Hepatitis B

Recommend hepatitis B vaccinations to all patients on the methadone program who are found to have no immunity to the hepatitis B virus.

Patients who are acutely infected or who are chronic carriers of hepatitis B should be referred to a gastroenterologist for special assessment and follow-up.

Hepatitis C

A high percentage of patients entering methadone programs will be hepatitis C antibody positive.

Patients should be treated in accordance with Hepatitis C, A Management Guide for General Practitioners (RACGP 1999).
  • Patients who are hepatitis C antibody positive but who have 3 normal serum aminotransferases (ALT and AST) over 6 months should have liver function tests repeated at 6 monthly intervals and a Hepatitis C polymerase chain reaction test at 12 months.

  • If the patient has 3 abnormal serum aminotransferases over 6 months referral to a gastroenterologist or liver clinic for specialist assessment and shared care is indicated.

Impaired liver function

Patients with chronic liver disease on long term methadone maintenance generally do not need dose alterations but abrupt changes in liver function might necessitate substantial dose adjustments.