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SafeScript turns four: What have we learnt?

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It has been four years since SafeScript was launched statewide in Victoria.
 
The real-time prescription monitoring service was introduced after a successful trial in the Western Victoria Primary Health Network region, and became mandatory one year later in April 2020.
 
Drug-induced deaths had been steadily increasing in the seven years leading up to its introduction, peaking at 543 in 2018 before declining in the ensuing years to 500 by 2021.
 
Prior to its rollout, GPs relied on the Prescription Shopping Information Service (PSIS) to get information about a patient’s high-risk medication use. However, while helpful, there was a lag time between recent prescriptions and what was recorded.
 
Dr Paul Grinzi, a GP who specialises in drug and alcohol management, believes SafeScript has been a ‘vast improvement’.
 
‘It’s real-time, not retrospective, includes all medications and not just those on the PBS, and there aren’t the dosing thresholds of the PSIS which limited the information available to us,’ he said.
 
‘It provides a more robust and reliable tool to identify and manage patients who may be at risk of harm due to their medication use.’
 
Despite backing from prominent medical organisations such as the RACGP, Victoria, Queensland and South Australia are the only Australian states in which it’s mandatory for prescribers and pharmacists to participate in prescription monitoring.
 
But for Dr Abhishek Verma, a member RACGP Expert Committee – Standards in General Practice SafeScript has been a game changer in terms of ensuring patients receive prescriptions from regular, authorised prescribers for schedule four and eight drugs of dependence.
 
‘The older “Doctor Shopper hotline” was rarely contemporaneous and was clunky to access and not readily available without contacting Services Australia,’ he said.
 
‘The real-time nature of SafeScript, with full prescribing and dispensing histories, as well as alerts, has been tremendously useful at identifying patients who might be misusing, hoarding or potentially tracking high-risk medicines.’
 
Under the old system, Dr Verma says patients could conceivably travel to different clinics and pharmacies to obtain medication without any real visibility of this behaviour.
 
‘This has been mitigated to a huge extent by SafeScript,’ he said.
 
Southbank-based practice owner Dr Peter Bennett is also a supporter and recalls the time-consuming nature of calling PSIS compared to the easier log-in process with SafeScript.
 
‘The main difference is the convenience of not having to call and wait on hold for a report while the patient is waiting in the same room,’ he said.
 
‘Then if they were identified I would have to wait for them to send me the report. The new system is superior.
 
‘Now my software will automatically flag whether the patient is identified or not … every time I go to prescribe a schedule eight drug and then I can log in and check what the issue is.
 
‘Also, all my schedule eight permits are stored there.’
 
According to the Alcohol and Drug Foundation, more than 35,000 Australians have died from drug overdoses in the past 20 years, with most of these deaths involving prescription drugs such as opioids and benzodiazepines.
 
Every two minutes, one person in Australia is hospitalised because of prescription medications. Real-time drug monitoring aims to address this issue by arming doctors with information so they can then discuss concerns with their patients.
 
Doctors can also still override the system and prescribe medications, even if a patient is flagged.
 
‘Whenever I prescribe a targeted medication, my software automatically checks with SafeScript and flags it green, yellow or red depending on the patient’s history,’ Dr Bennett said.
 
According to SafeScript, the clinical alerts are based on the prescribing and dispensing history of a patient. These are:

• Multiple provider episodes: When prescriptions from four or more prescribers or four or more pharmacies have been recorded in SafeScript within the last 90 days
• High-risk drug combinations: When prescriptions for certain drug combinations have been recorded in SafeScript within the last 90 days, such as:
  • Methadone and a benzodiazepine
  • Methadone and a long-acting opioid
  • Fentanyl and a benzodiazepine
  • Fentanyl and a long-acting opioid
• Opioid dose threshold: When the daily morphine equivalent dose (MED), calculated based on an average over the last 90 days, exceeds 100 mg MED daily (ie a high-risk dose)

More than 35,000 Australians have died from drug overdoses in the past 20 years, with most of these deaths involving prescription drugs such as opioids and benzodiazepines.

Logging in to SafeScript requires a username and password before an authentication code is sent to the GP’s mobile phone via SMS or phone call.
 
‘The login process is rightfully protected by multi-factor identification, which is essential given the sensitive information on the database,’ Dr Verma said.
 
‘I personally don’t have any issues with the login process, as it provides an option to remember your access for a day by putting in a temporary pin for that day, so you don’t need to re-login every time.’
 
Dr Grinzi says the login process – ‘For a government website’ – is excellent.
 
‘The main improvement I’d like to see is for the logging-in process to be integrated with the clinical software, avoiding logging into both systems each time,’ he said.
 
Dr Bennett agrees with the need for software integration.
 
‘The only improvement I would suggest is that SafeScript be fully incorporated into my software like the Australian Immunisation Register is now, so I don’t have to log in to see the patient history and access my permits,’ he said.
 
Tasmania was the first state to implement a real-time prescription monitoring system in 2009 called DORA. Since then, every state and territory has launched a version of their own system with Western Australia the last to do so in March 2023.
 
So, are patients aware of SafeScript?
 
‘It’s my impression that many patients are not aware of SafeScript,’ Dr Grinzi said.
 
‘[However], there certainly has been less expressed concern about this process from patients who are aware since it rolled out a few years ago, suggesting an acceptance of its role in prescribing safety.’
 
Meanwhile, Dr Bennett believes most patients know that prescription shopping is being scrutinised, but are unsure how.
 
‘[They know] it’s frowned upon, but they don’t know how this is being targeted,’ he said.
 
According to Dr Verma, he has seen a growing awareness of real-time drug monitoring.
 
‘Certainly, my anecdotal observation is that I see fewer new patients “trying it on” to attend for controlled medication than I did perhaps five or six years ago,’ he said.
 
‘Whether this is directly correlated to the wide implementation of real-time prescription monitoring would be hard to delineate definitively, but I would intuitively think there would be a link.’
 
All three GPs say they use SafeScript regularly and that it informs their clinical practice.
 
However, Chair of RACGP Specific Interests Addiction medicine Dr Hester Wilson has also previously warned that real time drug monitoring in isolation is not a silver bullet, with research in 2020 showing that some harms were exacerbated, particularly in people refused psychotropic medications.
 
According to the Australian Institute of Health and Welfare, opioid prescriptions in Victoria reduced from 3,916,274 in 2018–19 to 3,419,941 in 2020–21.
 
In the same period, benzodiazepines reduced from 1,618,156 to 1,456,851.
 
Dr Grinzi says one of the main benefits of SafeScript is its ability to allow healthcare professions to make informed decisions when prescribing medications that could contribute to preventable overdoses.
 
‘SafeScript … has been an invaluable tool in improving patient safety and wellbeing,’ he said.
 
‘Whilst most patients have a ‘green alert’, the ‘orange’ and ‘red’ alerts have triggered some helpful discussions about overdose risk and assist with framing the consultation around safety.’
 
Dr Verma says he uses the platform on a daily basis.
 
‘Especially when dealing with new patients or complex patients,’ he said.
 
‘The issues relating to skyrocketing rates of prescription medications abuse are a clear and present danger, and the visibility SafeScript affords is a vital tool in prudent and safe prescribing.’
 
More information about real-time drug monitoring is available on the Department of Health and Aged Care website.
 
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benzodiazapines drug and alcohol harm reduction opioids real-time prescription monitoring SafeScript

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