Inadvertent harms

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The SHPA and Pharmacy Guild are among stakeholder groups which have endorsed Palliative Care Australia’s new position statement on access to opioids

Palliative Care Australia released the position statement, Sustainable access to prescription opioids in palliative care, with endorsement from 12 other peak health organisations, to call for a “future-proof” approach to ensure sustainable access to prescription opioids for Australians receiving palliative care.

The statement warns that palliative care patients are being placed at risk of harm as an unintended consequence of increased government and regulatory restrictions surrounding non-cancer opioid prescribing to reduce the misuse and abuse of opioids within the wider community.

PCA’s National Clinical Advisor and Palliative Care Nurse Practitioner Kate Reed said ensuring palliative care professionals receive adequate support to manage the pain and breathlessness needs of their patients is crucial to provide quality and compassionate palliative care to all those who need it.

“All Australians receiving palliative care must be able to access necessary and appropriate evidence based opioids to manage and prevent suffering from uncontrolled pain and other symptoms,” said Ms Reed.

“Finding relief from severe pain can be a challenging and exhaustive experience for people living with life-limiting conditions and their caregivers.

“Opioids are an essential part of the pharmacological options needed to help relieve the pain and/or breathlessness that may be experienced by someone living with a life-limiting illness.

“It is therefore essential that authorised prescribers of opioid analgesics, including GPs, palliative care specialists and nurse practitioners, are given adequate support to treat their patients’ pain needs promptly and appropriately without unnecessary regulatory barriers,” said Ms Reed.

“With the right care, including appropriate medication, pain can be well managed in the vast majority of people at the end of life.

“Therefore, there is an urgent need to increase the understanding of appropriate use of opioids within the Australian palliative care context and provide leadership and guidance to authorities as they review regulatory processes,” said Ms Reed.

The statement, which has been endorsed by Palliative Care Nurses Australia, Australian College of Nursing, Royal Australasian College of Physicians, Australian College of Nurse Practitioners, Australian College of Rural & Remote Medicine, Australian Healthcare & Hospital Association, The Australian Pain Society, Painaustralia, Paediatric Palliative Care Australian & New Zealand, The Pharmacy Guild of Australia, The Society of Hospital Pharmacists of Australia and The Australian & New Zealand Society of Palliative Medicine makes eight key recommendations, including the reformation of the Palliative Care Medications Working Group to review the Palliative Care Schedule of the Pharmaceutical Benefit Scheme.

“The misuse and overprescribing of opioids is a serious public health issue that must be addressed. However, it must not be at the expense of people receiving palliative care who have a human right to access medicines including opioids,” said Ms Reed.

The eight recommendations are:

  1. All prescribers are enabled to access appropriate opioids (oral and parenteral) consistently for pain and breathlessness management for people living with life-limiting illnesses, without the burden of unnecessary regulatory barriers.
  2. Compulsory palliative care and opioid management education for all medical, nursing, allied health and pharmacists to be built into undergraduate curriculum to ensure a consistent baseline competency in pain and symptom management.
  3. Ensure an adequate supply and stock (imprest) of minimum levels of opioids commonly used in palliative care including parenteral formulations in acute facilities, community pharmacies and out of home settings such as residential aged care facilities and prisons, with processes in place to manage planned or emergency shortages.
  4. Nationally consistent and streamlined prescribing approval policies for opioids that promotes pain and addiction specialists working closely with palliative care. This will ensure patients with opioid dependency are recognised as a group of patients with increased complexity in pain and symptom management in the setting of a life-limiting illness.
  5. The introduction of national real time monitoring for all opioid prescriptions with software that is enabled to identify palliative care prescriptions at point of care across acute, sub-acute, aged care and primary care sectors. This will improve patient safety championing the quality use of medicines framework and improved data collection to further inform research and regulation.
  6. Palliative care teams to work with acute services to develop opioid stewardship policies informing clinical plans to ensure appropriate prescribing, de-prescribing, and dispensing of opioids with rapid communication to the primary care team and community pharmacy to reduce risk of forced tapering of appropriate opioid management.
  7. The Australian Government to re-form the Palliative Care Medications Working Group to review the Palliative Care Schedule of the Pharmaceutical Benefit Scheme (PBS). This Schedule must meet current, evidence-based practice guidelines and an improved awareness to prescribers.
  8. A review of the Medicare Benefits Schedule (MBS) specific to palliative care by way of item numbers and explanatory notes to facilitate consultation in primary and specialist practice. This will recognise the complex, multidisciplinary nature of symptom management plans and goals of care/ advance care planning discussions, and the different requirements of providing palliative care across all settings including home visits, after-hours support and within aged care services.

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