Real-time prescription monitoring: helping people at risk of harm

Abstract

Misuse of opioid analgesics and other psychoactive medicines is a serious and increasing problem in Australia. Measures are being taken to try and prevent this progressing to a public health crisis like the opioid overdose epidemic seen in the USA. One measure is real-time prescription monitoring. This provides real-time information about the patient's supply of psychoactive medicines which have a high risk of being misused. Having identified a patient at risk, many factors may delay appropriate management or result in the patient being discharged from care. These factors include subconscious negative stereotyping, a focus on preventing 'doctor shoppers' diverting psychoactive medicines, and a fear of sanction by regulators. The Medical Board of Australia provides guidance about good practice. Patients should be treated with respect, free from bias and discrimination, and without prejudicing care because of the belief that their behaviour has contributed to their problems. seeking psychoactive medicines for their intoxicating effect or for trafficking. 2 Trust is basic to the doctor-patient relationship. When this is exploited by a drug-seeking person it may cause negative feelings and indiscriminate refusal to continue treatment for other patients assumed to be fraudulently seeking prescriptions. The focus on preventing 'doctor shoppers' may influence this attitude but, like any other medical condition, patients with multiple providers will benefit from a patientcentred approach. Escalating opioid prescribing There was a 15-fold increase in the supply of prescription opioids between 1992 and 2012. 3 During this time several new, potent opioids and many new formulations were marketed in Australia. Approximately three million Australians now use opioids each year. About 2.5 million report lifetime non-medical use of pharmaceutical drugs. In 2016 more than 700,000 Australians used opioid analgesics non-medically to achieve a drug effect. 4 Every day there are nearly 150 hospitalisations, 14 emergency department presentations and three deaths involving opioids. 5 Increasing numbers of people are being treated in alcohol and drug clinics or being prescribed medicines to treat pharmaceutical opioid dependence. Opioids and benzodiazepines are commonly involved in overdose deaths. Non-medical use of opioid

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

“…Other interventions may also help reduce the number of BZD prescriptions sought by patients and prescribed by GPs, such as reducing pack sizes where possible, increasing the availability of non-drug interventions for insomnia management 45 , and introducing real-time prescription monitoring to identify patients who visit multiple doctors for scripts. 46 S2: Benzodiazepines, z-drugs, and non-benzodiazepines prescription (total number of prescriptions and crude rates per 1,000 consultations) among patients regularly attending Australian general practice, 2011-2018 Supplementary Table S3: proportion of incident prescriptions of benzodiazepines, z-drugs and non-benzodiazepines with an incident insomnia diagnosis among patients attending general practice every-year from 2011-2018 Supplementary Figure S1: Proportion of overall benzodiazepines, z-drugs and nonbenzodiazepines scripts, written with more repeats than recommended by guidelines. Australian general practices, 2011-2018 * Results adjusted for age, sex.…”

Substances Detected During Coroner Postmortem Toxicology Analyses in Poisoning- and Nonpoisoning-Related Suicides

“…Up-scheduling medicines to prescription only and legislating stricter therapeutic indications can reduce access to toxic medicines. On a patient level, real-time prescription monitoring has been implemented in many parts of the world and should be used by health care practitioners to help reduce problematic medicine misuse . Patients with identified suicide risks should be prescribed the less toxic agents as first-line treatment (ie, SSRIs in preference to TCAs) or treatments such as long-acting antipsychotic depot injections, which remove the means for self-poisoning.…”

Trends and Associates of Non-Medical Prescription Opioid Use in Australia

“…The states and territories have been adopting real-time prescription monitoring system which provides the patient history of opioid prescriptions to prescribers, to prevent people with multiple prescribers to obtain excessive amount of opioid medications. The effectiveness of the prescribing monitoring system remains uncertain [10,11], with concerns over unintended stigmatisation of patients which may jeopardise their treatments [10]. Further assessment and improvement are needed to enhance patient outcome and safety.…”