Date: 7 February 2018
Regardless of one’s views of the merits of the decision to upschedule over-the-counter, codeine-containing medicines, there can be little argument that the ensuing public debate has visibly increased the level of awareness of the serious problem of the misuse of prescribed drugs in Australia.
In recent years, thousands of families have had to deal with the personal trauma of losing loved ones to prescription overdoses; however this issue has not attracted the attention that it deserves with the calls by patient advocates and clinicians for substantive action often going unheeded.
Thankfully, the over-the-counter codeine upscheduling debate has finally brought out into the open the much more serious problem of addiction to prescription opioids and sedatives.
The number of fatal overdoses each year directly attributed to these prescription medicines is multiple times higher that the number where over-the-counter codeine is even considered to be a contributing factor. Nevertheless, the codeine decision has lifted the lid on this much wider problem to the extent that it can no longer be glossed over by governments, clinicians, the media and consumer advocates.
For many years, the Guild has campaigned for a mandatory, nationally consistent real time prescription monitoring system with the support of patient groups such as Script Wise. During that time, coroners from around Australia have repeatedly called for the introduction of such a system to enable doctors and pharmacists to identify and support patients who are at risk from the misuse of prescription medicines.
In recent months, during the codeine upscheduling debate, doctors’ groups including the Australian Medical Association (AMA), the Royal Australasian College of Physicians (RACP) and the Royal Australian College of General Practitioners (RACGP) have publicly signalled their support for a real time prescription monitoring system.
It is now time that these doctor organisations joined the Guild in becoming active champions for mandatory real time prescription monitoring because, as prescribers, it is their members who have primary responsibility for ensuring they have visibility of at-risk patients who may be ‘doctor shopping’.
With the upscheduling of codeine, the need for mandatory real time prescription monitoring of drugs of dependence is more urgent than ever before. MedsASSIST, the real time monitoring system that was introduced by the Guild and voluntarily taken up by 70 per cent of pharmacies, has had to be shut down as it was only ever able to be used for over-the-counter, codeine-containing medicines.
It is likely that many patients who are suffering with pain will now seek prescriptions, including for higher strength codeine products or other opioids. Currently, there is no real time monitoring to identify these patients at the doctor’s surgery and there is a collective responsibility to ensure that the upscheduling decision does not make matters worse for at-risk patients.
Implementation of a national real time prescription monitoring system needs to be taken forward by Federal and State and Territory Health Ministers through COAG. The Federal Minister Greg Hunt has put $16 million on the table, which should enable the provision of data and a national alerting system for doctors and pharmacies. A number of States, including Tasmania and Victoria, have developed or are committed to developing real time prescription monitoring and support systems. It is crucial that Ministers commit to a mandatory, nationally consistent real time prescription monitoring system as soon as possible, with a view to achieving Minister Hunt’s goal of having it in place by the end of this year.
In the meantime, doctors, pharmacists, allied health professionals and pain management teams need to be working collaboratively in identifying and supporting at-risk patients, ensuring that they do not fall through the cracks while this real time prescription monitoring system is built.
This is one of the reasons why the recent decision by Minister Hunt to fund a $20 million Pain MedsCheck trial is so important. Often, it is community pharmacists who first identify patients who are at-risk of dependence. The Pain MedsCheck will enable pharmacists to conduct targeted, in-pharmacy reviews that will include an assessment of the patient’s prescription and other over-the-counter medicines, as well as the provision of education, advice and where necessary referral to a GP or other health professional.
With the widespread incidence of chronic pain in our society that is not well treated and the increased public awareness of issues of addiction to prescription medicines, the Pain MedsCheck is a very timely intervention that will build on the established role of community pharmacies as a trusted, first port-of-call for patients seeking advice and assistance.
With the advent of the long overdue real time prescription monitoring system, the Pain MedsCheck can become even more effective and targeted in the future, heralding a more proactive and team based approach to the support and management of patients suffering from chronic pain.
Contact: The Guild