The Morrison government has given the states until the end of the year to connect to a national monitoring system for powerful painkilling drugs to reduce the death rate from overdoses and avoid a US-style opioid crisis.
Declaring he is “passionate” about reducing opioid-related harm, Health Minister Greg Hunt has sought to fast-track plans that would give GPs and pharmacists immediate information about a patient's use of addictive medication, such as Oxycontin or Endone, and other high-risk “schedule 8” drugs.
The idea of a real-time national prescription monitoring system has been on the agenda for years, but the minister has now set a time frame and written to the states and territories urging them to connect “as a matter of priority”.
“The Commonwealth expects all other states and territories to integrate their systems by the end of this year, if not the middle of this year,” Mr Hunt’s spokesman told The Age on Thursday.
Much of the delay has come down to each jurisdiction having fragmented software systems to track how pharmaceuticals are monitored. NSW, which has the highest rates of opioid-related deaths, does not even have the ability to monitor prescriptions in “real time” within its own state, nor does Western Australia. Victoria has its own tracking system, known as Safescript, and with Queensland is working to integrate its software into the Commonwealth's data framework. The ACT has already done so.
The push to fast track the process comes amid growing concern that Australia needs to lift its game if it wants to avoid following in the footsteps of the US, where opioids have become such a problem President Donald Trump recently declared a public health emergency.
Proponents hope that prescription monitoring will help curb the practice of “doctor shopping” - people visiting multiple GPs to obtain multiple scripts for powerful painkillers such Oxycontin, or addictive benzodiazepines such as Valium or Xanax. However, it is also hoped that tracking prescriptions will force GPs to consider ways to treat patients other than simply dispensing powerful drugs.
The issue is challenging for governments because more than 3.2 million Australians live with chronic pain and many say they need medication to get by. Opioids are also useful in dealing with acute pain, for instance, after major surgery, as well as treating cancer patients and those in palliative care.
Doctors say they support prescription monitoring but argue that without additional measures such as greater access to opioid treatment and more education for doctors and patients it might not have the desired impact.
“While this is a really fantastic measure, if it’s not supported by other measures it may not have any benefit at all - it may in fact make things worse,” said Dr Hester Wilson from the Royal Australian College of General Practitioners. “What happens to the person who has a dependency, who can’t get what their body and their brain needs? Where do they go? Out to the streets to buy something?”
Pain Australia board member Malcolm Hogg also warned there could be unintended consequences for people with chronic pain. For instance, rapidly removing opioids could end up placing them at risk and lead to withdrawal symptoms such as anxiety and depression.
Others say prescription monitoring would not solve broader problems such as the under-training of GPs when it comes to pain management, or the lack of specialist pain services, particularly in rural and regional towns.
“It’s a bit like closing the door after the horse has bolted,” said addiction specialist Simon Holliday, a doctor working in the NSW town of Taree.
Figures obtained by The Age and The Sydney Morning Herald found that Australia had 8500 opioid-related deaths between 2010 and 2016 (the last year nationally consistent data was available). NSW had 2369 opioid-related deaths in that period, while Victoria was close behind with 2311 opioid-related deaths, followed by Queensland with 1740.
A NSW Health Department spokeswoman said the state was committed to the federal scheme but “to facilitate a national approach, NSW requires a system that is able to capture real-time information.” The government had allocated $1.35 million in seed funding towards this, she said.
Western Australia also says it has also committed to real time prescription monitoring but requires newer technology. In Victoria, the government says Safe script has resulted in a 25 per cent reduction in the proportion of people taking high-risk doses of opioids between April and October last year.
“Prescription medicine dependency can happen to anyone,” said Victorian Health Minister Jenny Mikakos. “We want to make sure all Victorians, no matter who they are and where they live, can get the help they need. Too many lives have been tragically cut short due to overdoses from some prescription medicines.”