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National system urgently needed to counter doctor shopping, drug deaths

Medical defence organisation Avant has joined calls for a national system to provide a real-time record of patient prescriptions amid an alarming rise in doctor shopping and deaths and hospitalisations involving the use of prescribed drugs of dependence.

Avant said the lack of national system to track prescriptions was putting patients at risk and leaving doctors prescribing opioids and other strong pain relievers exposed to legal action by depriving them of vital clinical information.

“Doctors are stuck. It’s like they’re prescribing blind, as they don’t have the benefit of the complete clinical picture,” Avant’s Senior Medical Advisor Dr Walid Jammal said. “Avant is adding its voice to those of a number of coroners, health groups and colleges calling for a national real-time prescription monitoring system as a matter of urgency.”

In the past two decades there has been a 15-fold increase in the prescription of opioids, and state coroners have expressed alarm at a concurrent jump in the abuse of prescription drugs, leading to dependency, harm and death.

In 2013, the Coroners Court of Victoria reported that almost 83 per cent of drug-related deaths involved prescription drugs, predominantly opioid analgesics and benzodiazepines.

Adding to the complexity, many GPs face demands from patients addicted to prescription drugs, or who want to sell them on the black market, Avant said, warning “this can lead to inappropriate prescribing to patients who should not receive drugs of dependence, and inappropriate non-prescribing to patient who should receive them”.

In a position statement on the issue released on 23 April, Avant said the prescription of drugs of dependence was becoming an increasingly legally and clinically fraught area of medical practice, with GPs in particular falling foul of often confusing and contradictory laws and regulations regarding their use.

The defence fund said that since 2009 it had seen a 56 per cent jump in calls to its medico-legal advisory service from doctors prescribing drugs of dependence, and the issue was the cause of more than 230 claims made against medical practitioners, including accusations of over-prescribing, prescribing without authority and denial of a prescription, underlining the extent of uncertainty and concern among the medical profession.

Altogether, more than a fifth of doctor professional misconduct cases involved illegal or unethical prescribing as the primary issue, Avant said, and argued that the incidence could be reduced through better education about the legal and clinical aspects of prescribing drugs of dependence.

“In Avant’s experience, many practitioners have little knowledge of their legal obligations around prescribing drugs of dependence and the regulations applicable in their state. In our view, there is also confusion amongst practitioners over the role of the PBS in providing authority to prescribe certain medications,” it said.

Almost 90 per cent of doctors surveyed by Avant backed the call, and three-quarters said a national real-time prescription monitoring system would help them.

Coroners in three states have made repeated recommendations for the establishment of such a system, and Avant said its introduction was now a matter of urgency.

“This system will go towards supporting the safety of patients and minimising the risk of doctor shopping for the purpose of drug diversion or on-selling,” the defence fund said.

Adrian Rollins