Don’t add S3s to RTM, says ACT Guild

The family of a woman who died from multi-drug toxicity are calling for compulsory real time monitoring, but the ACT Government disagrees… for now

And the Pharmacy Guild’s ACT Branch agrees with the Territory Government that adding doxylamine to the DORA system is not necessary.

The ACT Government has tabled its response into the death of Lauren Maree Johnstone, who died in January 2015 of the combined effects of medicines including doxylamine, tramadol, codeine, oxycodone, zopiclone and fluoxetine – declining to make the ACT’s real time monitoring system mandatory.

While several health providers including a GP and two surgeons were treating Ms Johnstone, and were unaware of each others’ prescribing, these medicines had been lawfully prescribed or obtained. Ms Johnstone was also taking OTC medicines.

ACT Health Minister Rachel Stephen-Smith told the Territory’s Legislative Assembly that “Ms Johnstone’s death came about as a result of compliance with her prescribed medication regime aggravated by the addition of non-prescription medication”.

Ms Stephen-Smith said the Government noted the Chief Coroner’s recommendation to mandate the use of the Drugs and Poisons Information System Online Remote Access (DORA) real time monitoring website, but added that “system limitations currently preclude making the ACT DORA system mandatory for prescribers and pharmacists”.

“The ACT adoption of the national real-time prescription monitoring system by 2021 will, however, significantly increase functionality for prescribers and dispensers,” she said.

“Following the rollout of the new system, the government will re-evaluate the potential to mandate the use of real-time prescription monitoring in the ACT.”

Earlier this month, Federal Health Minister Greg Hunt told The Age that he had written to all states and territories asking for them to make integrating their systems a priority.

He said that this integration is expected by the end – if not the middle – of 2020, comments welcomed by the national Pharmacy Guild… though to date, jurisdictions such as NSW and Western Australia still have no system of their own.

Ms Johnstone’s daughter, Ariarne Bunyan, has told the ABC that the geography of the border between NSW and the ACT means it is easy for ACT residents to have scripts filled nearby in NSW.

She urged the adoption of a national, mandatory real time prescription monitoring system.

Simon Blacker, president of the ACT Branch of the Pharmacy Guild, said that DORA had to date had a “reasonable” uptake in the Territory, and that he hoped that as time goes on, the system becomes more widely accepted by pharmacists.

“As I understand it, DORA’s not actually designed to be a mandatory recording system – I anticipate that this will be possibly revisited in 2021 when the national real time monitoring system is realised, and we all get a view of it and understand how it will work,” he told the AJP.

“We’d like more people to be using it; but because it’s a standalone system, it’s not integrated, and that’s a technical issue we’d like tackled.

“We’re hoping that with the national rollout, it’s more seamless and easy to use – I’ve had pharmacists in the ACT say to me that it’s ‘clunky,’ but the feedback is also that once you’re in and know it, it’s a good system, just not integrated.”

This means that a pharmacist, on a busy day and faced with a regular, long-term customer with a valid script, may not decide to take the time to log into the system.

“If we’re at a stage in the future where the dataset can give you popups when you’re actually in the dispense program, pharmacists will feel more informed and be able to use it more easily,” Mr Blacker said.

He said that adding doxylamine to real time monitoring would be “an overreach”.

“As documented by the ACT Health Minister, with a review with stakeholders this year and the national scheme to come, the logical step is to broaden the system to a range of prescription only medicines.

“To suggest that we need to also record S3 medicines is a step too far, and there are significant logistical challenges with that idea.

“A lot of people use doxylamine safely, and I think it’s a step too far.

“Also with this unfortunate circumstance, it comes back to the fact that back then, doxylamine would’ve been with the Mersyndols and codeine-and-paracetamols, and so that’s a problem of that time [before OTC codeine was upscheduled to prescription-only].”

Mr Blacker also said that the Guild strongly encourages the NSW Government to implement real time prescription monitoring.

“With Victoria, Tassie, the ACT and now Queensland looking at it, you’d hope the most populous state would have a plan as well, to ensure a national result sooner rather than later,” he told the AJP.

At the ACT’s Legislative Assembly, Ms Stephen-Smith also noted that “monitoring the dispensing of controlled medicines is only one piece of the puzzle”.

“We also need to focus our efforts on harm reduction in the community and the delivery of alcohol, drug and mental health services,” she said.

Ms Stephen-Smith said that the ACT Government plans to continue to work to reduce the risks and harms associated with unsafe use of medicines, and thanked the Chief Coroner for her recommendations.

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