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UTI resources – SA

Image of UTI SA Resources

From 1 March 2024, following amendments to the SA Controlled Substances (Poisons) Regulations 2011, the South Australian Community Pharmacy Urinary Tract Infection Services Scheme will be enabled.   This will mean that trained community pharmacists are able to provide assessment and treatment (including specified antibiotics, as appropriate) for eligible women aged from 18 to 65 years, with uncomplicated UTIs, as assessed by a community pharmacist.

 

SA Community Pharmacy UTI Infection Services will support South Australian women with increased choice and access to early advice and timely treatment for UTIs. The services are complementary to those already being provided by general practitioners and will be key to women accessing services, in particular when those services are not available.

 

Conditions for providing SA Community Pharmacy UTI Infection Services are outlined in the SA Government Gazette notice of 2 February 2024. The SA Community Pharmacy Urinary Tract Infection Services UTI Management Protocol supports pharmacists and includes further details of the scheme, including a Clinical Flow Chart and Supplementary Information.

 

A condition of the scheme is that pharmacists must undertake additional mandatory training on UTIs and associated treatment options prior to offering services under the scheme. This course is one of the accredited mandatory training options available.

 

For more information, please refer to the South Australian Department of Health and Wellbeing website.

 

 

Background

A urinary tract infection (UTI) is a general term used to describe an infection involving any part of the urinary system.

 

UTI’s are very common – particularly in women and the elderly. The most common type of UTIs are bladder infections, also known as cystitis.

 

Most UTIs are caused by bacteria which normally live harmlessly in the bowel. If these bacteria spread into the urinary system they can cause:

 

  • urethritis – infection in the urethra
  • cystitis – infection in the bladder
  • pyelonephritis – infection in the kidneys.

 

UTIs are a common cause of hospitalisations that are potentially preventable. Click here for more details.

 

 

PSA Resources

1. Complete PSA training program: Managing Uncomplicated Cystitis. This training module will give you the knowledge you need to identify who can be supplied antibiotics for uncomplicated cystitis, and who will need to be referred to their GP.  It will also give you the knowledge you need to choose the most appropriate antibiotic to treat uncomplicated cystitis.

2. Provide UTI Self Care Card. PSA self-care fact cards provide information for individuals about self-care and preventative health. The UTI fact card provides information for individuals on the signs and symptoms of cystitis, treatment, self-care information, links to further resources and when individuals should seek medical attention.

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below.

3. Familiarise yourself with the Cystitis treatment guideline for pharmacists. 

Keep up to date on the latest information on the UTI trial, as well as many other important practice specific issues – renew your PSA membership!

UTI resources – Tasmania

Urinary Tract Infections (UTI)

In 2021 the Tasmanian Government committed to undertake a scope of practice review for local pharmacists and to consider what other services and support pharmacists could safely provide for the community (the Review).  In December 2022, KPMG were appointed to conduct the review and provided their report in mid-2023. The Tasmanian Government has accepted all the recommendations made in the report.

 

The first initiative will allow endorsed pharmacists, practising in approved premises to be involved in a 12-month pilot to prescribe antibiotics for uncomplicated urinary tract infections in accordance with the protocol published on Department of Health website.

 

This pilot will commence on the 1st of March 2024.

 

Pharmacists who meet the conditions and approved training requirements can apply to be endorsed to supply approved oral antibiotics when practising in approved premises. The Protocol for Management of Urinary Tract Infections (Tasmanian Community Pharmacist Pilot Program) details the type of antibiotics that can be supplied as well as the permitted quantity of supply.

 

Tasmanian pharmacists should refer to the Protocol for Management of Urinary Tract Infections (Tasmanian Community Pharmacist Pilot Program) .

 

Further information is available on the Tasmanian Department of Health Tasmanian Community Pharmacy Program website.

PSA Resources

How can Tasmanian pharmacists start to get ready

1. Complete PSA training program: Managing Uncomplicated Cystitis. This training module will give you the knowledge you need to identify who can be supplied antibiotics for uncomplicated cystitis, and who will need to be referred to their GP.  It will also give you the knowledge you need to choose the most appropriate antibiotic to treat uncomplicated cystitis.

2. Provide UTI Self Care Card. PSA self-care fact cards provide information for individuals about self-care and preventative health. The UTI fact card provides information for individuals on the signs and symptoms of cystitis, treatment, self-care information, links to further resources and when individuals should seek medical attention.

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below.

Keep up to date on the latest information on the UTI trial, as well as many other important practice specific issues – renew your PSA membership!

UTI resources – VIC

Image tile of Vic Resources for UTI

In November 2022, the Victorian Government announced its commitment to test an expanded role for community pharmacists.

 

In this pilot, participating and appropriately trained community pharmacists will be able to provide certain Schedule 4 medications under a structured prescribing model for antibiotics for uncomplicated urinary tract infections in women.

 

Victorian pharmacists should refer to the Victorian Drugs, Poisons And Controlled Substances Regulations 2017 Secretary Approval Community Pharmacist Statewide Pilot and to the Victorian Protocol for Management of Urinary Tract Infections published by the Victorian Department of Health

PSA Resources

How can Victoria start to get ready

1. Complete PSA training program: Managing Uncomplicated Cystitis. This training module will give you the knowledge you need to identify who can be supplied antibiotics for uncomplicated cystitis, and who will need to be referred to their GP.  It will also give you the knowledge you need to choose the most appropriate antibiotic to treat uncomplicated cystitis.

2. Provide UTI Self Care Card. PSA self-care fact cards provide information for individuals about self-care and preventative health. The UTI fact card provides information for individuals on the signs and symptoms of cystitis, treatment, self-care information, links to further resources and when individuals should seek medical attention.

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below.

Keep up to date on the latest information on the UTI trial, as well as many other important practice specific issues – renew your PSA membership!

