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Guild to doctors: join us

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Doctor groups need to join the Guild to drive the implementation of real-time monitoring, says David Quilty

In this week’s edition of Forefront, Pharmacy Guild executive director David Quilty echoed the recent words of AMA president Dr Michael Gannon, who said recently that Guild advocacy over codeine has shone a light on the issue of opioid misuse.

“If anything good has come of the Guild’s advocacy on low dose codeine, it’s been shining a light on the opioid epidemic we have,” Dr Gannon told Sky News on 1 February, the day codeine-containing preparations were upscheduled to Prescription Only.

Now, Mr Quilty writes that “there can be little argument that the ensuing public debate has visibly increased the level of awareness of the serious problem of the misuse of prescribed drugs in Australia”.

“In recent years, thousands of families have had to deal with the personal trauma of losing loved ones to prescription overdoses; however this issue has not attracted the attention that it deserves with the calls by patient advocates and clinicians for substantive action often going unheeded,” he writes in Forefront.

“Thankfully, the over-the-counter codeine upscheduling debate has finally brought out into the open the much more serious problem of addiction to prescription opioids and sedatives.”

Mr Quilty points out that the number of fatal overdoses directly attributable to prescription medicines of concern is “multiple times higher” each year than those where low-dose codeine can be considered to be a contributing factor.

“Nevertheless, the codeine decision has lifted the lid on this much wider problem to the extent that it can no longer be glossed over by governments, clinicians, the media and consumer advocates.”

The Guild’s advocacy for a mandatory, nationally consistent real time monitoring system has gone alongside multiple calls from coroners around Australia to institute such a system, and doctor groups including the RACGP, RACP and AMA have all recently shown their support.

“It is now time that these doctor organisations joined the Guild in becoming active champions for mandatory real time prescription monitoring because, as prescribers, it is their members who have primary responsibility for ensuring they have visibility of at-risk patients who may be ‘doctor shopping’,” Mr Quilty writes.

“With the upscheduling of codeine, the need for mandatory real time prescription monitoring of drugs of dependence is more urgent than ever before.

“MedsASSIST, the real time monitoring system that was introduced by the Guild and voluntarily taken up by 70% of pharmacies, has had to be shut down as it was only ever able to be used for over-the-counter, codeine-containing medicines.

“It is likely that many patients who are suffering with pain will now seek prescriptions, including for higher strength codeine products or other opioids.

“Currently, there is no real time monitoring to identify these patients at the doctor’s surgery and there is a collective responsibility to ensure that the upscheduling decision does not make matters worse for at-risk patients.”

While federal and state governments have made moves towards developing real time monitoring, in the meantime health professionals need to collaborate to identify at-risk patients, Mr Quilty writes.

Pain MedsChecks will go part of the way towards identifying such patients, he writes.

“With the widespread incidence of chronic pain in our society that is not well treated and the increased public awareness of issues of addiction to prescription medicines, the Pain MedsCheck is a very timely intervention that will build on the established role of community pharmacies as a trusted, first port-of-call for patients seeking advice and assistance.”

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