Prescription Drug Abuse – a Big Problem with a Simple Solution
Many more people die from prescription drug overdoses than from illicit drug overdoses.1 Yet the problem attracts a fraction of the attention that illicit drug abuse gets. Relatively simple solutions have been identified but their implementation needs to be made a priority.
The fundamental problem is that prescription drug abusers visit many doctors and many pharmacists, via whom they regularly received an array of taxpayer-subsidised prescription drugs. As responsible and competent as each of these individual doctors and pharmacists may have been, they had no way of knowing who else was prescribing or dispensing drugs to motivated doctor and pharmacy shoppers.
Without this information it must be near impossible for time pressured clinicians to pick who is faking it and who is really ill. This is especially true for the diagnosis of psychiatric disorders and pain management, where there are few, if any, objective ways of confirming disease.
In the absence of a system of collating information about the prescriptions of drugs written and dispensed, nothing can be done. There will be more suffering, more deaths and more children without parents because the attractions of abusing prescription drugs are considerable.
First, they are cheap, usually subsidised by taxpayers through the Pharmaceutical Benefits Scheme.
Second, the fact they are used for therapeutic purposes can lull abusers into the false belief that the drugs are inherently safe.
Third, abusing prescription drugs doesn’t carry the same legal risks as illicit drugs, despite the fact they are often more physically dangerous. Drug abusers know they may be able to explain to the police’s satisfaction why they have a stash of prescription Stilnox, Valium or dexamphetamine.
The good news is there is a very simple solution. Currently there are some isolated measures designed to help doctors and pharmacists suspicious of doctor shoppers but clearly they are inadequate. What is needed is a comprehensive, easy to use, “real time” system of sharing information before prescriptions are dispensed.
The Commonwealth and State governments may need to co-operate and remove privacy restrictions so that pharmacists can share information about what drugs have been dispensed to individuals presenting prescription in their pharmacies. This change, along with a modest investment by government in the software needed to allow the real time sharing of information between pharmacists, will shut off the pipeline of prescription drugs that is fuelling this misery.
No patient with a genuine therapeutic need would be denied medications. Only patients who are continuously requesting prescription drugs faster than the recommended dosage would be denied.
This solution will save lives as well as taxpayers’ money. Millions of dollars that currently subsidise pharmaceutical abuse and addiction via the PBS can be redirected to therapies that help address real disease and real need.
I wrote an opinion piece calling for this change in 2011 2 but first pursued this reform in early 2009. 3 Lenette Mullen, president of the Pharmacy Guild of WA, has been calling for this type of reform for even longer. In 2011 the WA president of the Australian Medical Association, David Mountain, also made a similar call. He also identified that professional doctor shoppers motivated by money, rather than addiction, are supplying a flourishing black market.
In response to a letter I wrote to him about the death of a mother of seven from a combination of prescription drugs the WA Coroner identified that “other similar cases … highlight the need for there to be a central register for all medications which would record all scripts (for prescription drugs)”.
In 2011 the Gillard Government announced the staged rollout of the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system. It is anticipated the ERRCD will eventually allow real time sharing of information by pharmacists but the roll out of the ECCRD is proceeding at snail’s pace. In the meantime the problem of prescription drug abuse gets worse and hundreds are dying.
The first stage implemented in July 2012 involves “real time transfer of dispensing information for community pharmacies into the ERRCD system”. Second phase will involve the sharing of this information with dispensers and providers. No specific dates provided. Until the second phase is implemented all it does is captures statistics and people will continue to pharmacy shop and some will die.
Records will not be limited to schedule 8 drugs but it has yet to be decided which other drugs will be included. This will be done through a process of assessing the evidence of diversion and stakeholder and community consultation. This sounds like a drawn out process. Why not just get on with it with schedule 8’s and a few other we know are problems like Stilnox and adjust by adding others over time if necessary?
WA Health Minister Kim Hames has stated that Poisons Act 1964 needs to be overhauled and the Medicines, Poisons and Therapeutic Goods Bill 2012 will be presented to parliament late in 2012. There is no sign of it so far. Why wasn’t it made a priority given the consensus for its need and the number of deaths?
State Government needs to coordinate with Federal Government to implement the system and nobody seems to be driving the issue with any urgency. I would love to have the opportunity to drive this reform.
Martin delivers his Valedictorary speech in WA Parliament.
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