This appeared last week:
8 December 2017
GPs will play a central role in the first serious attempt to stop doctor shopping and illicit use of pharmaceutical drugs on the Australian mainland.
Under legislation passed on October 19, Victoria will have the distinction of becoming the first state to impose a mandatory real-time prescription monitoring regime, giving doctors, pharmacists and nurse practitioners ready access to a patient’s prescription history.
The initiative rides on the back of Tasmania’s successful DORA monitoring system, which has been in place since 2011. But the challenge for Victoria is to cover a population 12 times larger, and an expanded list of medications. Not to mention the problem of bordering jurisdictions that have yet to get on board with real-time monitoring.
Under DORA, pharmaceutical drug-related deaths in Tasmania have plunged, while the toll in all other parts of the country has continued to rise. This has been achieved under a voluntary system which, to date, has monitored only Schedule 8 opioids and alprazolam, which was added in 2013 when still an S4 drug.
Victoria’s SafeScript system, to be introduced late next year, is intended to capture S8 drugs, S4 medications including diazepam and other benzodiazepines, the anti-psychotic quetiapine, and so-called Z-class drugs used against insomnia. In time, it will also take in codeine products due for upscheduling in February next year.
Based on current best estimates, this means approximately 4.5 million prescription records each year will be uploaded to the SafeScript database, excluding codeine products, according to a spokesman from Victoria’s Department of Health and Human Services.
Other states are supposedly moving towards similar monitoring schedules under a commonwealth scheme for which Tasmania was the test case, under a project that began in 2008. But only Victoria has set a target and slapped down a commitment of $29.5 million to put the machinery in motion.
Dr Cameron Loy, chair of the RACGP’s Victorian faculty, praises the leadership of Victorian Health Minister Jill Hennessy and the state’s DHHS for a “solid effort” to consult GPs and other stakeholders and take advice on SafeScript. “This was not lobbying (by the RACGP). It was genuine collaboration and advice-seeking from the DHHS,” Dr Loy told The Medical Republic.
“We contributed to the discussion on regarding what drugs would be included. The DHHS sought expert advice and analysis on every substance of concern we presented.”
RACGP delegates also advised on complex questions, such as drug users entering and exiting prisons, and GPs’ need for a system to fit in with their workflows and business imperatives. Four GPs have been involved in the planning phase.
“Integrating into our workflow completely will take some evolution, but it is seen clearly on the work plans for SafeScript,” Dr Loy said.
As DORA operates in Tasmania, the regulator keeps a full clinical database of records and notes attached by doctors and pharmacists. Clinicians who log in to check a patient’s history see an abbreviated version to support their prescribing and dispensing decisions.
“We give them enough information to make a safe, quick decision,” Peter Boyles, Chief Pharmacist of Tasmania, told The Medical Republic.
DORA shows what opioid medications have been dispensed for a patient, the doses and quantities; where they were dispensed; whether another doctor holds authority to prescribe; and whether the patient has been declared a “drug-seeker” or been declared “drug dependent” under the state’s Poisons Act.
Where doctors seek authority to prescribe a controlled drug, applications are handled by a full-time team of five people, including three pharmacists. Cases judged to be at risk of harm go to an advisory panel which may decide to impose conditions on quantity or pick-up, but knockbacks are rare.
Tellingly, even as the number of Tasmanians prescribed opioids to treat chronic pain increased three-fold in the decade to 2015, average dosages have declined sharply. In the period from 2010 to 2014, deaths related to the use of pharmaceutical opioids in Tasmania fell to an average of 17 per year, from 25 per year in 2005-09, a drop of 34%.
“We are very pleased with the response, but there are still 17 people a year, on average, dying from pharmaceutical opioids supplied through the health system. I don’t call that a victory,” Mr Boyles said.
Lots more here:
The article provides a great summary of what has gone on so far in Tassie and what is planned for Victoria – which it points out is a larger ask!
What is clear is that such systems are not the total answer – they never could be – but they sure can help.
I hope Victoria can make its system work as there are lives to be saved. Well worth a close read of the whole article.
David.
