Real-time prescribing won’t solve opioid abuse alone


Victoria’s planned real-time prescribing system is only part of the answer to curbing prescription opioid misuse, pain experts warn.

Last month Victoria announced it would move to roll out the model in 2018, making it the second state after Tasmania to introduce such a system.

Real-time prescribing has been recommended by many coroners as a way to reduce doctor-shopping and prescription medicine overdoses, which claimed 372 lives in Victoria last year.

Victoria’s SafeScript system will provide up-to-the minute details on patients’ prescribing histories for S8 and select S4 medicines (benzodiazepines).

Under the new laws, doctors and pharmacists will be required to check the database before prescribing or dispensing these medicines or face fines of $15,000, according to MDA National risk advisor Karen Stephens.

However, she said exemptions exist for health professionals working in low-risk locations like hospitals, prisons and aged care.

Victorian pain specialist Dr Michael Vagg said a software platform, in tandem with appropriate education, ‘will make it easy for doctors to have good conversations with patients about sensible prescribing’.

“The aim is to enable good prescribing rather than to be Big Brother.”

But the reforms will only go so far to address problems of prescription drug misuse, he said.

“When we are trying to talk about using less opioids what we are really talking about is the crisis in the under-management of persistent pain and the appalling levels of underfunding and underdevelopment of pain management services.”

Professor Adrian Reynolds, clinical director of Tasmania’s alcohol and drug service, agreed.

He said it was positive to see Victoria implementing real-time prescribing monitoring, albeit almost a decade after Tasmania.

“If this Victorian system is well designed and if it is used consistently and properly by clinicians, we can expect that it will identify a relatively large number of patients who have developed an opioid addiction and who will require alternative clinical management by their general practitioners, with the assessment, support and advice or direct clinical involvement of addiction medicine specialists.”

But Victoria must also invest in the training of many more addiction medicine specialists, and in its clinical-regulatory frameworks.

“Neither real-time reporting nor education will in themselves solve prescription opioid problems in the Australian community. ”

 

 

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