Wednesday, March 16, 2016

The Pressure To Do Something About Excessive Narcotic Prescribing Is Building. Hard To Know Why It Is Taking So Long.

This appeared a few days ago:

GPs prescribing opioids “in the dark”

Nicole MacKee
Monday, 7 March, 2016
GPs are continuing to “prescribe in the dark” as states and territories negotiate the detail associated with wider implementation of a real-time prescription drug monitoring, says a leading GP and medical advisor.
Dr Walid Jammal, Senior Medical Advisor, Advocacy, at Avant Mutual Group, said the profession had been calling for the national rollout of real-time prescription drug monitoring for many years.
“Coroner after coroner has called for this. The states and territories are working on it – and it’s a huge task – but some would argue that it should have happened many years ago,” Dr Jammal told MJA InSight.
“No one argues with the need for responsible prescribing and that that responsibility ultimately lies with the prescribing doctor. But real-time monitoring really sheds light on the issue because GPs are currently prescribing in the dark.”
Dr Jammal’s comments come as the MJA published a short report analysing the capacity and coverage issues associated with wider implementation of a real-time prescription drug monitoring program.
The MJA authors highlighted challenges for policy makers such as the information that would need to be collected, how long it would be held, and the increased demand for professional development and specialist support for addiction and pain management.
Lead author Dr Rowan Ogeil, an NHMRC Peter Doherty Early Career Fellow at Monash University and Turning Point in Melbourne, said it was “extremely important” for states and territories to consider the issues raised in the paper as plans for implementation progressed.
“We have nominated a couple of key areas – capacity and coverage – which cover everything from privacy and how long records would be kept, to who’s going to respond and how they are going to respond to any issues that are flagged,” he told MJA InSight.
Dr Ogeil said there had been a proliferation of opioid medications available since the early 1990s, with just 11 preparations available in 1992, and 146 available in 2013. There had also been a 15-fold increase in the number of Pharmaceutical Benefits Scheme opioid prescriptions dispensed, rising from around 500 000 in 1992 to more than 7 million in 2012.
Lots more here:
Here is the original MJA article

Prescription drug monitoring in Australia: capacity and coverage issues

Rowan P Ogeil, Cherie Heilbronn, Belinda Lloyd and Dan I Lubman
Med J Aust 2016; 204 (4): 148.
doi:  10.5694/mja15.00929
Recent years have seen increases in prescription of pharmaceutical opioids and benzodiazepines, and in the associated harms.1 This presents challenges for clinicians and governments regarding appropriate monitoring and responses. Real-time prescription drug monitoring programs (RT-PDMPs) are being considered in Australia2,3 to enable detection of drug diversion (when drugs are transferred from a licit to an illicit channel of distribution or use), and inappropriate prescribing or dispensing. RT-PDMPs are supported by professional bodies, but challenges exist for policy makers in terms of capacity and coverage.
More of the article is here:
The question that really has to be asked is why this is all taking so long. We have had discussions for years, coroners recommendations for years, software developed and yet we are still waiting and seem to have no idea when we will see some finality and an actual working system in place.
Would love to know from those on the ground just what the problem is - other than just State Health Department intertia?
David.

3 comments:

Terry Hannan said...

David, this MJA posting coincides with this weeks JAMA paper and guidelines for the use of opioids in chronic pain syndromes.
http://archinte.jamanetwork.com/article.aspx?articleid=2502413
The first point I would like to make (having directed a chronic pain centre for nearly 2 years) is that Dr Loser in Seattle demonstrated the neuropathophysiology of pain in the spinal cord and how in chronic non-surgically remedial pain syndromes the use of opioids creates tolerance and dependency and according to his standards are contraindicated (as are Benzodiazepines) in CPS.
The second point is that despite the known knowledge on CPS management interns, Consultants and nursing staff have very poor skills in the management of these patients in hospital.
As a result of the second point the 8 hour dynamic shift changes and cultural attitudes to these patients and the psychopathology of the individual patients without effective information management systems-particularly around prescribing-leads to very poor outcomes.
Management is a real "headache".

Trevor3130 said...

David, before laying too much blame with State Health Departments, it would be helpful to know which (if any) domains are able to share information across jurisdictional boundaries with complete accuracy, certainty and precision. Security? Criminal justice? Welfare? Motor vehicle registration?

Bernard Robertson-Dunn said...

Terry,

Crimtrac provides a range of services across state jurisdictions.
https://www.crimtrac.gov.au/services-police

The exchange of data is done "with complete accuracy, certainty and precision".

The original data may or may not be accurate, certain or precise.