Opioid deaths show importance of prescription monitoring: Coroner

Coroner reports into the deaths of two women in Tasmania have underlined the importance of a prescription monitoring system.
 
Both women were prescribed opioid drugs before they died in 2018. While the coroner, Olivia McTaggart, said the exact cause of death was unable to be determined in each instance, mixed drug toxicity was cited as likely.
 
Ms McTaggart also found that prescribing authority was not up to date with the state’s Pharmaceutical Services Branch (PSB) in either instance and said overwork could have been a factor.
 
‘Unfortunately, coroners often encounter cases where doctors regularly prescribe Schedule 8 substances without current authorities from PSB to do so, no doubt due to workload issues or insufficient attention to the expiration of the authority,’ the report reads.
 
Ms McTaggart said that all prescribers of Schedule 8 substances ‘should ensure that they are in possession of current authorities from PSB in respect of their patients’.
 
She also wrote that prescribers should register with the state’s real time prescription monitoring service, known in Tasmania as the Drugs and Poisons Information System Online Remote Access (DORA).
 
Ms McTaggart urged doctors to ‘have working knowledge of its use and access it when needed to enhance safe prescribing practices’.
 
The DORA system is not mandatory for GPs in Tasmania and is due to be phased out this year as part of the nationwide plan to install real-time prescription monitoring systems that can be used across different jurisdictions.
 
RACGP Tasmania Chair Dr Tim Jackson agrees on the importance of having an authority system, while describing the current one as ‘a bit clunky’.
 
‘It helps remind the patient more than anything that the drugs they’re taking have potential for harm and addiction and need to be taken seriously,’ Dr Jackson told newsGP.
 
‘[It also] helps the GP managing the use of those drugs in those particular people.’
 
He says he finds DORA of particular use when assessing prescriptions for any new patients or when he suspected someone of doctor-shopping.
 
Both women subject to the recent coroners’ reports had established GPs.
 
Dr Jackson also agrees that overwork is a risk.
 
‘[Requiring] authorities for opioids and dangerous drugs is a good system… and it helps us educate patients. That’s what I would probably call good red tape,’ he said.
 
‘But there’s a lot of other red tape that we have to do that really is not a great use of our time and it’s very frustrating.
 
‘At the end of the day, we’re trying to put our patients first with their clinical needs.
 
‘Then we all do our paperwork when the patients aren’t with us – that’s generally after hours or weekends, lunchtimes. The more that can be rationalised, the better really.’
 
An addiction medicine specialist consulted by the coroner said adequate support needs to be in place for the system to have the most impact.
 
‘For this regulatory monitoring to be most effective [there] needs to be clinical support for clinicians such as networks for ongoing prescriber support and engagement, advice, and review readily available as well,’ they said.
 
The national real-time prescription monitoring system has been planned for several years, with its original launch date significantly delayed.
 
Its implementation was first recommended in Australia in 1980 by the Royal Commission Inquiry into Drugs.
 
The DORA system in Tasmania was the first real-time prescription monitoring system to be installed in the country, while Victoria was the first state to adopt mandatory real time prescription monitoring in 2020.
 
Most states now have systems in place where prescription information can be shared on a national data exchange. The ACT’s new system came online this month, while the new TasScript system for Tasmania is scheduled to go live later this year.  
 
The push for prescription monitoring has increased in recent years as the number of deaths involving prescription drugs has risen.
 
Opioids are the most common drug involved in drug induced deaths, according to the Australian Institute of Health and Welfare (AIHW). Drug types such as heroin, opiate-based analgesics including codeine and oxycodone and synthetic opioid prescriptions such as tramadol and fentanyl were found in 1129 such deaths in 2019, it reports.
 
That figure accounted for slightly more than 60% of the total 1874 drug-induced deaths that year.
 
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