More governments are hopping on board the prescription monitoring train. Recently, Queensland joined Victoria in passing legislation that will enable a real-time database, which will monitor the prescribing of dependence-forming medicines, such as sedatives, sleeping tablets and some pain medications, and be searchable by pharmacists and doctors.
There are undoubtedly benefits to having more information on medication and prescribing data, especially for high risk medications like Schedule 8 and some Schedule 4 medicines.
Monitoring prescribing seems imperative when you consider recent mortality data, especially the new Australian Bureau of Statistics report released just yesterday, which finds that opioids accounted for just over 3 deaths per day in 2018. Most unfortunately perhaps is the fact that the majority of these opioid-induced fatalities (over 80%) were unintentional overdoses, involving the use of pharmaceutical opioids, often in the presence of other substances.
If you drill down into the data, nearly 89% of the opioid related fatalities occurred in the setting of other substances. Benzodiazepines were the most common drug to appear alongside opioids with 63% of deaths having both drugs present. Approximately one-quarter of opioid-induced deaths also recorded an anti-depressant or anti-psychotic drug.
Polypharmacy, or multiple medication use at the same time, is therefore the crucial issue in minimising opioid related harm. Which is why monitoring of scripts, to ensure that people are not on combinations of these potentially fatal medications together makes sense, and why Real Time monitoring seems like such an attractive option.
Before our monitoring train gathers more passengers, we must stop and think about an even more vital element: where is this train heading? The end goal is about reducing harm, especially for people living with multiple complex chronic conditions that require all these medications.
Our main concerns remain around the outcome of monitoring, the consequences for the consumers. What is a doctor or a pharmacist to do when they encounter people who need multiple medications? Refuse to prescribe? Refuse to dispense? What are the alternatives?
We need to stop looking for the easy, quick fix solutions. The problem is hard, the solutions vary and can be difficult to access. Pain management needs investment in a range of treatments, that suit the person, not the existing health system. Under our promise of universal healthcare, every person should have a choice: the choice to get a referral to physiotherapist if that is what will help them with their function and mobility; the choice to see a psychologist who may be able to help with identifying and developing skills to change negative thoughts; the choice to be referred to a pain specialist who knows that the management of severe and persistent pain problems requires the skills of more than one medical group, the choice to see a pharmacist who can guide them through their medication regime, have an exercise plan that can help with strengthening their body, talk to a nutritionist to check their diet.
Most importantly, people who experience ongoing persistent pain all want to talk to a health professional that both acknowledges and understands their pain, not someone who is forced by punitive regulatory systems to reduce their access to medications and ignore their pain.
So if we want a ‘Real’ solution, we do need more governments and health providers on board the monitoring prescribing train, but we also need to make sure we have laid tracks that will take us where we all want to go.
This means doing the hard yards, investing in patient centred care that understands the unique needs of each and every person living with pain.
Anything less risks leaving us sitting on a train, stuck in a tunnel heading nowhere.