Don’t implement real-time monitoring alone: expert

A proposed real-time monitoring system might do more harm than good if it’s not backed up by other measures, an addiction expert has told MJA InSight.

Professor Nick Lintzeris, Clinical Professor, Discipline of Addiction Medicine at the University of Sydney, says that the proposed Electronic Recording and Reporting of Controlled Drugs system would need to be supported with better access to addiction services and agreement on the “flags” of misuse, InSight reports.

“On its own – don’t do it,” he told MJA’s Nicole Mackee.

“It will be an expensive model, and all it will be doing is inconveniencing doctors and patients. To introduce a system without clarity about what are the ‘flags’, who can use that information, and what are the responses to these patients would probably cause more harm than good,” Prof Lintzeris says.

“Many of us would like to see a national consensus as to what we would consider safe or unsafe.”

Stakeholders have been calling for the real-time monitoring system for some time, as prescription drugs overtake illicit drugs as factors in overdose deaths.

Earlier this year, following the death of a man with asthma who doctor shopped extensively to obtain diazepam, codeine, oxycodone and tramadol, a Victorian coroner called for such a monitoring system to prevent similar harms.

At the time, the Pharmacy Guild’s Anthony Tassone told the AJP that a real-time prescription monitoring program would only be part of a solution – comments similar to those now made by Prof Lintzeris.

“Real-time prescription monitoring will go a long way to helping address avoidable deaths from prescription medicines, but it’s not a silver bullet: we need a broader solution involving appropriately funded support services for patients and their families,” Tassone said at the time.

Prof Lintzeris told MJA InSight this week that Australia needs “more specialist pain clinics, and more addiction specialists working in those clinics”.

“The vast majority of pain clinics do not have an addiction specialist working within them – it would be like saying we’re going to have a pain clinic without a psychiatrist or physiotherapist.”

Prof Lintzeris says that more research into the treatment of concomitant pain and opioid dependence is also needed.

“We don’t have enough evidence about how to treat the patient in pain who has become dependent on their prescription opioid – there are no guidelines anywhere in the world – so we need more research in this space as well.”

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1 Comment

  1. PeterC

    Most of us have been saying all these things for years but little progress seems to be made, I don’t think we should suppress our natural bias for action simply because others aren’t ready. Pharmacy’s particular responsibility is to push for responsible medication use and harm minimisation based on evidence. Sure, shedding light on the nature and extent of pain management and addiction problems will create pressure to respond where it is needed, but is that a bad thing? Perhaps it is will actually help the expansion of specialist pain management services? And what about primary health care responses to inadequate pain management and addiction? It is all very well to focus on specialist services but this is an endemic problem and – as always – primary health care clinicians will necessarily have to carry much of the management burden. Better information about inappropriate medication use would also be expected to benefit primary care. Full speed ahead I say.

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