Opioid Dependence Treatment (ODT) Resources

Pharmacist handing cup to patient

Background 

Substance Use Disorder (SUD), specifically in relation to opioids, is the term used to describe persistent opioid use, despite serious harms and negative consequences. This term may also be used more broadly for other substances, including alcohol and tobacco.1 

 

The harms associated with opioid SUD impact the individual but may also extend to the wider community. These may include: 

  • Loss of life through opioid overdose. 
  • Medical impacts, including transmission of blood borne viruses (e.g. hepatitis C, hepatitis B and HIV). 
  • Mental health issues, such as depression. 
  • Social issues, such as impacts on relationships, employment, education, housing, parenting, finances, and crime.  
  • Financial costs related to health, social services, and the judicial system.2

 

Dependence refers to the gradual physiological adaptations to the ongoing use of an opioid, which includes tolerance and the presence of withdrawal symptoms when the opioid is ceased. This may occur with prescribed opioids, as well as non-prescribed opioids used for non-therapeutic purposes. 

 

The term “dependence” can be confusing in the context of substance use disorders. A person who is being treated by a physician with opioids (for instance in chronic pain), may develop a dependence to opioids (characterised by tolerance, dose escalation, and withdrawal symptoms) without an associated substance use disorder (characterised by continued use despite harm, seeking behaviours, and supplementation with non-prescribed opioids). 

 

For the purposes of Opioid Dependence Treatment (ODT), a person would be referred for treatment if they have developed a substance use disorder to opioids from any source, or a dependence to opioids obtained from non-prescribed sources used in a non-therapeutic manner. 

 

Role of Community Pharmacy 

ODT aims to reduce the harms related to opioid use in the community, including the social, economic and health impacts. Community pharmacy plays a critical role in ODT, providing 85% of dosing sites nationally for people seeking treatment for opioid dependence2. Pharmacists provide treatment for methadone, sublingual buprenorphine as well as administer long-acting injectable buprenorphine.  

 

Since July 1st, 2023, ODT medicines have been listed on the PBS, becoming part of the Section 100 Highly Specialised Drugs (HSD) Program – (Community Access), with an accompanying funding programme to subsidise the daily dispensing fees associated with delivery of an ODT program in the community pharmacy setting. These changes will make ODT more affordable, lead to more people seeking treatment, normalise treatment as regular healthcare and increase locations for people seeking treatment.  

 

Pharmacists must be aware of the changes and confident in providing the ODT Program.  

  • Factsheets and information on the PBS ODT Program are available here. 
  • More information on the Opioid Dependence Treatment (ODT) Community Pharmacy Program through the Pharmacy Programs Administrator (PPA) is available here 

 

State and territories run and operate their own ODT programs, which have individual policies, guidelines, and regulations that pharmacists must adhere to. Information for each state is available below.  

 

References

1. Naren T et al 2022, Lifestyle interventions in the management of substance use disorder, Australian Journal of General Practice (AJGP), Volume 51, Issue 8, August 2022.  

2. AIHW 2023, National Opioid Pharmacotherapy Statistics Annual Data collection, available from: https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/national-opioid-pharmacotherapy-statistics/contents 

1.  Register to become an Opioid Treatment Program (OTP) Pharmacy 

To supply methadone or buprenorphine (including buprenorphine-naloxone) pharmacists must register with the NSW Ministry of Health and work in a PBS approved pharmacy. 

 

2. Familiarise yourself with the NSW protocols and guidelines 

Extensive information and resources are available on the NSW Health Community Pharmacists and the NSW Opioid Treatment Program website. Some key resources are outlined below: 

 

3. OTP Transition to Section 100 HSD Program 

The NSW Health website provides information about the OTP transition for community prescribers, community pharmacists, public sector services and patients: 

 

Additionally, NSW Health have issued an exemption for computer generated OTP prescriptions, providing the prescription for methadone or buprenorphine is sent directly to the pharmacy, and not given to the patient.  For these computer-generated OTP scripts, the prescriber is not required to hand write the following details: 

  • The name of the substance 
  • The quantity prescribed in words and figures 
  • Adequate direction for use 
  • The number of repeats authorised if the prescription is to be dispensed more than once, and if repeats are ordered, the repeat interval. 

 

Please see the NSW Health Criteria for Issuing Computer Generated Prescriptions (Number 4) for further information. 

 

4.  Long-acting injectable buprenorphine 

Pharmacists in NSW may administer depot-buprenorphine as long as it is within their scope of practice and professional competency to administer. Pharmacists and proprietors offering this service must be satisfied that the medicine will be administered safely to the patient. 

 

Recommended training: 

    • This course enables pharmacists to acquire the relevant knowledge and skills to administer long-acting injectable buprenorphine in a safe and person-focused environment. 
    • It is fully funded by the NSW Ministry of Health and is only available for pharmacists who work in NSW. 
    • It is designed for appropriately trained pharmacist immunisers only. 
    • If you are not a pharmacist immuniser, you must complete an accredited immunisation training course before administering medicines by injection and before completing long-acting injectable buprenorphine course. 

 

  • Other requirements: 

 

5. Use language that reduces stigma 

Language is powerful—especially when discussing alcohol and other drugs (AOD) and the people who use them. The language pharmacists use when providing the OTP Program is critical to reduce stigma.  

 

Language matters was developed by NADA (The Network of Alcohol and other Drugs Agencies) and NUAA (NSW Users and AIDS Association), in consultation with non-government AOD workers and people who use drugs. Download the resource here. 

 

6. Provide relevant Self Care Cards to people seeking treatment for opioid dependence 

PSA self-care fact cards provide information for individuals about self-care and preventative health. The below fact cards provide information for individuals on drug overdose, methadone & buprenorphine, and safer injecting practices, as well as links to further resources and when individuals should seek medical attention. 

  • Drug Overdose 
  • Methadone and buprenorphine
  • Safer injecting practices

 

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click below. 

7. Register for the Take Home Naloxone Program 

Opioid overdose is a major cause of harm and death in Australia. Naloxone is a short-acting opioid antagonist, registered by the TGA for the reversal of opioid overdose. Increasing access to naloxone for people who are at risk of experiencing or witnessing an overdose is an important strategy to prevent and respond to opioid harm or death. 

