Crossing borders


There is a “pressing need” for real-time prescription monitoring in NSW, says coroner, following a man’s death after buying opioids in both ACT and NSW

NSW needs to urgently join Tasmania, Victoria and the ACT in implementing real-time prescription monitoring, the ACT Chief Coroner Lorraine Walker has said following another opioid-related death.

Jay Alan Paterson, 43, died in 4 September 2017 at Calvary Public Hospital in Canberra after experiencing a polypharmacy overdose related to opioid painkillers.

Mr Paterson had injured his knee and had extensive surgery in 2007 and 2008, for which he was prescribed Endone and OxyContin for the first time, as well as Quilonum and Stilnox to assist with sleep.

During this time he was working as an Australian Federal Police (AFP) agent.

He subsequently suffered a back injury in 2009 while undertaking a police training course, and resigned from the AFP in 2013.

Mr Paterson was formally diagnosed in January 2017 with PTSD as a result of incidents while in the AFP. He was prescribed propranolol for this condition.

The evidence showed he had also developed a physical dependence on, and a tolerance to, prescription opioid pain-killing medication due to taking medications on and off from 2007 until his death, the inquest found.

This was due to physical conditions that were causing him pain, for which he had not been able to find alternate ways to manage in the long term.

He had come to the attention of the ACT Chief Pharmacist in 2014 for engaging in drug seeking behaviour, although this was said to have ceased by mid- to late-2017 when he began seeing one GP practice regularly in Queanbeyan in NSW.

Mr Paterson had done this despite residing in the ACT, as a specialist had said it would be preferable for him to access the NSW public health system for pain management treatment.

Medical records showed that in the month of August 2017, Mr Paterson was prescribed 296 tablets of oxycodone – 240 OxyNorm capsules and 56 OxyContin tablets.

These had been dispensed at four different pharmacies, three of which were in NSW and one in the ACT.

It became apparent that he had misled the GP as to the amount of opioid medication in his possession, falsely reporting that medication had been stolen by a friend on one occasion and, on another, saying his wife had confiscated his medications.

Evidence suggested Mr Paterson had leveraged off the information disparity and differences in regulation between the two jurisdictions to obtain opioid medication more readily in NSW than he was able to access in the ACT, said the coroner.

Mr Paterson was found unconscious in his residence on 31 August 2017, following polypharmacy overdose – most likely oxycodone, paracetamol and propranolol – leading to liver and kidney damage. He eventually died from hypoxic-ischaemic brain injury.

“Delegates of the ACT Chief Pharmacist interviewed by coronial investigators, when shown Mr Paterson’s prescription record for 2017, said they considered Mr Paterson was engaging in drug seeking behaviour in 2017 and they had no visibility over what was occurring in NSW,” said Ms Walker.

“There is no real-time prescription monitoring system available in NSW at the present time, despite the recommendations of many coroners over the years,” she said.

I share the view of NSW Deputy State Coroner Grahame, and other Australian coroners, that there is a pressing need for a real-time prescription monitoring system in NSW, ideally as part of a national system.—ACT Chief Coroner Lorraine Walker

“A national real-time prescription monitoring system might have enabled Mr Paterson’s Queanbeyan doctors to have seen the amounts of medication prescribed to him in the ACT, and to ensure that Mr Paterson could not leverage off the differences in regulation to obtain opioid medication in NSW that he was, or would have been, denied in the ACT.”

She added that, given the geographical location of the ACT as an island within NSW, NSW Health and ACT Health should develop processes and procedures in relation to dealing with drug dependent persons who seek treatment across the two jurisdictions concurrently.

NSW Health told AJP it remains committed to a national approach to real-time prescription monitoring and recognises it has the potential to provide numerous benefits to healthcare providers and the general community.

“The Australian Digital Health Agency is undertaking an architectural review of the proposed national system,” said the organisation.

“NSW Health is awaiting the outcomes of this review, as it will inform future planning and provide greater clarity on the capabilities of a National Data Exchange platform being developed by the Commonwealth, as well as the roles and responsibilities of each participating jurisdiction in implementing the system.”

NSW Health Minister Brad Hazzard has previously stated that the NSW government is “totally committed” to getting real-time prescription monitoring, however a system has not yet been implemented.

He has also said that such a system needs to be national “otherwise it would be pointless because people would just cross the border into other states to access the drugs.”

Last week the Pharmaceutical Society of Australia said it was surprised no funding had been allocated for a real time prescription monitoring system in the recent NSW Budget, as the government had reported a surplus.

“Medicine safety is a health priority and it is disappointing to see that there is no investment by the NSW Government in a real time prescription monitoring system in NSW,” said PSA NSW Branch President Professor Peter Carroll.

“All states, except NSW and WA, have either implemented or set strategies to introduce a real time monitoring system.

“However NSW continues to fall further behind despite experience internationally and locally that when such systems are implemented they have the desired effect in reducing harm,” he said.

Minister Hazzard was contacted for comment but did not respond by the time of publication.

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