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GPs blindsided by major changes to opioid pack sizes


Doug Hendrie


5/06/2020 4:23:49 PM

Angst and confusion have marred the introduction of welcome changes to opioid prescribing, GPs say.

Laptop displaying PBS homepage.
A detailed listing of the changes to opioid medications only became available on the PBS website the day after the new regulations came into effect.

UPDATED

GPs, pharmacists and patients have been caught unawares after major changes to opioid pack sizes came into effect this week.
 
The slashing of pack sizes for many potent opioids came into effect on Monday 1 June – but GPs say crucial detail on which medications are affected is missing.
 
The communication issue led to some GPs being unable to prescribe the new, smaller pack sizes through their usual clinical software until an update was rolled out days after the new regulations were enforced.
 
A detailed listing of the changes to opioid medications only became available on the Pharmaceutical Benefits Scheme (PBS) website on Tuesday 2 June.
 
Similarly, no public announcement of the changes was made until the Therapeutic Goods Administration (TGA) issued a release on 2 June.
 
Dr Rob Hosking, Chair of the RACGP Expert Committee – Practice Technology and Management (REC–PTM) told newsGP the issue is leading to ‘angst among GPs, pharmacists and patients’.
 
‘This could definitely have been done better, with proper education and greater publicity for GPs and pharmacists – and certainly ensuring software vendors were able to get this in place before the date,’ he said.
 
‘They’ve rolled it out, incompletely prepared, during a time when we’re already struggling to manage electronic prescribing and remote consultations.
 
‘We’re seeing pharmacists calling GPs saying they can’t dispense because it doesn’t meet the new requirements.’
 
GP Dr Steven Kaye, a member of the REC–PTM, told newsGP there has been a noticeable lack of detail around the changes.
 
‘If you have a big change like this – and this is a big one – we would normally be informed by medical media and often with direct communication from the PBS to let us know the thinking and the rationale,’ he said.
 
‘What were we actually supposed to treat people’s pain with? We need the lead time so we can rethink how we care for people with pain after you restrict pack sizes.
 
‘People are upset because of the time wastage. There will be a substantial number of my colleagues quite grumpy about this.’
 
CEO of software vendor Medical Director Matthew Bardsley told newsGP his company had received the embargoed PBS update containing the changes around 20 May, with the changes to the software going live on 1 June. 
 
He said around 50% of his clients have auto-updates turned on, but the other 50% will need to manually update the software.
 
‘All communication can be improved. This may be a case in point,’ he said.
 
‘From our perspective, we will maintain our diligent monitoring of all communications from the Department of Health.
 
‘Our standard processes have been stretched during COVID-19. It’s been prolific, the pace at which we have had to implement change. It’s required extraordinary efforts.’
 
Former Chair of the REC–PTM Dr Nathan Pinskier told newsGP the first he knew of the changes was when his daughter, a first-year hospital intern, texted him about the positive changes to opioid availability.
 
‘We need advance notice of these changes so we can then educate our GP workforce and ensure changes to software are embedded. We can’t prescribe a reduced quantity if the software doesn’t register it,’ he said.
 
Dr Pinskier said the ongoing response to the coronavirus pandemic could have been a reason this had not been better publicised.
 
Despite this week’s frustrations regarding communication, GPs have been broadly supportive of efforts to better control how opioids are prescribed, with the new pack size restrictions applied only to opioids for acute issues.
 
Chair of the RACGP Expert Committee – Quality Care Professor Mark Morgan has welcomed the PBS changes.
 
‘GPs know they need to be cautious when prescribing opioids and to carefully monitor a patient’s use of these drugs,’ he said.
 
‘Opioids have important therapeutic uses but they can cause dependence, lead to risky use and cause harm.’
 
A TGA spokesperson said the changes have been communicated publicly since mid-2019, with a prescription opioid information hub going live last August.

‘We have engaged with key stakeholders for many months as part of our communication strategy,’ the spokesperson told newsGP.

The spokesperson said the recent PBS opioid changes aligned with the TGA’s changes, which include restricting and harmonising indications, introducing smaller pack sizes, including boxed warning and class precaution statements in the product information and improving safety information in the consumer medicines information. 

‘Importantly, these changes maintain access to opioids for cancer and palliative patients and larger pack sizes will remain available,’ the spokesperson said.

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Dr Vanessa Elisabeth Magrath   13/06/2020 2:10:09 PM

Perhaps Medicare should now cover physiotherapy or exercise physiology? Will they accept rebates as poor as those for gps? If you want to reduce opiod use there has to be an affordable alternative.


Dr Simon Holliday   14/06/2020 4:53:43 PM

Dr Steven Kaye asks, "‘What were we actually supposed to treat people’s pain with?"
We need to distance ourselves from the comprehensive marketing strategies of the pharmaceutical manufacturers because their treatments are frequently ineffective for complex problems like chronic pain. One review by Moore et.al. (https://www.bmj.com/content/346/bmj.f2690) concluded that no single pharmaceutical, opioid or otherwise, provided a significant (50%) reduction in pain for most patients. Our Health system does have to make non-pharmaceutical approaches accessible. This does not just mean GPs making more referrals to Allied Health. Many of the principles of Chronic Disease Management are effective in chronic pain work and vice versa. A multidisciplinary group collated an outline of both pain and opioid management for time-poor GPs which is freely available at https://www.nps.org.au/australian-prescriber/articles/prescribing-wellness-comprehensive-pain-management-outside-specialist-services