 

The Take Home Naloxone Program fully subsidises the cost of naloxone, including despensing fees, to participating community pharmacies. A PBS prescription is not required. Register for the Take Home Naloxone Program through the Pharmacy Programs Administrator (PPA) here. 

 

Learn more about naloxone and why you should talk to your patients about naloxone from Turning Point, Australia’s leading national addiction treatment, education and research centre. 

 

8. Register for the Needle & Syringe Program 

The Needle and Syringe program aims to minimise the transmission of blood borne viruses amongst people who inject drugs.

  

Register for the Needle & Syringe Program here. 

 

9. Pharmacy Incentive Program 

To support community pharmacies to provide OTP services, NSW Ministry of Health funds an incentive scheme.  Further information is available here. 

 

10. Do you have more questions?

PSA Members can call the Pharmacist to Pharmacist Advice Line on 1300 369 772 for professional advice and support.

 

For specific advice on the NSW OTP, pharmacists can call the Duty Pharmaceutical Officer (NSW Ministry of Health) on (02) 9391 9944 or email moh-pharmaceuticalservices@health.nsw.gov.au 

 

DASAS is a free 24/7 telephone service that provides general advice to health professionals who require assistance with the clinical diagnosis and management of patients with alcohol and other drug related concerns. Contact information here: 

  • (02) 8382 1006 (Sydney metropolitan) 
  • 1800 023 687 (regional, rural and remote NSW) 

 

Keep up to date on the latest information on OTP programs in NSW as well as many other important practice specific issues – renew your PSA membership! 

1. Obtain an Opioid Dependency Treatment Centre Licence 

To supply methadone or buprenorphine (including buprenorphine-naloxone), or administer long-acting injectable buprenorphine, pharmacists must apply to the Health Protection Service (HPS) to obtain an Opioid Dependency Treatment Centre Licence. 

 

2. Familiarise yourself with the ACT protocols and guidelines 

The Opioid Maintenance Treatment in the ACT: Local Policies and Procedures can be found in the pharmacist section on the ACT Health website, Opioid Maintenance Treatment. 

 

All pharmacists dispensing treatment must successfully complete training for the safe administration and dispensing of opioid maintenance treatment. For information on course availability, please contact  Canberra Health Services Alcohol and Drug Services. 

 

Pharmacists are required to undertake refresher training delivered by ACT Health every 5 years.  

 

3. Long-acting injectable buprenorphine  

Pharmacists in the ACT may administer long-acting injectable buprenorphine (LAIB) as long as it is within their scope of practice and professional competency to administer, and in accordance with the prescription, as well as completing appropriate training. More information is available at: Pharmacist Vaccinations and Injectables, ACT Health.  

 

Mandatory training requirements: 

  • Complete the Opioid Maintenance Treatment in the ACT – Pharmacist Training Program provided by Canberra Health Services. For information on course availability, please contactCanberra Health Services Alcohol and Drug Services. 
  • Complete accredited clinical training on LAIB, which includes the PSA course: Long-acting injectable buprenorphine administration by pharmacists. 
    • This training is designed for appropriately trained pharmacist immunisers only. 
  • Undergo supervised practical injection training for administration of LAIB (this can be coordinated by Canberra Health Services or through a private prescriber/nurse). 

 

Mandatory additional training: 

  • It is also mandatory that you complete the Administering medicines by injection course before administering any medicine by injection. Undergo supervised practical injection training for administration of LAIB. This may be facilitated using a blended model including – attend and observe a public clinic (Canberra Health Service, Alcohol and Drug Service at Building 7 at The Canberra Hospital can facilitate this via appointment only) or observe a private prescriber/nurse currently providing this service.
     

Other requirements: 

  • Be familiar, and practice in accordance with the PSA Guidelines for pharmacists administering medicines by injection
  • Injectable services provided by pharmacists should only be provided in a safe, clean environment for the benefit of both the pharmacist and patient. These services should be provided in a closed consultation room.
  • Pharmacists administering LAIB must electronically document the administration of the medicine and provide documentation to the patients LAIB prescriber.

 

4. Use language that reduces stigma 

The language pharmacists use when providing Opioid Dependency Treatment is critical to reduce stigma.

  

“The Power of Words practical guide and desktop flip book are designed to support healthcare and other professionals working with people who use alcohol and other drugs to reduce stigma and improve health outcomes. 

 

Stigma is a common and complex problem for people who use alcohol and other drugs. The World Health Organization has ranked illegal drug dependence as the most stigmatised health condition globally, with alcohol dependence listed at number four.” 

 

Download the Power of Words resource here. 

 

5. Provide relevant Self Care Cards to people seeking treatment for opioid dependence 

PSA self-care fact cards provide information for individuals about self-care and preventative health. The below fact cards provide information for individuals on drug overdose, methadone & buprenorphine, and safer injecting practices, as well as links to further resources and when individuals should seek medical attention. 

  • Drug Overdose 
  • Methadone and buprenorphine 
  • Safer injecting practices 

 

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below. 

6. Register for the Take Home Naloxone Program 

Opioid overdose is a major cause of harm and death in Australia. Naloxone is a short-acting opioid antagonist, registered by the TGA for the reversal of opioid overdose. Increasing access to naloxone for people who are at risk of experiencing or witnessing an overdose is an important strategy to prevent and respond to opioid harm and death. 

  

The Take Home Naloxone Program fully subsidises the cost of naloxone, including dispensing fee, to participating community pharmacies. A PBS prescription is not required.  

 

Register for the Take Home Naloxone Program through the Pharmacy Programs Administrator (PPA) here. 

 

Learn more about the naloxone and why you should talk to your patients about naloxone from Turning Point, Australia’s leading national addiction treatment, education and research centre.  

 

 

7. Register for the Needle & Syringe Program 

The Needle and Syringe program aims to minimise the transmission of blood borne viruses amongst people who inject drugs.  

 

More information on the Needle & Syringe Program is available here, and locations/information on current providers is available here. 

 

8. Do you have more questions? 

PSA Members can call the Pharmacist to Pharmacist Advice Line on 1300 369 772 for professional advice and support. 

