Real-time system needed, but not ‘silver bullet’

codeine tabsules spill from orange pill bottle

A Victorian coroner has called for a real-time prescription monitoring system to reduce pharmaceutical drug related harms and deaths following the death of a 47-year-old man who doctor shopped extensively to obtain a range of medicines including large amounts of diazepam.

Pharmacy Guild Victorian Branch president Anthony Tassone says such a system is needed, but it would be only part of a broader health solution.

Frank Frood, who suffered from severe asthma, died from bronchopneumonia on a background of methadone and benzodiazepine use.

The coroner noted that the PBS summary of PBS benefits paid for medicines dispensed to Frood in the two years before his death ran to 26 pages; he was going to great lengths to “prescription shop” to obtain diazepam.

In the 12 months before his death, Frood was dispensed codeine, diazepam, oxycodone and tramadol from a series of medical practices.

“Mr Frood was clearly engaged in prescription shopping and at the time of his death, as is the case even today, there were no effective tools available for prescribing doctors to establish who else a patient had attended for scripts, other than relying on all doctors to make reports to Drugs and Poisons Regulation in line with relevant legislation,” wrote coroner Audrey Jamieson.

She cited Coroners Prevention Unit data that indicate between 2009 and 2015 Victoria has seen an average of 376 overdose deaths a year; this rate has increased every year since 2010, reaching 420 deaths in 2015.

Pharmaceutical drugs consistently contribute in about 80% of these deaths, despite recent safety focused initiatives including improved prescribing guidelines, drug rescheduling and reformulation of some drugs into “purportedly safer preparations”.

“There is thus an ongoing, urgent need for Victoria to implement a real time prescription monitoring system to achieve reductions in pharmaceutical drug related harms and deaths.

“An RTPM system will, for the first time, enable prescribers and dispensers to find out what drugs a presenting patient has been dispensed in what quantities, when and by whom.

“In addition, an RTPM system will enable a range of other prevention-focused interventions alongside identifying prescription shoppers: for example, identifying doctors whose prescribing practices might be clinically suboptimal so they can be provided targeted education and providing automated warnings to prescribers and dispensers regarding potential issues with drug interactions and drug quantities.”

Anthony Tassone told the AJP that the Guild supports and is calling for such a real-time system.

“It’s important that it does not only capture S8 medicines as some real-time systems do in other states, such as Tasmania,” he says.

“And it’s critical that we have a broad enough scope to capture all medicines of concern, including diazepam which is S4, and consider that there is data available at the time of prescribing, not just dispensing.

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

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