7 August 2017

Victoria goes it alone on real-time monitoring

Drugs TheHill

The Victorian government’s decision to go it alone with a mandatory real-time prescription monitoring for high-risk medicines has exposed some disarray in the plans for a national scheme.

Victoria’s Health Minister, Jill Hennessy, recently announced a $29.5 million plan to roll out the surveillance program to crack down on the misuse of dangerous prescription drugs within the next year, including $1 million to train doctors and pharmacists.

“In an Australian first, and following worldwide best practice, using the system will be mandatory for doctors and pharmacists before prescribing or supplying a high-risk medicine,” the state minister said in a statement.

As well as Schedule 8 drugs such as morphine and oxycodone, the new rules will apply to benzodiazepines, “Z-class” medicines taken for insomnia, and the anti-psychotic, quetiapine. Codeine will be added to the watch list at a later date.

The Victorian announcement on July 28 came the same day federal Health Minister Greg Hunt made a $16 million commitment to activate a national monitoring scheme, to begin next year, covering S8 drugs.

To date, real-time prescription monitoring operates only in Tasmania. However, that system, launched in 2012 as the forerunner of the commonwealth’s Electronic Recording and Reporting Controlled Drugs (ERRCD) system, is voluntary and confined to S8s.

Doctors have commended Victoria’s step, but they are in the dark as to how the state will manage the burden of a real-time mandatory system, including S4 medications.

Melbourne addiction medicine specialist, Dr Benny Monheit, said the tougher Victorian rules signalled a “new frontier” for Australia and the mandatory nature of the proposed system could present an enormous technology challenge.

It was also uncertain how many drug-dependent patients might be identified as a result, he said.

“We have been lobbying for this for years because of the deaths from poly-drug use, but now it’s coming closer to reality we are starting to assess the implications for workforce and for managing these patients,” he said.

Dr Nathan Pinskier, who chairs the RACGP’s e-health and practice systems committee, said doctors had been calling for a national script monitoring system for years, in line with coroners’ recommendations in several states. “It remains unclear how one state can run a monitoring system in isolation,” he said.

Details of the technology to be employed, and how clinicians will engage with real-time monitoring, are still under wraps.

According to the federal health department, all governments are still working towards an agreed national approach.

“The commonwealth funding is expected to cover the costs of maintaining national consistency in systems, supporting national governance arrangements, and further enhancements for real-time prescription monitoring, particularly capacity to integrate with prescribing and dispensing software,” a department spokeswoman said.

Among states that responded to requests for a progress update, South Australia Health said it had provided “in principle” support for a surveillance scheme. “We are committed to working co-operatively with the commonwealth and other states and territories to address the concerns around prescription drug abuse and will continue to consider options for implementing real time prescription monitoring in South Australia. However, funding is an issue.”

NSW Health said was “exploring the feasibility of implementing the national system to enable real-time monitoring by doctors and pharmacists” under a COAG approach.

That state adopted a customised version of the ERRCD system last year and has completed the consolidation and migration of historical records.

“This means NSW now has a system in place which has the capability to enable real-time prescription monitoring,” it said.

Western Australia also has a monitoring system in place, and Health Minister Roger Cook has expressed full support for a single national approach.

But Ms Hennessey was not for delaying. She said 372 Victorians had died from prescription medicine overdoses in the past year, including many “doctor shoppers”. The toll had far exceeded the state’s road deaths for five years in a row.

RACGP Victoria Chair Cameron Loy said it was “very pleasing” that Victoria was extending the monitoring scheme to include high-risk S4 medicines such as benzodiazepines, zolpidem, zopiclone and quetiapine.

“GPs in Victoria have been closely involved in designing and reviewing what will be Victoria’s new system because of the risks of prescribing addictive medications, not just for patients who are doctor shopping but also for patients we have been seeing for a long time,” Dr Loy said.