New prescription monitoring system reveals thousands at risk

A newly implemented system monitoring prescriptions of potentially dangerous drugs has found more than 27,000 people are at increased risk of harm or overdose.

Key points

Key points:

  • First month of Victoria’s SafeScript program shows thousands are at risk of harm
  • System provides prescription information to enable safer supply of high-risk medicines
  • Experts are calling for national roll-out to help tackle opioid abuse

New data from the first month of Victoria’s real-time prescription monitoring system has revealed nearly 15,000 people were red-flagged for visiting multiple doctors or pharmacies, and a further 13,000 people were recognised as taking excessive doses or risky combinations of medicines.

The SafeScript program, which allows doctors and pharmacists to access a central database of prescription records, was rolled out across Victoria on April 1 following a successful trial last year.

Over the past decade, the number of deaths involving prescription medicines has significantly increased, and in Victoria, now exceeds the road toll.

The program is designed to help GPs and pharmacists make safer decisions when it comes to prescribing and dispensing high-risk medicines, and help identify patients who are developing signs of dependence.

The system monitors prescription medicines commonly implicated in drug-related deaths such as morphine and oxycodone, as well as benzodiazepines, which are typically prescribed to relieve anxiety and help people sleep.

Each time a monitored drug is prescribed or dispensed, it is recorded in the system, said program director Matthew McCrone.

Health practitioners are notified when a patient has previously been prescribed a medicine, is taking excessive doses or risky combinations of medicines, or is visiting multiple providers.

“Each time a doctor goes to prescribe, or a pharmacist goes to dispense, that information is available to them,” Mr McCrone told RN’s Health Report.

Improving quality of care

So far, 11,000 GPs and pharmacists have registered for SafeScript in Victoria, which from April 2020 will be mandatory for health professionals to check before writing or dispensing prescriptions for high-risk medicines monitored through the system.

The initial uptake has been encouraging, but Mr McCrone said the real challenge was to ensure health professionals were equipped with the necessary skills and knowledge to properly assess and support people, especially those at risk of dependence.

“This is why as part of the implementation we have rolled out statewide training,” he said.

“It’s to refresh those important clinical skills about how to prescribe safely, how to deprescribe if necessary, and how to manage pain outside of pharmacotherapies.”

The Victorian Government has invested almost $30 million into the program, which includes a telephone hotline for GPs and pharmacists to seek clinical advice regarding patient care.

In addition to refreshing clinical knowledge, Mr McCrone said it was critical healthcare professionals developed counselling skills to manage sensitive conversations with patients about prescription medicine use and potential dependence.

Training was equally important to ensure healthcare professionals didn’t inadvertently pass on “the wrong message”, or unnecessarily cut people off from their medications, said Suzanne Nielsen, deputy director of the Monash Addiction Research Centre.

“We really want to avoid the situation that’s been reported fairly widely in the US where there’s a range of chronic pain patients that haven’t been able to access medication that they’ve been on long-term,” Dr Nielsen said.

She said there were a number of reasons why people might visit multiple providers, consume high doses, or take certain combinations of prescription medicines — not all of which warranted concern.

“If a healthcare professional gets an alert with SafeScript, it’s really just a first step of trying to work out: how significant is the risk?” she said.

“It’s really a clinical tool to know you should check something, but it’s doesn’t necessarily mean that for every alert that something needs to change.”

Calls for national roll-out

Health professionals welcomed the increased access to information in Victoria and there are now calls for national scheme to be implemented.

“The Commonwealth has engaged the software vendor that developed the system for us,” Mr McCrone said.

“So, it will be available — the same functionality and technology as what we have delivered here in Victoria — and we just implore all the other states to come on board.”

But Dr Nielsen said it was important to first understand the outcomes of the SafeScript program before moving to a national roll out.

“In this initial phase, it’s very important that we are paying very close attention … What happened to these patients? Were they offered referrals? Did they need to have a change in their medication? Were they able to get appropriate care?” she said.

“This is a great chance for us to learn how to get the most benefit for patients out of these kind of systems without having some of the unintended harms.”

Australia would need to roughly double the number of drug and alcohol treatment services to meet current needs, Dr Neilsen added.

It’s a number that’s likely rise as more people are identified through SafeScript.

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