 

For specific advice on Opioid Maintenance Treatment, pharmacists can contact the Canberra Health Services Alcohol and Drug Services, Alcohol & Drug Intake & Helpline on (02) 5124 9977.  

 

Keep up to date on the latest information on OTP programs in the ACT as well as many other important practice specific issues – renew your PSA membership! 

1. Register your pharmacy details with the Queensland Opioid Treatment Program (QOTP) 

If your pharmacy wishes to become involved in delivering this important public health program, email Queensland Health at QOTP@health.qld.gov.au with the following information: 

  • Pharmacy name 
  • Pharmacy business address 
  • Pharmacy phone number 

 

2. Familiarise yourself with the QLD protocols and guidelines 

Extensive information and resources are available on the QOTP website. Some key resources are outlined below: 

  

3. Long-acting injectable buprenorphine 

Pharmacists in QLD may administer long-acting injectable buprenorphine as long as it is within their scope of practice and professional competency to administer. Pharmacists offering this service must be satisfied that the medicine will be administered safely to the patient. 

 

Recommended training requirements: 

 

Other requirements: 

 

4. Use language that reduces stigma 

The language pharmacists use when providing Opioid Dependence Treatment is critical to reduce stigma.  

 

“The Power of Words practical guide and desktop flip book are designed to support healthcare and other professionals working with people who use alcohol and other drugs to reduce stigma and improve health outcomes. 

 

Stigma is a common and complex problem for people who use alcohol and other drugs. The World Health Organization has ranked illegal drug dependence as the most stigmatised health condition globally, with alcohol dependence listed at number four.” 

 

Download the Power of Words resource here. 

 

5. Provide relevant Self Care Cards to people seeking treatment for opioid dependence 

PSA self-care fact cards provide information for individuals about self-care and preventative health. The below fact cards provide information for individuals on drug overdose, methadone & buprenorphine, and safer injecting practices, as well as links to further resources and when individuals should seek medical attention. 

  • Drug Overdose 
  • Methadone and buprenorphine 
  • Safer injecting practices 

 

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below. 

6. Register for the Take Home Naloxone Program 

Opioid overdose is a major cause of harm and death in Australia. Naloxone is a short-acting opioid antagonist, registered by the TGA for the reversal of opioid overdose. Increasing access to naloxone for people who are at risk of experiencing or witnessing an overdose is an important strategy to prevent and respond to opioid harm and death. 

 

The Take Home Naloxone Program fully subsidises the cost of naloxone, including dispensing fee, to participating community pharmacies. A PBS prescription is not required. Register for the Take Home Naloxone Program here. 

 

Learn more about the naloxone and why you should talk to your patients about naloxone from Turning Point, Australia’s leading national addiction treatment, education and research centre.  

 

 

7. Register for the Needle & Syringe Program 

The Needle and Syringe program aims to minimise the transmission of blood borne viruses amongst people who inject drugs.  

 

Register for the Needle & Syringe Program here. 

 

8. Do you have more questions? 

PSA Members can call the Pharmacist to Pharmacist Advice Line on 1300 369 772 for professional advice and support.

  

For specific advice on QOTP, pharmacists can contact the Queensland Health via email at QOTP@health.qld.gov.au . 

 

The Alcohol and Drug Clinical Advisory Service (ADCAS) is a specialist telephone support service for health professionals in Queensland, providing clinical advice regarding the management of patients with alcohol and other drug concerns. This free service is available from 8.00am-11.00pm, 7 days a week. Contact at 1800 290 928. 

 

Keep up to date on the latest information on OTP programs in QLD as well as many other important practice specific issues – renew your PSA membership! 

1. Apply to become a Pharmacotherapy (opioid replacement therapy) Pharmacy 

To make an application for permission to be a pharmacotherapy supplier, complete the application form available on the Victorian Department of Health website. 

 

2. Complete the Victorian Opioid Pharmacotherapy Program (VOPP) 

The aim of these training programs is to provide pharmacists and pharmacy support staff with the relevant knowledge, skills and tools required to deliver a safe and patient-centred Opioid Replacement Therapy (ORT) service. 

 

The VOPP and LAIB training: 

  • are fully funded by the Victorian Department of Health for all pharmacists and pharmacy staff in Victoria 
  • have all you need to know about delivering an ORT service 
  • help you establish your pharmacy to support patients with an opioid dependence 
  • enable you to play a key role in reducing the health, social and economic harms to individuals and the community 

 

The VOPP will help pharmacists and pharmacy staff identify those who would benefit from pharmacotherapy, engage in a discussion of the benefits of the program in a non-stigmatising manner, and ensure the consistency and quality of services offered. 

 

The LAIB trainingwill enable pharmacist acquire relevant knowledge and skills to administer long-acting injectable buprenorphine in a safe and patient-focused environment. 

 

The table below illustrates the training available to pharmacists to: 

Provide ORT service

NB: VOPP is not a requirement to provide an ORT service, but highly recommended by the Victorian Department of Health. 

NB: VOPP is not a requirement to complete the LAIB training but is highly recommended.  

NB: An accredited injection administration training (i.e. the immunisation training) is a requirement to administer LAIB. The LAIB training is highly recommended, but not a requirement to provide LAIB in Victoria.  

 

 

It is also recommended that you complete the Administering medicines by injection course before administering any medicine by injection, as well as, be familiar, and practice in accordance with the PSA Guidelines for pharmacists administering medicines by injection. 

 

3. Familiarise yourself with the Victorian protocols and guidelines 

Extensive information and resources are available on the Victorian Department of Health website. Some key resources are outlined below: 

 

 

4. Use language that reduces stigma 

The language pharmacists use when providing opioid replacement therapy is critical to reduce stigma.  

 

“The Power of Words practical guide and desktop flip book are designed to support healthcare and other professionals working with people who use alcohol and other drugs to reduce stigma and improve health outcomes. 

 

Stigma is a common and complex problem for people who use alcohol and other drugs. The World Health Organization has ranked illegal drug dependence as the most stigmatised health condition globally, with alcohol dependence listed at number four.” 

 

Download the Power of Words resource here. 

