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RACGP recommends options for regulation of schedule 8 prescription opioids


Paul Hayes


9/03/2018 11:59:33 AM

The RACGP has made a submission to the Department of Health detailing its proposed options for the regulation of schedule 8 prescription opioid medicines.

The RACGP supports the implementation of a national real-time prescription monitoring system as part of a comprehensive approach to improved clinical governance.
The RACGP supports the implementation of a national real-time prescription monitoring system as part of a comprehensive approach to improved clinical governance.

‘The RACGP recognises the need for policy interventions to improve the use of opioids,’ RACGP President Dr Bastian Seidel wrote in the submission to Professor John Skerritt, Deputy Secretary for Health Products Regulation at the Department of Health (DoH).
 
‘The RACGP believes opioids have important clinical uses, and interventions to reduce harms are needed, but these should not impede therapeutic supply to those with approved indications.’
 
The submission outlines eight key options that the RACGP proposes could benefit the regulation of schedule 8 (S8) prescription opioid medicines:
 
Option 1: Three-day pack size for acute pain
The RACGP strongly supports smaller pack sizes, and believes three days of opioid medication is a reasonable maximal amount for acute presentations.
 
Option 2: Re-wording of the indications for S8
The RACGP supports a review of the wording for justification of prescribing, as this should be aligned with clinical guidelines.
 
Option 3: Restricting access to highest dose preparations to specialist authority prescribing
The RACGP believes specialist review is only warranted for patients with chronic non-cancer pain who are on >100 mg oral morphine equivalent daily dose (OMEDD), or patients on long-term opioids who have past or active substance use disorder, severe mental health issues (antipsychotic therapies), or who are using multiple psychoactive drugs.
 
Option 4: Strengthening of the Risk Management Plans for opioids products
The RACGP does not support a US-style approach of pharmaceutical company-delivered education and training, but rather an education program led by an organisation such as NPS Medicinewise.
 
Option 5: Warnings and labelling
The RACGP believes an emphasis on the risks of opioid medications to the consumer is appropriate and would be valuable in assisting GPs in explaining these risks to their patients.
 
Option 6: Incentives to develop new products for pain relief
As non-opioid alternatives to pain management are important, the RACGP believes some funding should be directed towards the development of non-pharmaceutical services (such as-evidence based physical treatments).
 
Option 7: Potential changes to use of appendices in the Poisons Standard to provide additional regulatory controls for strong S8 opioids
The RACGP does not support mandated education.
 
Option 8: Increase in healthcare professionals’ awareness of non-opioid alternatives in the management of chronic pain
The RACGP supports education and training activities for GPs to deliver improved chronic pain
management, and treatment for patients with substance-use disorders.
 
According to Dr Seidel, improved levels of clinical governance, including the implementation of a national real-time prescription monitoring system, would also be beneficial.
 
‘Good clinical governance around the use of opioids has been sub-optimal at all levels,’ Dr Seidel wrote. ‘Consistent policies and standards around the use of opioids in all states and territories would support a consistent approach to problematic prescribing.’
 
Email qualitycare@racgp.org.au for more information on the RACGP’s submission to the DoH.



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Cynthia Filipcic   13/03/2018 10:27:36 PM

I agree with the above submission.
I do not agree with the funding of pharmacists to 'manage' chronic pain.
What we really need is more pain clinics/better/easier access to pain specialists for those patients on large doses of opioids (often 'inherited pain patients'). These patients really need a good long-term therapeutic relationship to help wean them off their opioids. What their GPs need is easy access to a pain specialist for advice how to do this. Not a several month long waiting list, then a ridiculous 'education session' (which seems to be designed to put patients off) before they can even see a pain specialist. Time for these specialists to get out of their ivory towers and cone and help us in the real world! I think we should be able to have a monthly pain clinic run by GPs overseen by a specialist.


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