28 February 2018

ACT ramps up push for real-time monitoring

Addiction Drugs Pharmacy

ACT Health Minister Meegan Fitzharris has vowed to push for national real-time prescription monitoring, while rolling out a system to stop “doctor shopping”, in her jurisdiction this year.

Minister Fitzharris said she would use her role as 2018 chair of the Council of Australian Governments health ministers’ council to widen scrutiny of controlled pharmaceutical drugs.

By March 2019, doctors and pharmacists in the ACT would have access to real-time information to curb the illicit or excessive use of S8 medicines and possibly some S4 drugs, she said.

But she wants to see a nationally consistent set of rules, as called for repeatedly by coroners.

“This year I will chair the COAG Health Council and personally seek to advance national prescription monitoring,” she said.

The ACT’s move follows public concern over the 2010 death of a young Canberra man, Paul Fennessy, from positional asphyixia after an overdose of opioids and other drugs.

The case highlighted the apparent ease with which Mr Fennessy, 21, a polysubstance abuser with mental-health issues, was able to procure pharmaceutical opioids without the intervention of the health system.

Coroner Margaret Hunter found that in the period between December 2007 and January 2010, Mr Fennessy had used 18 different prescribing doctors and at least 18 dispensing chemists.

“He was recorded as having had at least four overdoses in 2009 despite undergoing detoxification programs and management of his drug issues,” she said in her findings in December 2016.

“It was clear from the evidence that his detoxification was marred by his inability to accept the rules in relation to bringing drugs into the detoxification and rehabilitation facilities, with the result that he was discharged without completing his rehabilitation.”

In January 2010, Mr Fennessy presented on two occasions to Canberra Hospital’s emergency department, the first time because he had ceased his medication and believed he was hallucinating and that he had had seizures, the coroner said.

“The second occasion arose as a result of a drug overdose where he was found unconscious and not breathing, whereupon he was resuscitated and admitted to The Canberra Hospital. It was later on, after he left the hospital, that he was found deceased.”

Writing in Fairfax Media earlier this month, Ms Fitzharris conceded that Mr Fennessy should not have “slipped through the cracks the way he did”.

So far, only Tasmania has real-time prescription monitoring in place, while Victoria is in the process of establishing a more ambitious stand-alone reporting system.

Since Tasmania adopted the DORA monitoring system in 2011, covering only opioids and alprazolam, deaths in the state related to pharmaceutical opioids have dropped from an average of 25 per year to 17.

ACT Health is already using the Drugs and Poisons Information System (DAPIS), on which DORA is based.

Using  the DAPIS database, the regulator identified 1400 patients in the nine months to May 2017 who were potentially procuring controlled drugs without authority or in excessive amounts.

It intends to add DORA, which stands for DAPIS online remote access, by March 2019, giving prescribing doctors, pharmacists and nurse practitioners a window on patients’ drug activity.

“DORA builds on the value of DAPIS as a public-health tool by equipping pharmacists and prescribers with improved information about their patient, in order that they may better detect and address risks of drug misuse or dependency before a prescription is written or dispensed,” Ms Fitzharris said.

“The scheme will cover controlled medicines classified under Schedule 8 of  the Commonwealth Poisons Standard.

“Consideration will also be given to enabling the option to declare some prescription only (S4) medicines as reportable as part of the process for developing the enabling legislation.”

The ACT Government committed $729,000 in its 2016-17 budget to this project.