Getting real (time) about prescription monitoring

03 August 2018

Following a joint inquest involving four deaths involving prescription opioids and so-called doctor shopping,1 a Coroner has recommended that Queensland Health urgently consider and determine how a real-time prescription monitoring system could be implemented in Queensland.

Why was a real-time prescription monitoring system recommended?

Data provided by Medicines Regulation Queensland at the inquest suggested the annual number of prescriptions for opioids by general practitioners has increased from 754,200 in 2006 to 1,593,344 in 2012. There has also been an 846% increase in the base supply of oxycodone since 2010 and a three-fold increase in the prescribing of the synthetic opioid fentanyl between 2006 and 2010. Coronial statistics indicate an annual death toll in Australia from prescription opioids of 1500 people and increasing.

Each of the four deaths investigated by the Coroner involved abuse of prescription drugs. Common to each of the deaths was a lack of awareness by the prescribing doctors that patients were seeing other doctors for prescriptions and having these prescriptions dispensed at different pharmacies to avoid detection.

Each of the general practitioners involved in the inquest, experts called and stakeholders such as the AMA, RACGP and Pharmacy Guild of Australia agreed that there is an urgent need for access to real-time prescription monitoring.

What will change with a real-time prescription monitoring system?

Reporting of prescription drug dispensing is currently regulated separately by each State and Territory. Common across all jurisdictions is a requirement for pharmacists to record transactions for all schedule 8 (controlled) drugs in a register.

Tasmania and the Northern Territory are currently the only jurisdictions to employ a real-time prescription monitoring system for controlled drugs. Victoria is presently developing its own system modelled on the Tasmanian software.

In Queensland, electronic records of dispensing of all controlled drugs are uploaded on a monthly basis by pharmacies to a monitoring system maintained by Medicines Regulation Queensland (now Medicines Compliance and Human Tissue Unit). This information is used to monitor at-risk patients but is not presently available for doctors and hospitals to view.

Since at least July 2010, the Australian Government has supported the development of a nationally consistent system to collect and report data on the dispensing of controlled drugs through a proposal referred to as the Electronic Recording and Reporting of Controlled Drugs (ERRCD) initiative.

The ERRCD software is designed for pharmacists to upload data at the time of dispensing, which is then available to medical practitioners and pharmacists through an online viewer.

Why has a real-time prescription monitoring system not been introduced earlier?

While it is broadly agreed that a nationally consistent approach to prescription monitoring is needed, coordinating such a system across jurisdictions has proved difficult. While the Commonwealth Department of Health has built and designed the ERRCD system software, its position is that the State and Territory governments are responsible for implementing the system within their own jurisdiction, including meeting the cost of implementation. Evidence was given during the inquest that a Queensland Department of Health review of the ERRCD found that there would be significant challenges to implementing the ERRCD system in Queensland in the absence of the Commonwealth or some other entity coordinating the development, implementation, maintenance and upgrades. The absence of certainty as to whether the ERRCD will become the prevailing national system has meant that investment in upgrading the current monitoring system in Queensland to a real-time model has been forestalled.

In April 2018, the Council of Australian Governments Health Council agreed that different state systems can be used as long as they are interoperable within a national system.

Some commentators have pointed out that the introduction of a real-time prescription monitoring system is just the beginning of treating the opioid epidemic. The risk of dependent patients substituting prescription drugs for illicit drugs is real. Data out of the United States suggests that after OxyContin was reformulated to prevent it being crushed and snorted to extract its active ingredient, there was a one-for-one replacement of deaths by heroin.2 The increased detection of drug-dependent patients brought about by a real-time monitoring system will test the resourcing and coordination of services for treating and managing those patients.

This article was written by Josh Liddle, Law Grad and Katharine Philp, Partner.

1 Inquest into the death of William John House, Vanessa Joan White, Jodie Anne Smith and Daniel Keith Milne delivered 21 May 2018.
2 Seeking the right prescription, The Economist, 2 June 2018.

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