 

5. Provide relevant Self Care Cards to people seeking opioid replacement therapy 

PSA self-care fact cards provide information for individuals about self-care and preventative health. The below fact cards provide information for individuals on drug overdose, methadone & buprenorphine, and safer injecting practices, as well as links to further resources and when individuals should seek medical attention. 

  • Drug Overdose 
  • Methadone and buprenorphine 
  • Safer injecting practices 

 

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below. 

6. Register for the Take Home Naloxone Program 

Opioid overdose is a major cause of harm and death in Australia. Naloxone is a short-acting opioid antagonist, registered by the TGA for the reversal of opioid overdose. Increasing access to naloxone for people who are at risk of experiencing or witnessing an overdose is an important strategy to prevent and respond to opioid harm and death. 

 

The Take Home Naloxone Program fully subsidises the cost of naloxone, including dispensing fee, to participating community pharmacies. A PBS prescription is not required. Register for the Take Home Naloxone Program here. 

 

Learn more about the naloxone and why you should talk to your patients about naloxone from Turning Point, Australia’s leading national addiction treatment, education and research centre.  

 

 

7. Register for the Victorian Needle & Syringe Program 

The Victorian Needle and Syringe program aims to minimise the transmission of blood borne viruses amongst people who inject drugs.  

 

Information on the Victorian Needle & Syringe Program is available here. 

 

8. Do you have more questions? 

PSA Members can call the Pharmacist to Pharmacist Advice Line on 1300 369 772 for professional advice and support.  

 

For specific advice on pharmacotherapy, pharmacists can contact the Victorian Department of Health at pharmacotherapy@health.vic.gov.au 

 

For clinical advice – the Victorian Drug and Alcohol Clinical Advisory Service (DACAS) is a 24/7 specialist telephone consultancy service that is free of charge for health and welfare professionals. Contact at 1800 812 804. 

 

Keep up to date on the latest information on OTP programs in Victoria as well as many other important practice specific issues – renew your PSA membership! 

1. Obtain an authority to supply Medication Assisted Treatment for Opioid Dependence (MATOD) 

If your pharmacy would like to become involved in delivering MATOD, an authority under South Australian controlled substances legislation is required prior to supplying a drug of dependence to a drug dependent person. 

 

Complete the Authority Application form to start the process.  

 

2. Familiarise yourself with the SA protocols and guidelines 

Extensive information and resources are available on the SA Health website. Some key resources are outlined below: 

 

3. Long-acting injectable buprenorphine 

Pharmacists in South Australia cannot administer long-acting injectable depot buprenorphine. Pharmacists are to make arrangements with prescribers to supply the product directly to the healthcare practitioner who will be administering the injection. 

 

4. Use language that reduces stigma 

The language pharmacists use when providing Opioid Dependence Treatment is critical to reduce stigma.  

 

“The Power of Words practical guide and desktop flip book are designed to support healthcare and other professionals working with people who use alcohol and other drugs to reduce stigma and improve health outcomes. 

 

Stigma is a common and complex problem for people who use alcohol and other drugs. The World Health Organization has ranked illegal drug dependence as the most stigmatised health condition globally, with alcohol dependence listed at number four.” 

 

Download the Power of Words resource here. 

 

5. Provide relevant Self Care Cards to people seeking treatment for opioid dependence

PSA self-care fact cards provide information for individuals about self-care and preventative health. The below fact cards provide information for individuals on drug overdose, methadone & buprenorphine, and safer injecting practices, as well as links to further resources and when individuals should seek medical attention. 

  • Drug Overdose 
  • Methadone and buprenorphine 
  • Safer injecting practices 

 

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below. 

6. Register for the Take Home Naloxone Program 

Opioid overdose is a major cause of harm and death in Australia. Naloxone is a short-acting opioid antagonist, registered by the TGA for the reversal of opioid overdose. Increasing access to naloxone for people who are at risk of experiencing or witnessing an overdose is an important strategy to prevent and respond to opioid harm and death.

  

The Take Home Naloxone Program fully subsidises the cost of naloxone, including dispensing fee, to participating community pharmacies. A PBS prescription is not required. Register for the Take Home Naloxone Program here. 

 

Learn more about the naloxone and why you should talk to your patients about naloxone from Turning Point, Australia’s leading national addiction treatment, education and research centre.  

 

 

7. Clean Needle Program (CNP) Pharmacy Scheme  

The Clean Needle Program (CNP) Pharmacy scheme aims to minimise the transmission of blood borne viruses amongst people who inject drugs.  

 

Register for the CNP here 

 

8. Do you have more questions? 

PSA Members can call the Pharmacist to Pharmacist Advice Line on 1300 369 772 for professional advice and support. 

 

For specific advice on MATOD from a regulatory perspective, contact the Drugs of Depedence Unit (DDU) on 1300 652 584 or at HealthDrugsofDependenceUnit@sa.gov.au.   

 

For 24-hour clinical advice from senior medical staff, regarding opioid dependent patients and patients with other drug and alcohol related issues, contact the Drug and Alcohol Clinical Advisory Service (DACAS) on (08) 7087 1742. 

 

Keep up to date on the latest information on OTP programs in SA as well as many other important practice specific issues – renew your PSA membership! 

1. Apply to participate in the WA Community Program for Opioid Pharmacotherapy (CPOP) 

If your pharmacy would like to become involved in delivering CPOP, complete the application form to start the process.  

 

2. Familiarise yourself with the WA protocols and guidelines 

Extensive information and resources are available on the WA Mental Health Commission website. Some key resources are outlined below: 

 

3. Complete training provided by the Government of WA 

All pharmacists working in CPOP pharmacies (including locums) are required to complete the CPOP Pharmacist Training provided by the Government of Western Australia Mental Health Commission. The training is available here.  

 

4. Long-acting injectable buprenorphine (LAIB)  

In Western Australia, this Structured Administration and Supply Arrangement (SASA) authorises a registered pharmacist trained in the CPOP to administer LAIB, when requested by the patient and prescriber. The conditions and criteria in the SASA must be met by the administering pharmacist.

