A recent inquest into the deaths of four patients from overdoses
to prescription painkillers has elicited further calls for a real-time
prescription monitoring system and mandatory education for GPs on prescribing
In all four cases, the patients visited multiple GPs to
obtain prescriptions, prompting the Queensland coroner to call for the
implementation of a real-time prescription monitoring system over the next two
years. The coroner also encouraged Queensland Health to provide further
education on prescribing painkillers for GPs.
there is a lack of effective, independent and mandatory clinical education and
support to GPs," the coroner said, in response to a number of the doctors
explicitly stating during the inquest they weren’t educated on prescribing
However, while the courts have highlighted the growing
prevalence of prescription drug misuse and the need to introduce law reforms to
address it, a national real-time prescription monitoring system is estimated to
still be five years away.
Currently more people in Australia die from prescription
drug use than illicit drug use. Between 2011 and 2015, 2,145 overdose deaths
occurred from prescription opioids while 985 deaths were due to heroin
according to Australia’s Annual Overdose
Report 2017 by the Pennington Institute. Despite this, the uptake on
real-time monitoring services by state governments has been slow, until
recently. It is something Avant has been advocating
on behalf of our members, calling for reforms to improve the way drugs of
dependence are prescribed, monitored and regulated.
Implementation across the states
first state to implement a real-time prescription monitoring system in 2011,
known as DORA, to monitor the prescription of Schedule 8 medicines.
to implementing a real-time service, as a result of recommendations made across
21 coronial inquests since 2012. The system will make it mandatory for doctors
to check prescription history through its portal, SafeScript, before being able
to prescribe high-risk medicines and will be rolled out at the end of 2018.
South Australia: Premier
Steven Marshall announced that SA would implement a real-time system as part of
his election campaign last year. An implementation date is yet to be confirmed.
ACT: A nine-year
inquest involving a prescription drug-related death in the ACT has led to some
positive progress in this area, with a bill introduced in May 2018 to establish
a voluntary real-time service.
NSW: During an
inquest in May this year, NSW health authorities stated they have no timeline
for implementing a real-time monitoring service despite the state government
committing to do so.
Western Australia: The
state is looking to roll out a real-time prescription monitoring system by the
end of 2018.
Northern Territory: The
Northern Territory has been utilising real-time information software retrieval
systems since 2015.
In April 2018, the Health Council of the Council of
Australian Governments confirmed that a national real-time system would be
established. The federal system will collate data from all state systems to
effectively monitor prescriptions across state lines.
Your legal obligations
The legal obligations of doctors differ slightly across states
and territories, so familiarise yourself with the regulations where you
practise. Generally though, you require approval from the relevant state or
territory authority if you wish to prescribe a drug of dependence:
- to a patient for more than two months (this timeframe includes prescriptions by previous doctors)
- if the patient requiring the drug is considered “drug dependent”
- before prescribing certain drugs, for example, amphetamines or methadone.
If in doubt, contact your local authority for further
information, or Avant for advice.
Should you or
Drug-seeking behaviour by patients is often sophisticated,
manipulative and demanding. Familiarising yourself with these behaviours can help
you identify patients seeking drugs for the wrong reasons and decide whether
you should prescribe them medication.
The Royal Australian College of General Practitioners
outlines some of these behaviours in their clinical
guidelines. These include:
- aggressively complaining about needing
- frequent unscheduled clinic visits for early
- frequently calling the clinic
- unwilling to consider other medications or
- pattern of lost prescriptions
- claiming to be on a waiting list or unable to
afford dental work and needing to manage pain.
If you suspect that a patient is seeking drugs for the wrong
reasons, some strategies you could use to minimise the risk a patient may abuse
or misuse the drugs include:
- dispensing controlled or smaller quantities of
- setting up specific dispensing arrangements with
their pharmacy (also noted on the prescription)
- informing patients that call up the practice to
get top ups or because they lost their script, to see the GP in person instead
- referring the patient to a pain management
specialist clinic, addiction medication specialist or for a psychiatric
consultation, where appropriate, to provide a second opinion on prescriptions
and advise on other treatment.
You may also be able to obtain a fuller picture of the
patient’s habits and prescriptions outside your practice by calling Medicare's
Prescription Shopping Information Service, which is available 24 hours a
day, seven days a week on 1800 631 181. It’s important to note that patients
will only be flagged as a doctor shopper if they have visited six or more
doctors and received 25 prescriptions from these doctors in total. Therefore, only
frequent drug-seeking behaviour is identified. The Service also doesn’t monitor
private scripts or those from the Department of Veterans’ Affairs.
Key things to keep
- Be cautious when prescribing drugs of dependence.
- Familiarise yourself with drug-seeking
- Make the most of services that can help you
identify drug-seeking behaviour.
- Employ strategies to minimise the risk of a
patient misusing or abusing drugs.
- Understand when a permit is required for
prescribing drugs of dependence.
- Refer the patient to a specialist for further
treatment if appropriate.
For more information, download our factsheet Prescribing drugs of dependence or complete our eLearning course, Prescribing: principles and practices.
To speak with an expert for advice regarding prescribing drugs of
dependence, call Avant’s Medico-legal Advisory Service (MLAS) on 1800 128 268, available 24/7 in emergencies. MLAS can also be contacted via email at firstname.lastname@example.org.