Victoria first state to adopt mandatory prescription monitoring

Morgan Liotta

31/03/2020 4:23:50 PM

From 1 April, all prescribers in the state will be required to view patients’ prescription histories.

Doctor checking script at computer
Victoria is the first state to adopt a mandatory real-time prescription monitoring system.

Victorian GPs and other prescribers will be mandated to view patients’ prescription histories in SafeScript prior to writing or dispensing a prescription for a medicines monitored through the system, in a bid to reduce potential harm from medication misuse.
Victoria is the first state to adopt a mandatory system.
SafeScript assists healthcare professionals with identifying high-risk patient circumstances, but does not prevent them from prescribing or dispensing a medicine they believe is clinically necessary.
There were 3395 authorised prescribers of opioid pharmacotherapy drugs in 2019.
Dr Rob Hosking, Chair of RACGP Expert Committee – Practice Technology and Management (REC–PTM), told newsGP Victoria mandating of SafeScript will ‘absolutely’ help push for a nationwide adoption of prescription monitoring.
‘Already there is pressure from GPs in other parts of Australia who have heard about Safescript to adopt real-time prescription monitoring in their state. [For example,] Queensland is adopting an almost identical system,’ he said.
‘The key benefit is that it exposes the patient’s list of prescriptions and dispensed medications for the monitored medications regardless of where they have attended.
‘This provides GPs with the reassurance that what the patient is telling them is legitimate ­­– hence it reduces doctor shopping and exposes inappropriate use of these medications.’
Dr Hosking believes SafeScript also allows ‘more relaxed’ consultations with patients who rarely use these medications but occasionally find them beneficial – for example, diazepam intermittently for severe anxiety or oxycodone for acute flare-ups of back pain – meaning there are fewer confrontations with unsuspecting patients who have grown accustomed to regularly obtaining medication inappropriately.

Dr Hosking also identifies some issues of prescription monitoring systems across jurisdictions. The ACT and Tasmania currently have non-mandatory local systems.
‘Some systems currently in use in other states [and territories] are not mandated and are also not very user friendly, so they are not widely used,’ he said.
‘Safescript is integrated into general practice software and works mostly well ­– although there could be improvements in the user interface.’
For GPs to best assess and manage patients requesting drugs of dependence, Dr Hosking says there is a huge amount of information and advice available.
‘In many cases Safescript can be used to start the conversation about helping the patient manage their pain and/or their addiction, if they have one,’ he said.
‘In Victoria there has also been extra funding of services to help manage cessation of inappropriate use.’

With the current coronavirus pandemic, Dr Hosking assures that Safescript will remain active to assist GPs; however, he cautions there may be challenges for GPs managing patients and prescribing medications via telehealth consultations.
‘Prescribing controlled substances and pain management is challenging during face-to-face consultations, and will be more so if using telehealth,’ he said.
‘Many practitioners will prefer to see these patients face-to-face after appropriate screening for respiratory conditions if they are unstable in their dosing.
‘However, patients who have been on these controlled medications long term, and are stable, will be able to be managed quite easily and safely via telehealth.’
The new challenge with these patients will be how to manage getting the prescription to the patient or pharmacy and how the patient will obtain the medications, Dr Hosking outlined.
Standard procedures have been adjusted in light of coronavirus, including procedures prior to prescribing or supplying medicines to patients.
The Victorian Government has announced that prescribers will not be required to apply for a Schedule 8 treatment permit for non-drug-dependent patients for the next six months, but instead check SafeScript. Practitioners will need to apply for Schedule 8 treatment permits for drug-dependent patients, including opioid replacement therapy.
During the pandemic, health practitioners should take all reasonable steps to access SafeScript, as it is a very effective in providing up-to-date information about a patient’s prescribing and dispensing history, the State Government stated on its website.
The SafeScript system monitors prescription medicines that are causing the greatest harm to the Victorian community, based on the latest research and recommendations from an expert advisory group. Medicines that are monitored include:

  • all Schedule 8 medicines
  • benzodiazepines, such as diazepam
  • ‘Z-drugs’ (zolpidem, zopiclone)
  • quetiapine
  • codeine-containing products. 
RACGP resources  
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Dr M Isaac   1/04/2020 10:43:04 AM

Its great we have a system to check past prescriptions history but ..
1- Slightly time consuming
2- The system doesn't include medication like Tramadol which is a bit surprising! and lots of patients on Tramadol for no good reason apart from addiction basically. Other medicines are Lyrica , Duromine .
3- Including a small dose of codeine 9 mg in safe script is a bit odd and bizarre and it shouldn't be off the shelf , they should have kept it as pharmacy only medicine.

Well done Victoria !