open two different boxes of medication.
• These costs will all contribute to your PBS Safety Net tally, so that you are likely to reach the Safety Net earlier.

No extra charges for ‘consultations’, ‘administration’, ‘dosing’ or ‘dispensing’ or ‘new bottles’ can be charged at community pharmacies

You are eligible if you are on methadone, Suboxone, Subutex or buprenorphine injections and you also:  

• Access your medications at a community or hospital pharmacy.  
• Have a Medicare card or the ability to get one.  
• Sign the privacy agreement allowing the pharmacy to register you in the PBS program:  
  • The privacy agreement gives your pharmacist permission to share your details with the PBS regulators.   
  • It has to be signed for you to be eligible for the PBS subsidy.  

• The PBS co-payment program is an Australian government program that aims to make many medications affordable by:
  • setting a maximum amount of money a person has to pay for PBS listed medications each year
  • paying the rest of the cost of the medication to the pharmacist or supplier.

• The PBS safety net is a maximum amount of money or maximum number of PBS registered medication scripts you must pay for per year.

• The yearly maximum you can pay for PBS medications is:
  • $262.80 or about 36 scripts for people who have a concession card
  • $1,563.50 or about 50 scripts for people who don’t have a concession card.

• Once you have paid the maximum amount of money that you are required to pay, your medication costs will be reduced to:
  • No money for people who have a concession card
  • Up to $7.30 every 28 days for people who don’t have a concession card.

• The year starts on 1 January and ends on 31 December, not when you first pay for a medication on the PBS.

• Each person has to be registered in the PBS registry by a GP or registered health care practitioner and you also need to register using the Safety Net prescription form and the Safety Net Card found here: https://www.servicesaustralia.gov.au/pb240.

• Every PBS medication you receive counts towards the PBS safety net, even if you are paying for two different dosages of Suboxone or Subutex, or you are receiving completely different medications that are funded through PBS co-payments.

• If you access all your PBS medications at the same pharmacy, the pharmacy will need your Safety Net prescription form and Safety Net card the first time you fill a script at that pharmacy.

•  If you go to multiple pharmacies to get your PBS medications, you will need to keep track of your medication costs by taking the form and card to each pharmacy and monitoring the costs over the year:
  • To keep track of your PBS spending, you need the Safety Net prescription form and a Safety Net card.
• You can combine costs within your family and reach the safety net more quickly. Family can be:
  • Married or defacto partners
  • Dependent children who are younger than 16
  • Dependent children who are under 25 and who attend school, college or university full-time

More information including links to the list of PBS medications can be found here: https://www.servicesaustralia.gov.au/how-to-reach-threshold-sooner-family?context=22016d 

Yes, Methadone, Subutex, Suboxone or buprenorphine injections are included in the Closing the Gap medications.

More information about the Closing The Gap PBS co-payment program can be found here: https://www.pbs.gov.au/info/publication/factsheets/closing-the-gap-pbs-co-payment-measure 

At Pharmacies  

If you have been receiving the injectable form of buprenorphine (Sublocade/Buvidal) at a pharmacy, with a script from your GP, you will be charged the same 28-day fee as people who are getting methadone, Subutex or Suboxone.  

• That means, if you have a concession card you will pay $7.30 every 28 days, and without a concession card, you will pay $30 every 28 days.  

• In some cases, particularly in the first month of getting the buprenorphine injection, you may need the injection more often than every 28 days.  

• You will have to pay the 28-day concession or non-concession price for each new script.  

• If you reach the PBS safety net threshold, you receive the medication for free (concession card holders) or for $7.30 (non-concession cardholders).  

• The PBS system regulates the number of scripts and the amount of medication a GP can normally prescribe.  

• Under the PBS, there is a maximum number of scripts, the amount of time the scripts can be for, as well as a maximum dosage. For opioid treatment medications, the maximum is:  

• • Three 28-day scripts of any of the medications.  

• • A maximum dose of 150mg per day for methadone.  

• • A maximum dose of 32mg for buprenorphine, Subutex or Suboxone.  

• Your GP will need to provide you with a PBS streamlined authorised script with specific information about your doses written on the script:  

• • Your GP should know how to do this.  

• • Information for GPs about how to write prescriptions in the new system is available on the PBS website: Information for Prescribers.  

• The PBS has guidelines about how medications are prescribed, mainly things like how high a dose a person can receive of each medication.  

• • For methadone, the higher limit is 150mg per day  

• • For Suboxone and Subutex, the higher limit is 32mg per day.   

• If your script fits within these ‘normal’ limits, your GP can easily write it with the addition of an ‘Authority’ identification:  

• • This is known as a streamlined  ‘Authority’ script and GPs do this with all PBS medications.   

• If your script doesn’t fit within these limits, for example, you are on a higher dose or you are starting on the program and need to see your GP twice or more often for those on the 1 weekly buprenorphine injections, there are some differences including:  

• • Your GP may have to get a ‘PBS Authority’ script rather than a normal ‘streamlined’ Authority script by calling or contacting the committee to get permission.  

• • You may have to pay for more than 1 script in the 28-day time period.  

• • Anyone who has to pay for more than 1 script should not be required to do that on a regular basis without there being an extremely good reason.   

• Try to remain calm and polite or walk away and ask for support from someone who can negotiate on your behalf.  

• This is especially important if you feel like you have had problems discussing issues with your pharmacist in the past.  

Most states and territories in Australia have services and support to help you:  

• Learn about and change to the new system  

• Advocate or report issues with your GP or pharmacy.   

Private ODT clinics are mainly available in NSW and Queensland. The main differences between them and public clinics, community pharmacies and hospital pharmacies are:

• These are privately owned and operated and don’t receive government funding for people in who need free or enhanced access to opioid treatment.  

• They usually have GPs, pharmacists and other staff on site and no access to medications other than opioid treatment medications.  

• The money that funds their services comes from the people accessing opioid treatment medications; for example, client-paid dosing and administration fees, Medicare rebates from GP appointments GP and sometimes additional tests clients undertake that also incur Medicare rebates such as hepatitis testing and urine drug screen tests.  

• Private clinics are not community pharmacies and are not eligible for funding through the PBS. 

Public clinics are available in every state and territory of Australia except Victoria.  

• Public clinics usually provide methadone, Subutex, Suboxone and buprenorphine free of charge.  

• Most public clinics have a limited number of places available and prioritise who can attend them, so that you have to meet criteria to attend, such as being:  

• • New to the program.  

• • Pregnant.  

• • Recently released from prison.  

• • Not allowed to access other dosing points.  

• • In some other way difficult to place in a community pharmacy.  

• Many of these public clinics are restrictive in other ways so that they may:  

• • Have limited opening hours.  

• • Not allow takeaway doses.  

• Each state and territory has regulations relating to opioid treatment for people who are in prison.    

• This means, if the prison or correctional centre allows it, opioid treatment medications are provided to people following the regulations of that state or territory.