Time for real-time prescription monitoring

Real-time prescription monitoring

It’s a sobering fact: more people die from drug overdose than road traffic crashes.

Perhaps even more concerning is that most of these overdose deaths in Australia are not caused by illicit drugs, but by the fatal mixture of two or more pharmaceuticals – often medications I and my colleagues prescribe to help people improve the quality of their lives.

Take-home message one: The combination of opioids (like oxycontin) and medications such as benzodiazepines (e.g. valium) can be fatal – even more so if mixed with alcohol.

Dealing with drug dependence

Abuse of prescription drugs is a big problem and doctors and pharmacists are often unaware that some of their patients collect prescriptions from several prescribers and pharmacies. This can go unnoticed because our computer systems are not yet linked and the reporting systems have flaws.

For several years the RACGP, AMA and other health bodies have called for the introduction of Australia-wide Electronic Reporting and Recording of Controlled Drugs (ERRCD). Coroners have also been advocating fiercely for an ERRCD system.

Prescribers and dispensers should be able to access and share prescription information but this has only been happening in real-time in Tasmania.

Since 2009 doctors and pharmacists in Tasmania can access prescription information if there is a legitimate clinical need, via a secured, encrypted website. The information includes what opioid medications have been dispensed and when, and if there are concerns about drug dependence or ‘drug seeking’ behaviour.

The Tasmanian real-time prescription monitoring system has stopped doctor-shopping for restricted drugs. Similar data comes from overseas: New York has seen in a 75% drop in patients seeing multiple prescribers after the introduction of ERRCD.

Some sources claim the Tasmanian system has reduced opioid-related deaths, although it has been argued we need a better way of analysing prescription drug deaths.

ERRCD is an essential tool to help prescribers and dispensers, but is only one part of the solution to reduce opioid prescription misuse. We also need to review how we look after at-risk patients, including those living with mental health problems or substance use disorder.

Road to recovery

Chances are that I may actually not improve the quality of my patients’ lives by prescribing opioids or benzodiazepines long-term. There are drawbacks: side effects, risk of dependence, serious bodily harm and death. Occasionally the drugs can make the pain worse, a phenomenon called opioid-induced hyperalgesia.

Take-home message two: There is limited evidence of the long-term efficacy of opioids for the management of chronic non-cancer pain.

Some have argued that opiates such as Endone (oxycodone) have become the new paracetamol and that we also need to reappraise the treatment of pain in the acute setting.

GP teams, allied health practitioners and pharmacists will play a crucial role to help tackle the issues around drugs of addiction – while supporting their patients at the same time. Sometimes input will be required from addiction, mental health or pain disciplines.

Many resourcestools and education opportunities are available to assist doctors. Meanwhile, state governments need to get on with the much-needed introduction of real-time prescription monitoring programs that will ultimately connect into a national network.

7 thoughts on “Time for real-time prescription monitoring

  1. Well done on your Doctor’s Bag blog post “Time for real-time prescription monitoring“. I proposed two or three years ago that every time that another death occurs that involves prescribed opiods (which we know often involves the patient taking other drugs including alcohol), the RACGP should put out a media release with the new count of the number of such deaths that have occurred since the States said that they would implement real time monitoring of opiod prescriptions.

    Liked by 1 person

  2. Dr Frank’s suggestion has much merit. Coroners’ reports seem to go into the ether and have no effect. Real time monitoring will eventually be more effective. But my 30 year old take home message is: prescription prescribers who fail to pick up a doctor shopper are either irresponsible (give them a script and get rid of them) or diagnostically bereft. Their constant defence in Coroners’ courts is about the defects of the prescription shoppers’ line that they have not tried to access.

    Liked by 1 person

  3. Reblogged this on Dr Thinus' musings and commented:

    This is so needed and the overuse in the acute setting, especially in hospitals is so true. In busy EDs and wards it is simply the easy answer – zonk them out with an Endone and they don’t bother anyone or, even better, can be sent home “pain-free” for the GP to pick up the pieces and sort out the cause of the pain.
    Or, sadly with some revolving door situations the addiction

    Liked by 1 person

  4. Pingback: Re-Blogging: “Time for real-time prescription monitoring — Doctor’s bag” | Dr. Tavares' Blog on Patient Safety and Mental Health

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