12 June 2020


GPs left in the dark about major changes to reduce harms from prescription opioids

The Royal Australian College of General Practitioners (RACGP) is calling for improved communication to GPs after they were not adequately informed about major changes to prescription opioid prescribing.

It comes after the RACGP welcomed the changes to the Pharmaceutical Benefits Scheme (PBS) reducing opioid pack sizes, which came into effect on Monday 1st June. The changes were made in response to concerns about the high number of deaths and hospitalisations due to prescription opioids.

Although the changes came into effect on Monday 1st June, crucial information on what medications were affected was not adequately communicated to GPs ahead of time. Some GPs were unable to prescribe the new smaller pack sizes through their usual clinical software until an update was rolled out days after the regulations came into effect.

A detailed listing of the changes to opioid medications only became available on the PBS website on Tuesday 2nd June. The Therapeutic Good Administration (TGA) issued a press release to publicise the changes the same day.

Chair of the RACGP’s Expert Committee on Quality Care Professor Mark Morgan said the poor communication had caused unnecessary grief for GPs and their patients.

“Many GPs were caught unaware of the changes until half way through the process of prescribing. GPs and clinic staff had to call the PBS Authority Prescription phone line for information. Some GPs had to hand-write authority prescriptions while waiting for clinic software updates.

“Vulnerable and stigmatised patients who were using opioids for non-cancer pain and happened to be trying to get medication were caught up in the middle and faced unnecessary upset.

“Changes to the PBS to change prescribing need to go hand in hand with a comprehensive communication strategy. These changes should have been rolled out with supporting education and publicity for GPs and pharmacists well ahead of the day they were due to come into effect, and ensuring clinical software vendors’ updates were ready to go.

“The communication needs to be nuanced, rather than demonising opioids. Over the last decade there has been a seismic shift in our understanding of the pros and cons of using opioids for non-cancer pain. We are now much more aware that for most, but not all patients, taking opioids long term makes precious little difference to their pain and wellbeing.”

The RACGP has been working constructively with the TGA on the changes over the last year or so, and publicised them coming into effect via the media and several articles in our in-house news publication news GP.

Under the changes, opioid medications are now only available in smaller packs with no repeats for the treatment of non-chronic pain. Patients with long-term chronic pain can still access larger pack sizes and repeats when certain requirements are met. It comes after increasing recognition that opioids are a poor choice for most types of pain.

Chair of the RACGP Addiction Medicine network Dr Hester Wilson welcomed the changes but says more must be done to combat harm from opioids.

“Limiting a patient’s access to opioids is a step towards combatting the associated harms but it’s not a silver bullet.

“Unfortunately, we know some people who have their prescriptions limited without a collaborative plan to manage this change, will struggle and may turn to black market alternatives. That’s why it’s essential that government ensures that education for GPs and adequate treatment services are available across Australia, because substance use affects all communities.

“We should also be more proactive in helping patients with alcohol and other drug problems. One way to make a big difference would be increasing access to naloxone for patients who need it, and to their loved ones – this drug can temporarily reverse an opioid overdose and saves lives but not enough people know about it.

“Another important issue is improving access to Medication Assisted Treatment of Opioid Dependence; (methadone and buprenorphine).  This highly evidence based treatment improves health and wellbeing outcomes and is particularly effective for people who have developed an opioid use disorder through the use of prescription opioids for chronic pain.”

Dr Wilson said substance use needed to be treated seriously now more than ever, with reports that the COVID-19 pandemic has led to a noticeable increase in patients presenting with problematic use.

“The COVID-19 pandemic has been an extremely difficult time for many people.

“I urge anyone who has concerns about their drinking or drug use, including opioids, to reach out to their GP – they are there to help. And it’s never been easier to contact your GP with telephone and video, as well as face to face consultations now available.”

The RACGP has been encouraging Australians to consult with their GP if they have concerns about their use of opioids or other drugs.

The College also recently launched an online education program for GPs to further enhance their skills in caring for patients with alcohol and other drug issues, including prescription opioid dependence or misuse.


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