RACGP launches benzos guide, calls for real-time monitoring

The Royal Australian College of General Practitioners (RACGP) has repeated its calls for the immediate roll-out of a real-time prescription monitoring system as it launches a new guide on prescribing benzodiazepines.

The guide focuses on patient-centred care, accountable prescribing and harm reduction for the drug class, of which seven million prescriptions are written each year.

RACGP president Frank Jones said although benzodiazepines had been associated with both benefits and harms for patients, their use had led to growing concern about the harms associated with both authorised and unauthorised use.

“As GPs we need to be vigilant in identifying patients who may be misusing or abusing benzodiazepines because this can become a long-term and distressing problem,” Dr Jones said in a statement.

“Patients who have a substance use disorder may ‘doctor shop’ to gain prescriptions and increase their use and dosage. When taken in combination with other substances such as opioid medications, illicit drugs and alcohol, this can result in death.”

The release of the guide coincides with a recommendation from a Queensland coroner on Monday that real-time monitoring systems be introduced following an inquiry into the death of a Toowoomba nurse from an overdose of the opioid painkiller fentanyl.

Combinations of opioids with Schedule 4 drugs like benzodiazepines have been cited in a number of cases over the last decade of accidental overdose, leading to repeated calls for systems to be introduced to reduce doctor shopping.

Dr Jones said the guide should help reduce patient harm associated with benzodiazepine misuse but broader issues beyond the control of the RACGP also need to be addressed.

“There needs to be an immediate rollout of a real-time prescription drug database, something the RACGP has long called for,” he said.

“There is also the need for consistency across states when it comes to laws and definitions regarding drugs of dependence because current variations complicate and confuse health professionals.”

While the RACGP, the Pharmacy Guild and the AMA all support the introduction of a national system that can be used by both doctors and pharmacists such as the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system, there are some immediate options that doctors and pharmacists can take:

GPs who use the MediSecure electronic prescription exchange will soon be able to use its Dr Shop functionality. This will allow doctors to check in real time if a patient has been prescribed Schedule 8 or Schedule 4 drugs in the previous 90 days.

GPs and approved pharmacists can also register for Medicare's prescription shopping program, which includes a 24-hour Prescription Shopping Information Service (PSIS) and a Prescription Shopping Alert Service.

GPs are provided with a statement as to whether their patient meets the criteria of a prescription shopper, with patient summary reports available on those who do. A prescription shopper is defined as anyone who, within a three-month period, has been supplied with PBS items prescribed by six or more different prescribers or a total of 25 or more target PBS items.

Several states run their own programs, such as Queensland's Monitoring of Drugs of Dependence System (MODDS), although like ERRCD these are often restricted to Schedule 8 drugs and do not include Schedule 4 drugs like benzodiazepines.

The national roll-out of ERRCD, based on Tasmania's DORA system, was first mooted back in 2012, but as Pulse+IT reported in March last year, there are a number of hurdles the states and territories must overcome before the system can be used.

NSW seems to be the furthest along the road to implementing ERRCD in the big states, but it is Victoria which has been the most vocal about its introduction, with the AMA repeatedly stressing its urgency.

Posted in Australian eHealth


0 # Steve Hambleton 2015-07-30 10:17
GPs and pharmacists who interact with the national eHealth infrastructure (PCEHR soon to be My Health Record) can benefit from Medisecure and other compliant software to help them provide comprehensive patient care. Best Practice and Medical Director already are capable of uploading to the National Prescribing and Dispensing Repository. It's not the whole answer but its a big step in the right direction.

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