Home > Making policy in emergencies – insights for routine policy-making. The case example of opioid pharmacotherapy maintenance. DPMP monograph no. 35.

Mellor, Richard and Kearnes, Matthew and Lancaster, Kari and McLauchlan, Laura and Ritter, Alison (2021) Making policy in emergencies – insights for routine policy-making. The case example of opioid pharmacotherapy maintenance. DPMP monograph no. 35. Sydney: UNSW Social Policy Research Centre. https://doi.org/10.26190/thwy-pq45.

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COVID-19 has precipitated significant policy changes to many health and social welfare services. One area of policy change has been the opioid pharmacotherapy maintenance program. A treatment for opioid dependence, this pharmacotherapy treatment provides a prescribed, safe opioid medication of proven efficacy and cost-effectiveness in improving health and wellbeing, reducing mortality, and reducing illicit opioid consumption.

The opioid pharmacotherapy maintenance program serves some of society’s most marginalised members, and is often characterised by lack of flexibility and limited choice, resulting in experiences of stigma, control, and surveillance rather than supportive care. People receiving treatment may experience insecure housing, poor health status, be in receipt of income or disability support, and many have experienced incarceration. Stigma and discrimination in the context of opioid pharmacotherapy are well-documented. It is a highly regulated treatment, for example despite research evidence that takeaway doses – collection and self-administration rather than supervised dosing – can enhance treatment outcomes, these have been limited to date. In Australia, the medications are Schedule 8 drugs, and as such have significant regulations concerned with their prescribing and dispensing.

In this report we consider the conditions that enabled changes to opioid pharmacotherapy policy in response to COVID-19 in three Australian jurisdictions. In response to the emerging conditions precipitated by public health measures to address the pandemic, changes to opioid pharmacotherapy policies in Victoria, NSW and the ACT entailed efforts to reduce face-to-face contact between clients and the people dispensing and prescribing the medications. The policy changes included changed guidance on takeaway dosing allowing increased numbers of unsupervised doses; regulations enabling the delivery of these medications to people in isolation or quarantine; rapid expansion of long-acting injectable treatment formulations; and the expansion of more flexible prescribing practices.

This work focussed on the processes that enabled and facilitated these new policy guidelines. We aimed to analyse:
⎯ How the policy changes came about (e.g., what committees were organised, what discussions took place, and what other practices were carried out during the policy-making process);
⎯ Who was (or was not) involved in the process, and what perspectives were accounted for;
⎯ Whether this was business-as-usual, or a case of policy being done differently; and
⎯ The lessons that can be learnt and key insights to inform future policy-making.

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