GP backs coroner’s call for alcohol delivery curfew

An expert GP has called for increased funding for GPs to treat patients with alcohol addiction, after the ‘absolutely tragic’ death of a Victorian woman who had more than 300 bottles of alcohol delivered to her home in six months. 
 
On Tuesday, Victorian Coroner Ingrid Giles found the ease with which Kathleen Arnold, 30, was able to have alcohol delivered to her home in suburban Melbourne was a contributing factor to her 2023 death from acute ethanol toxicity.
 
The report’s release coincides with that of a new study by the University of New South Wales, which found up to 470,000 Australians may be missing out on much-needed substance use disorder treatment, and called for a doubling in dedicated support services.
 
Chair of RACGP Specific Interests Addiction Medicine, Dr Hester Wilson, said while more dedicated services are ‘absolutely’ needed to support people with alcohol and other drug (AOD) addiction, more funding is crucial in enabling GPs to intervene earlier, particularly for patients with limited funds in need of chronic complex care.
 
‘The big issue is that we have this absolute dismantling of funding for us in general practice, which means it’s hard for us to offer care to people who have limited financial means,’ she told newsGP.
 
‘Medicare does not fund us to do chronic complex care. Yet the majority of AOD treatment actually happens in the primary care setting.
 
‘We have a spectrum of presentations for people that are experiencing issues with substances, and there might be mild to moderate issues, but if we were supported in general practice, we could help people deal with that early.’
 
Dr Wilson said mechanisms and funding are also needed to support collaborative care, so GPs can work alongside AOD services to provide holistic care for the patient and their family.
 
However, with various services being financed by a mix of federal, state and philanthropic funding, it is often difficult to align services to meet people’s needs.
 
‘Integral to that is general practice being able to have the capacity to collaborate and having virtual services in the mix there as well,’ Dr Wilson said.
 
‘How do we work together collaboratively, to ensure that people can get the kind of care they need, where they need it, when they need it?’
 
In the wake of Ms Arnold’s death, Coroner Giles has recommended the prohibition of home delivery of alcohol between 10.00 pm and 10.00 am and to require a minimum two-hour delay between order and dispatch of alcohol for home delivery in Victoria.
 
She also called for the Victorian Health Department to develop a new Alcohol Action Plan to address alcohol-related harm.
 
Dr Wilson welcomed the coroner’s recommendation to restrict deliveries, limiting ease of access of alcohol.
 
‘[Ms Arnold’s death] is just absolutely tragic,’ she said.
 
‘I think about some of my people that I see that have a substance dependence, or gambling addiction, and they’re trying so hard to do things differently. But it’s that ease of access, of calling up the home delivery or Uber driver that makes it so much harder.’
 
Dr Wilson is encouraging GPs to ask patients for permission to take a ‘lifestyle review’ to unearth any possible hidden AOD issues, as patients often come in to seek treatment for something else.
 
‘Say to people, “look as part of my role as a GP, I’m concerned about your general health and wellbeing, and that includes some of the behaviours and habits, things like exercise, nutrition, alcohol, gambling, all those kinds of things. Is it OK if I ask you?”,’ she said.
 
‘I’ve never had anybody say no, but asking permission and explaining why is important, and then actually asking, “do you drink alcohol? How many standard drinks is that? How many days a week? In the morning? Are you concerned about it? Is your family concerned about it?”
 
‘The really important thing for us is that we are the person’s GP, and they’ll see that drug and alcohol service for a period of time, but they’ll continue seeing us.’
 
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