 

It is expected that pharmacists are:

  • familiar with and understand the requirements of the WA CPOP and the relevant SASA,
  • understand requirements for injection administration by completing an injection/immunisation course approved by the Department of Health. If you are not a pharmacist immuniser, the PSA offers an approved accredited immunisation training course .
  • understand the requirements specific to depot buprenorphine treatment and administration by completing the required training provided by CPOP.

 

It is the responsibility of the pharmacist to complete the expected training and product familiarisation to ensure that they are practising within their field of competency. It is also recommended that pharmacists:

 

5. Use language that reduces stigma 

The language pharmacists use when providing pharmacotherapy is critical to reduce stigma.  

 

“The Power of Words practical guide and desktop flip book are designed to support healthcare and other professionals working with people who use alcohol and other drugs to reduce stigma and improve health outcomes. 

 

Stigma is a common and complex problem for people who use alcohol and other drugs. The World Health Organization has ranked illegal drug dependence as the most stigmatised health condition globally, with alcohol dependence listed at number four.” 

 

Download the Power of Words resource here. 

 

6. Provide relevant Self Care Cards to people seeking treatment for opioid dependence 

PSA self-care fact cards provide information for individuals about self-care and preventative health. The below fact cards provide information for individuals on drug overdose, methadone & buprenorphine, and safer injecting practices, as well as links to further resources and when individuals should seek medical attention. 

  • Drug Overdose 
  • Methadone and buprenorphine 
  • Safer injecting practices 

 

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below. 

7. Register for the Take Home Naloxone Program 

Opioid overdose is a major cause of harm and death in Australia. Naloxone is a short-acting opioid antagonist, registered by the TGA for the reversal of opioid overdose. Increasing access to naloxone for people who are at risk of experiencing or witnessing an overdose is an important strategy to prevent and respond to opioid harm and death.

  

The Take Home Naloxone Program fully subsidises the cost of naloxone, including dispensing fee, to participating community pharmacies. A PBS prescription is not required. Register for the Take Home Naloxone Program here. 

 

Learn more about the naloxone and why you should talk to your patients about naloxone from Turning Point, Australia’s leading national addiction treatment, education and research centre.  

 

8. Needle & Syringe Program (NSP) 

All Western Australian pharmacies are approved to retail packaged needles and syringes (Fitpack ® and Fitstick ®) under the Pharmacy Registration Board of WA’s approval. 

 

Should a pharmacy want to retail single needles and syringes accompanied by a disposal container, the pharmacy is required to apply for an NSP approval to do so. 

 

Apply for a NSP approval here. 

 

9. Do you have more questions? 

PSA Members can call the Pharmacist to Pharmacist Advice Line on 1300 369 772 for professional advice and support.

  

The Community Pharmacotherapy Program (CPP) provides support, information, advice, training and resources for clients, pharmacists and medical practitioners involved in methadone and buprenorphine treatment for opioid dependence throughout WA. Contact via phone on (08) 9273 1907. 

 

The Drug and Alcohol Clinical Advisory Service (DACAS), operating from 8am-8pm Mon-Fri, is a specialist telephone consultancy service that provides clinical advice to health professionals on all issues relating to patient management of alcohol and other drug (AOD) use. Contact on (08) 6553 0520. 

 

Keep up to date on the latest information on OTP programs in WA as well as many other important practice specific issues – renew your PSA membership! 

1. Dispensing Opioid Substitution Treatment 

There are no specific requirements or authorisations for pharmacies/pharmacists to dispense Opioid Substitution Treatment in the NT.  

It is recommended that pharmacists are familiar with the National guidelines for medication-assisted treatment of opioid dependence prior to providing this service.  

 

2. Familiarise yourself with the NT protocols and guidelines 

All information relevant to Opioid Substitution Treatment is available in the Schedule 8 Code of Practice. More guidance for pharmacists on restricted S8 substances is available here.  

 

Some other useful resources are below: 

 

 

3. Long-acting injectable buprenorphine 

Pharmacists in the NT may administer long-acting injectable buprenorphine where instructed to by the prescriber. Pharmacists offering this service must be satisfied that the medicine will be administered safely to the patient. 

 

  • Recommended training requirements: 
  • Other requirements: 

 

4. Use language that reduces stigma 

The language pharmacists use when providing Opioid Substitution Treatment is critical to reduce stigma.

  

“The Power of Words practical guide and desktop flip book are designed to support healthcare and other professionals working with people who use alcohol and other drugs to reduce stigma and improve health outcomes. 

 

Stigma is a common and complex problem for people who use alcohol and other drugs. The World Health Organization has ranked illegal drug dependence as the most stigmatised health condition globally, with alcohol dependence listed at number four.” 

 

Download the Power of Words resource here. 

 

5. Provide relevant Self Care Cards to people seeking treatment for opioid dependence 

PSA self-care fact cards provide information for individuals about self-care and preventative health. The below fact cards provide information for individuals on drug overdose, methadone & buprenorphine, and safer injecting practices, as well as links to further resources and when individuals should seek medical attention. 

  • Drug Overdose 
  • Methadone and buprenorphine 
  • Safer injecting practices 

 

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below. 

6. Register for the Take Home Naloxone Program 

Opioid overdose is a major cause of harm and death in Australia. Naloxone is a short-acting opioid antagonist, registered by the TGA for the reversal of opioid overdose. Increasing access to naloxone for people who are at risk of experiencing or witnessing an overdose is an important strategy to prevent and respond to opioid harm and death. 

 

The Take Home Naloxone Program fully subsidises the cost of naloxone, including dispensing fee, to participating community pharmacies. A PBS prescription is not required. Register for the Take Home Naloxone Program here. 

 

Learn more about the naloxone and why you should talk to your patients about naloxone from Turning Point, Australia’s leading national addiction treatment, education and research centre.  

  

7. Register for the Needle & Syringe Program 

The Needle & Syringe Program (NSP) aims to minimise the transmission of blood borne viruses amongst people who inject drugs.  

 

Register for the NSP here. 

