SafeScript reduces some harms, but exacerbates others: Researchers

Matt Woodley

25/06/2020 3:53:51 PM

More integrated mental health and drug treatment services may be needed to offset the risk of increased mortality.

Electronic prescription
Increased mortality following restrictions to prescribed medicines has been reported in other parts of the world.

Researchers from the Burnet Institute have raised concerns about restricting access to high-risk medications via real-time prescription monitoring without appropriate investment in other support services.
The warning, published in the Medical Journal of Australia, comes after the researchers introduced questions about the use of real-time prescription monitoring in to their SuperMIX study, with the aim of exploring the effects of the introduction of SafeScript.
The authors, led by Dr Dagnachew Fetene and Professor Paul Dietze, found that 20% of participants (48/242) who used a medicine monitored by SafeScript reported being refused a prescription by a GP, many of whom were receiving treatment for mental health issues.
‘One-third (16/44) of those who have been refused were requesting the prescriptions for the treatment of anxiety and 45% were refused two or more times by doctors,’ they wrote.
‘Three percent of participants (8/245) reported having a prescription they had already been receiving withdrawn. In addition, six out of 241 participants were refused dispensing of a prescribed medicine by a pharmacist.
‘One-third of participants (15/47) who had been refused a prescription were told this was due to a risky combination of medicines or having multiple providers. A third of participants (14/45) who had been refused a prescription reported an intention to not seek medication from their doctors in the future.’
According to the researchers, most of these patients had moderate to severe anxiety (33/41) and depression (36/41) disorders measured through a self-administered Patient Health Questionnaire (PHQ).
‘In the case of refused prescriptions requested for the treatment of anxiety, 10 out of 13 patients had moderate to severe anxiety disorder and 11 out of 13 patients had severe depression disorder, suggesting unmet treatment needs in patients denied prescriptions,’ the researchers concluded.
Dr Hester Wilson, Chair of the RACGP Specific Interests Addiction Medicine network, previously told newsGP real-time prescription monitoring in isolation has the potential for harm, and called for more training for GPs and pharmacists around how to treat people who are picked up by the system.
‘We need to ensure they get the help they need, rather than say, “You’re on my system, you’re an addict, get out of my practice, get out of my pharmacy”,’ she said.
‘These patients have complex health and welfare needs – mental health, homelessness, domestic violence, addiction. They have real pain in their lives.
‘We need to think of novel ways to get better support for these people. As GPs, the fee for service model and short consultations fails them … medicine cannot resolve their complex life ache. We need multidisciplinary approaches, just as we do with pain services.’
Dr Wilson has also pointed to the potential for at-risk patients turning to the black market to help satisfy their addiction.
‘If people are dependent, they can’t just stop. So they will be forced to address the need in another way that is more dangerous,’ she said.
Her assessment is supported by Dr Fetene and colleagues.
‘It is important to understand what happens when people are refused prescriptions – what care they receive and whether this care is appropriate for their needs,’ they wrote.
‘Increased mortality following restrictions to prescribed medicines is reported elsewhere. Rigorous research should evaluate the impact of real-time prescription monitoring use in Australia to understand if similar outcomes are observed.’
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Dr Mary Louise Holland   25/06/2020 10:23:45 PM

I agree that the emphasis for some time now has been on NOT prescribing certain medications but not a lot about what to do next. This leaves many GPs feeling that they are doing the right thing by simply declining to prescribe. It is also true for many regional and rural GPs that there are very limited services to which they can refer, particularly those that are affordable and accessible - Emental health is not the answer for patients with complex mental and social health issues. Much more resourcing is needed.

Dr Dru Haywood   28/06/2020 10:47:06 AM

To me it sounds like the system is working as it should - and this intention comes from the punitive moralistic nature of the medical world - as well as the extreme blame that is heaped upon GPS for the addiction the root cause of which is people having rotten lives. Medicine regards benzodiazepines as the wrong medication for anxiety and opioids as the wrong medication for depression. Yet anyone addicted to these medications will tell you they are the only things that work. “medicine cannot resolve their complex life ache”. Too right. No matter what we do we can’t solve it. But for some people opioids and benzodiazepines are the only things that dull the pain.