Policy on transferring patients from methadone to buprenorphine

​Patients on the NSW Opioid Treatment Program (OTP) may be transferred from methadone to buprenorphine. There are three ways for health professionals to enable this transfer:

• Direct transfer (conventional method)
• Buprenorphine micro-dosing
• Bridging with a short-acting opioid

When using direct transfer, prescribers should refer to:

• NSW Clinical Guidelines – Treatment of Opioid Dependence
• Long-acting injectable buprenorphine (LAIB) for opioid dependence treatment

Micro-dosing and bridging

When using the micro-dosing or bridging methods, prescribers should refer to the NSW Interim Clinical Guidance – Outpatient Transfer from Methadone to Buprenorphine Using the Micro-dosing or Bridging Methods.

The evidence base for the micro-dosing and bridging methods is still developing. Use of opioid agonist treatment medications in this context is considered off-label and must be undertaken in accordance with:

• local clinical governance procedures
• legislation, policies or procedures that govern off-label prescribing

The following prescribers are eligible to undertake micro-dosing and bridging:

•  Addiction Medicine Specialists and Addiction Psychiatrists
•  Other medical practitioners who are OTP accredited
• Nurse practitioners who are OTP accredited and work in public or Justice Health & Forensic Mental Health Network settings