 

8. Do you have more questions? 

PSA Members can call the Pharmacist to Pharmacist Advice Line on 1300 369 772 for professional advice and support. 

 

For clinical advice – the Drug and Alcohol Clinical Advisory Service (DACAS) is a 24/7 specialist telephone consultancy service that is free of charge for health and welfare professionals. Contact at 1800 111 092. 

 

The NT Department of Health Alcohol and Other Drugs Service can provide advice to pharmacists currently providing an ODT service or looking to implement this service. Contact at: 

 

Keep up to date on the latest information on OTP programs in the NT as well as many other important practice specific issues – renew your PSA membership! 

1. Obtain pharmacy approval and pharmacist accreditation to become a dosing site for opioid pharmacotherapy  

Pharmacy Approval: 

  • To become a dosing site for opioid pharmacotherapy, a pharmacy requires approval from the Tasmania Alcohol and Drug Services (ADS). In addition, each pharmacist involved in the provision of dosing is required to obtain accreditation.  
  • To coordinate approval, contact the ADS on (03) 6230 7983. 

 

Pharmacist accreditation: 

  • To dose pharmacotherapy, pharmacists require to undertake a short professional development program and exam.  
  • The ADS recommends this is completed in the intern year.  
  • If accreditation has not already been obtained, this will be coordinated by the ADS pharmacist.  

 

 

2. Familiarise yourself with Tasmanian protocols and guidelines 

Extensive information and resources are available on the Tasmanian Government Department of Health website. This includes: 

  • Tasmanian Opioid Pharmacotherapy Program Policy and Clinical Practice Standards 
  • Dosing sheets for community pharmacies 
  • Depot buprenorphine guidelines for pharmacists 
  • Medication administration charts 

 

3. Long-acting injectable buprenorphine 

Pharmacists in Tasmania may administer long-acting injectable buprenorphine after meeting mandatory requirements set out by the Department of Health. Detailed information on the requirements are available in the Pharmacist Administration of Depot Buprenorphine in the Treatment of Opioid Dependence Policy.  

 

4. Use language that reduces stigma 

The language pharmacists use when providing Opioid Substitution Treatment is critical to reduce stigma. 

 

“The Power of Words practical guide and desktop flip book are designed to support healthcare and other professionals working with people who use alcohol and other drugs to reduce stigma and improve health outcomes. 

 

Stigma is a common and complex problem for people who use alcohol and other drugs. The World Health Organization has ranked illegal drug dependence as the most stigmatised health condition globally, with alcohol dependence listed at number four.” 

 

Download the Power of Words resource here. 

 

5. Provide relevant Self Care Cards to people seeking treatment for opioid dependence 

PSA self-care fact cards provide information for individuals about self-care and preventative health. The below fact cards provide information for individuals on drug overdose, methadone & buprenorphine, and safer injecting practices, as well as links to further resources and when individuals should seek medical attention. 

  • Drug Overdose 
  • Methadone and buprenorphine 
  • Safer injecting practices 

 

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below. 

6. Register for the Take Home Naloxone Program 

Opioid overdose is a major cause of harm and death in Australia. Naloxone is a short-acting opioid antagonist, registered by the TGA for the reversal of opioid overdose. Increasing access to naloxone for people who are at risk of experiencing or witnessing an overdose is an important strategy to prevent and respond to opioid harm and death. 

 

The Take Home Naloxone Program fully subsidises the cost of naloxone, including dispensing fee, to participating community pharmacies. A PBS prescription is not required. Register for the Take Home Naloxone Program here. 

 

Learn more about the naloxone and why you should talk to your patients about naloxone from Turning Point, Australia’s leading national addiction treatment, education and research centre.  

 

 

7. Register for the Needle & Syringe Program 

The Needle & Syringe Program (NSP) aims to minimise the transmission of blood borne viruses amongst people who inject drugs.  

 

Register for the NSP here. 

 

8. Pharmacy Incentive Program 

To support community pharmacies to provide OTP services, the Tasmanian Department of Health has an incentive scheme for community pharmacies that provides additional funding. For further information, contact adstopp@dhhs.tas.gov.au 

 

9. Do you have more questions? 

PSA Members can call the Pharmacist to Pharmacist Advice Line on 1300 369 772 for professional advice and support.  

 

For clinical advice – the Drug and Alcohol Clinical Advisory Service (DACAS) is a 24/7 specialist telephone consultancy service that is free of charge for health and welfare professionals. Contact at 1800 111 092. 

 

Keep up to date on the latest information on OTP programs in Tasmania, as well as many other important practice specific issues – renew your PSA membership! 

UTI resources – WA

On 4 August 2023, the WA Government announced its commitment to authorise Registered Pharmacists working in community pharmacy to supply antibiotics for the treatment of uncomplicated urinary tract infection (UTI) for female patients aged between 18 and 65 years.

 

Pharmacists who meet the conditions and approved training requirements as outlined in the Pharmacist Initiated Treatment of Urinary Tract Infection SASA will be authorised to supply approved oral antibiotics from the 4th of August 2023. The Pharmacist Initiated Treatment of Urinary Tract Infection SASA  details the type of antibiotics that can be supplied as well as the permitted quantity of supply.

 

It is important to note that WA’s treatment recommendations for the management of uncomplicated urinary tract infections (UTI) align with local resistance patterns in Western Australia. WA’s unique treatment recommendations for the management of uncomplicated urinary tract infection (UTI) are explained in WA Supplementary Information for Pharmacists.

As outlined in SASA and Supplementary information, the first-line antibiotic treatment option is nitrofurantoin and the second-line antibiotic treatment option is trimethoprim. Cefalexin has been EXCLUDED from the WA Pharmacist Initiated Treatment of Urinary Tract Infections Program.

 

Pharmacists must familiarise themselves with and adhere to WA’s Pharmacist Initiated Treatment of Urinary Tract Infection SASA and WA Supplementary Information for Pharmacists .

 

Complete your PSA training program today

Keep up to date on the latest information on the UTI program, as well  other important practice updates in WA – renew your PSA membership!

