Real-time drug monitoring not all good news?

3 minute read

Monitoring may make life easier for GPs, but will it help solve the drug problem?


Monitoring may make life easier for GPs, but will it help solve the drug problem?

Healthcare bodies have achieved the next step towards a national real-time drug monitoring scheme, but experts warn it may not be all it’s cracked up to be.

After Tasmania leading the way with a real-time prescription-drug system, and its announcement last week in Victoria, the RACGP is advocating for other states to quickly follow suit. It is hoped the $30 million Victorian scheme will save 90 lives over the first five years.

A live-monitoring system for prescription drugs has been the recommendation of 21 coronial inquests in Victoria since 2012, and has the support of medical bodies such as the RACGP and the AMA.

“An increasing number of people lose their lives in Victoria and in Australia through overdoses of prescription drugs, even more than through the scourges of illicit drug use or road accidents. It is an unnecessary tragedy,” said Dr Frank Jones, president of the RACGP.

However, Dr Alex Wodak, president of the Australian Drug Law Reform Foundation, said the evidence such programs were effective was mixed. Attempts to reduce demand were much more likely to be effective than reducing supply, Dr Wodak said.

“This is a market problem, with supply and demand components,” he told The Medical Republic.

“And the history of attempts to reduce supply is that the benefits are often pretty modest while unintended negative consequences are often quite significant.”

For example, the recent reformulation of oral prescription opioids, such as oxycodone, to make them tamper proof and less attractive to inject had led to an increase in the use of illicit drugs.

“We see at the Medically Supervised Injecting Centre in Kings Cross, that the percentage of people reporting injecting prescription opioids is falling, and injection of heroin is rising,” said Dr Wodak, a past director of the Alcohol and Drug Service at St Vincent’s Hospital in Sydney.

“This is scary, as at least when people inject prescription opioids they know the exact dose,” said Dr Wodak.

Measures intended to reduce supply also had the potential to interfere with the treatment of people with acute pain and cancer pain who had a legitimate need for the drugs.

“If the government was only going to do one thing, I would have preferred them to adequately fund treatment where the evidence is very strong for major benefits. For every one dollar spent on methadone, there is a saving of four to seven dollars,” he said.

In Victoria, around $7 million of the funding will go to training doctors, pharmacists and to help addiction counselling services for patients flagged by the new system, TMR understands.

Resources will also go to developing professional guidelines on safer prescribing, and training on how to use the software.

“This is expected to reduce the number of people taken to emergency departments with overdoses by more than 500 per year, and see a further 700 people a year referred to counselling to try and beat their addiction,” according to the Victorian Minister for Health, Jill Hennessy.

The program is set to start in 2018, and will allow doctors and pharmacists to have access to a live database, that would monitor the prescription of all Schedule 8 medication, and potentially some Schedule 4 drugs such as diazepam.

But no additional funding has been earmarked for increased resources for either addiction clinics or for opioid substitution programs, such as methadone and buprenorphine, TMR understands.

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