Plan to stop misusers falling through cracks

People in eastern Melbourne will now have access to a new program aimed at addressing pharmaceutical misuse

Pharmacists will have a key role in helping patients recover from misuse of prescription and over-the-counter medicines under the program, which aims to address gaps in treatment options.

The Eastern Melbourne Primary Health Care Network will provide $850,000 in funding to Connect4Health to deliver a Victorian-first Medication Support Service program, which will provide specialist assessment and treatment programs for individuals and families affected by pharmaceutical misuse or dependence.

The initiative is timely given the upcoming rescheduling of codeine-containing OTC preparations to prescription-only on 1 February 2018, and the rolling out of Victoria’s Real Time Prescription Monitoring System.

Dr Tamsin Short, executive director of Drug and Alcohol Services at Connect4Health, told the AJP that pharmacists are seen as “a key point in the patient’s recovery journey, both in terms of identifying the problem and helping people navigate into a support service”.

“When real-time prescription monitoring is introduced in Victoria in 2018, we expect that both doctors and pharmacists will be alerted to people who may be ‘doctor/pharmacy shopping’,” Dr Short says.

“The Medication Support Service will be an important resource and referral pathway for pharmacists who identify patients who have a problem with medication use, and we hope the referral pathways will be well-established by the time the codeine rescheduling and real-time prescription monitoring programs are implemented.”

She warns that “some challenges” are likely with the codeine re-scheduling.

“This is a significant change which will require additional support and information, as well as appropriate treatment pathways, which can be used by both doctors and pharmacists.

“Given that codeine re-scheduling will coincide with the introduction of real-time prescription monitoring in early 2018, there will be new ‘checks and balances’ in the system as well as associated training and development for doctors, so our hope is that there will not be an inadvertent increase in the strength of codeine prescriptions.

“Whilst codeine rescheduling will certainly make it harder for patients to access codeine, we know this will not ‘fix’ what is in reality a complex social and medical problem. Again, we anticipate that both doctors and pharmacists will be identifying more patients with codeine and opioid dependence, and the Medication Support Service will be a valuable new referral option for these individuals and families.”

People who misuse or become dependent on prescription and OTC medicines typically do not access traditional alcohol and other drug services, despite being at high risk of harm, says EMPHN CEO Robin Whyte.

This is partly due to stigma, and partly due to lack of specialist treatment programs for this type of misuse.

“Pharmaceuticals contribute to over 80% of all fatal overdoses in Victoria, with most of deaths deemed to be accidental,” she says.

Dr Short says that significant stigma remains in the community towards people who have problems with all types of substances, whether these be licit or illicit.

“Anecdotally, people who misuse pharmaceuticals often don’t identify as having a ‘drug and alcohol’ problem and therefore are reluctant to refer into a ‘drug and alcohol service’,” she says.

“This is why we feel the Medication Support Service is such a crucial addition to the alcohol and other drug sector, as it provides a referral pathway and treatment options for people who may not otherwise seek help.

“Basing the service within community health centres may also help to reduce the stigma, as the patient doesn’t have to present to a stand-alone ‘drug and alcohol service’ for help; their treatment is integrated alongside their GP, nurse and allied health services in the one clinic.”

Initiatives such as International Overdose Awareness Day (August 31) and advocacy from ScriptWise – which is about to launch a new initiative of its own – are helping raise community awareness about the dangers of pharmaceutical misuse and dependence, however. Recent data from the Victorian Coroner’s Court has also helped.

Dr Short encouraged pharmacists to refer relevant patients to Connect4Health by calling 03 9810 3084. Eligible patients include family members, patients or even self-referred patients, in the Eastern or North Eastern region of Melbourne.

“The Medication Support Service is funded by the Eastern Melbourne Primary Health Network and provided at no cost to the client,” she says. “We also welcome referrals for people with co-morbid mental health and/or illicit substance use.”

Further resources

A Bitter Pill To Swallow: 2014 campaign

Pharmacists Support Service: 1300 244 910


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