UTI resources – QLD

Authorisation to supply antibiotics for uncomplicated UTI without a prescription is provided under the Queensland Government Extended Practice Authority ‘Pharmacists’ (EPA).

 

Background

A urinary tract infection (UTI) is a general term used to describe an infection involving any part of the urinary system.

 

UTI’s are very common – particularly in women and the elderly. The most common type of UTIs are bladder infections, also known as cystitis.

 

Most UTIs are caused by bacteria which normally live harmlessly in the bowel. If these bacteria spread into the urinary system they can cause:

 

  • urethritis – infection in the urethra
  • cystitis – infection in the bladder
  • pyelonephritis – infection in the kidneys.

 

UTIs are a common cause of hospitalisations that are potentially preventable. Click here for more details.

 

 

PSA Resources

1. Complete PSA training program: Managing Uncomplicated Cystitis. This training module will give you the knowledge you need to identify who can be supplied antibiotics for uncomplicated cystitis, and who will need to be referred to their GP.  It will also give you the knowledge you need to choose the most appropriate antibiotic to treat uncomplicated cystitis.

2. Provide UTI Self Care Card. PSA self-care fact cards provide information for individuals about self-care and preventative health. The UTI fact card provides information for individuals on the signs and symptoms of cystitis, treatment, self-care information, links to further resources and when individuals should seek medical attention.

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below.

3. Familiarise yourself with the Cystitis treatment guideline for pharmacists. 

Keep up to date on the latest information on the UTI trial, as well as many other important practice specific issues – renew your PSA membership!

State and territory legislation

State and territory legislation

Links to state and territory based legislation relevant to pharmacists.

 

Medicines and poisons legislation

 

Continued dispensing

 

Other relevant state or territory legislation

UTI resources – NSW

On 13 November 2022, the NSW Government announced its commitment to:

 

  • commence a 12-month clinical trial to evaluate allowing appropriately trained pharmacists to prescribe medication for urinary tract infections; and
  • progress a state-wide pilot where appropriately trained pharmacists can prescribe medications for a range of minor conditions, in consultation with pharmacy regulators.

 

NSW pharmacists should refer to the NSW Authority for the Supply of specified restricted substances by pharmacists and to the NSW UTI Clinical Management Protocol for the Management of Urinary Tract Infections by Community Pharmacists.

Further information is available on the NSW Health Pharmacy Trial website and for pharmacists participating in the trial, the University of Newcastle NSW Community Pharmacy Trials website.

 

Purpose

The NSW Government, together with the University of Newcastle will deliver a 12-month state-wide clinical trial where appropriately trained pharmacists will be able to prescribe medications for UTIs.

 

The implementation of this large-scale pilot within a clinical trial framework will help the government and NSW Health to better understand, through robust data collection, the benefits and risks to patients of pharmacy prescribing in the context of the primary care setting in NSW.

 

The trial will capture data on treatment success, complications and any recommendations regarding the safe implementation for pharmacist prescribing for UTIs in NSW.

PSA Resources

How can NSW start to get ready

1. Complete PSA training program: Managing Uncomplicated Cystitis. This training module will give you the knowledge you need to identify who can be supplied antibiotics for uncomplicated cystitis, and who will need to be referred to their GP.  It will also give you the knowledge you need to choose the most appropriate antibiotic to treat uncomplicated cystitis.

2. Provide UTI Self Care Card. PSA self-care fact cards provide information for individuals about self-care and preventative health. The UTI fact card provides information for individuals on the signs and symptoms of cystitis, treatment, self-care information, links to further resources and when individuals should seek medical attention.

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below.

Keep up to date on the latest information on the UTI trial, as well as many other important practice specific issues – renew your PSA membership!

UTI resources

Pharmacists providing antibiotics for acute uncomplicated cystitis

Background

A urinary tract infection (UTI) is a general term used to describe an infection involving any part of the urinary system.

 

UTI’s are very common – particularly in women and the elderly. The most common type of UTIs are bladder infections, also known as cystitis.

 

Most UTIs are caused by bacteria which normally live harmlessly in the bowel. If these bacteria spread into the urinary system they can cause:

 

  • urethritis – infection in the urethra
  • cystitis – infection in the bladder
  • pyelonephritis – infection in the kidneys.

 

UTIs are a common cause of hospitalisations that are potentially preventable. In NSW, it’s estimated over 21,000 potentially preventable hospital presentations per year were due to UTIs, a rate that worsens in rural and remote locations. Click here for more details.

 

Pharmacists in some states can supply antibiotics for uncomplicated Urinary Tract Infections (UTI) without a prescription, where appropriate. Authorisation to supply antibiotics for this purpose is provided under state or territory legislation. Click on the jurisdiction you practice in below for more information on your local legislation.

 

Get ready with PSA resources

1. Complete PSA training program: Managing Uncomplicated Cystitis (Urinary Tract Infection).

 

This training module will give you the knowledge you need to identify who can be supplied antibiotics for uncomplicated cystitis, and who will need to be referred to their GP.  It will also give you the knowledge you need to choose the most appropriate antibiotic to treat uncomplicated cystitis.

2. Familiarise yourself with the Cystitis treatment guideline for pharmacists. 

3. Provide UTI Self Care Card to your patients. PSA self-care fact cards provide information for individuals about self-care and preventative health. The UTI fact card provides information for individuals on the signs and symptoms of cystitis, treatment, self-care information, links to further resources and when individuals should seek medical attention.

The Self Care program is designed for pharmacies to deliver improved health care to consumers. It provides resources and training to educate pharmacy staff, add value to the consumer’s experience, and aims to increase business growth with tailored health promotions and resources. To learn more click the button below.

Keep up to date on the latest information on UTI programs, and trials in your state or territory, as well as many other important practice specific issues – renew your PSA membership!

Resources for your state or territory

Biological disease-modifying antirheumatic drugs (bDMARDS)

PSA has joined NPS MedicineWise and seven other organisations representing pharmacists, specialists, consumers and research experts to form the Targeted Therapies Alliance. The Alliance provides stewardship and direction about the safe and wise use of biological disease-modifying antirheumatic drugs (bDMARDs) and other specialised medicines.