Progress made on national real-time prescription monitoring

Doug Hendrie

19/04/2018 3:06:51 PM

Australia is a step closer to achieving national real-time prescription monitoring, after federal and state health ministers agreed to push for a federated model.

Federal and state health ministers have agreed that different state prescription monitoring systems can be used as long as they are interoperable with a national system.
Federal and state health ministers have agreed that different state prescription monitoring systems can be used as long as they are interoperable with a national system.

Real-time prescription monitoring has been sought in Australia since 1980, when a Royal Commission into drugs recommended its implementation.
Dozens of coronial inquiries have supported the move to a real-time database monitoring prescriptions, which would make it harder for people to access dangerous quantities of addictive prescription drugs.
But the need has become increasingly urgent, with many more Australians now dying from legally prescribed opioid and benzodiazepine drugs than illegal drugs like heroin. More than 800 people die a year from prescription drugs.
The challenge has been getting Australia’s state and federal governments to agree on the model, with the most recent efforts under way from 2011.
At last week’s Council of Australian Governments (COAG) Health Council meeting, ministers agreed that different state systems can be used as long as they are interoperable with a national system.
The move is a compromise reached after Victoria decided to build its own system, SafeScript, rather than take up the Federal Government’s preferred option, an updated version of the Drugs and Poisons Information System Online Remote Access (DORA) system first trialled in Tasmanian clinics and pharmacies in 2012. SafeScript is expected to begin roll-out in September.
Since 2013, Australian states and territories have had the option to use the federal system, the Electronic Recording and Reporting of Controlled Drugs (ERRCD), but none have done so.
Not-for-profit organisation ScriptWise has long pushed for a real-time prescription monitoring system to reduce drug deaths. CEO Bee Mohamed told newsGP the latest COAG announcement is a welcome first step.
‘We’re living in Australia in 2018, and it’s really hard for doctors to know if patients have gone somewhere else,’ she said. ‘We know that there are areas of huge concern, particularly on the border between New South Wales and Victoria.
‘We need a national solution.’
But she said the Victorian system would be preferable to the currently proposed national system, as it was faster and better integrated with the software GPs and pharmacists already use.
‘Victoria’s system is the one we want as the national solution because it has minimal disruption for a GP – they don’t have to log in to a different program,’ she said. ‘We’ve seen SafeScript in trials and it’s literally seconds to see a record.’
Ms Mohamed said DORA suffered from a low uptake because it was more time consuming.
‘We believe the Commonwealth health department is open to conversations over which system should go national,’ she said.
RACGP President Bastian Seidel has road-tested DORA at his clinic in Tasmania’s Huon Valley. He said the system worked well as a way of seeing whether dispensing had been done appropriately, and to help patients who had run out of crucial drugs out of normal working hours.
As for which system he would want to use, Dr Seidel said he had no particular preference.
‘It’s very clear where we’re heading – but if each state is coming up with its own solution, we may as well make it nationally consistent. We welcome a national approach. It’s about time,’ he told newsGP.
Dr Hester Wilson, Chair of the RACGP Addiction Medicine Specific Interests network, welcomed the news from COAG. But she called for more training for GPs and pharmacists around how to treat people who would be flagged on the system as at risk of abusing prescription medicine.  
‘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 told newsGP.
Dr Wilson said that the common term ‘doctor shopper’ obscured a crucial divide between a small group of people who peddled a good story from doctor to doctor to access prescription medicines to on-sell for profit, and a vulnerable group who had real problems and were using these medicines to help with the pain.
‘These patients have complex health and welfare needs – mental health, homelessness, domestic violence, addiction. They have real pain in their lives,’ she said. ‘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.’

COAG-health-council Electronic-Recording-and real-time-prescription-monitoring Reporting-of-Controlled-Drugs safescript


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Sandra Kirby   11/10/2018 11:24:40 AM

Hello Doug
Could you tell me what, if anything is happening about the 2006 !!!! recommendation of the Victorian Government into Benzodiazepines which suggested contacting long term benzodiazepine prescribed patients to gently inform them of the inappropriateness of long term use and the damage done thereby? This was to be followed up by invitation to support for withdrawal including allied service provision for rehabilitation.
Sincerely and hopefully yours
Sandra Kirby