SafeScript reduces some harms, but exacerbates others: Researchers

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‘Three percent of participants (8/245) reported having a prescription they had already been receiving withdrawn.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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