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SafeScript NSW – New approval management functionality

JOVI STUART
Good evening everyone and welcome to tonight's webinar ‘Safe Script NSW New Approval a Management Functionality”.  We are joined tonight by presenter’s Dr Hester Wilson, Dr Frank McLeod and Elaine Chu and Fraser Drawn from the Save Script project team.  My name is Jovi and I am your RACGP representative for this evening.  Before we get started, I would like to make acknowledgement of country.  We recognise the traditional custodians of the land and sea on which we live and work, and we pay our respects to Elders past, present and emerging.  I would also like to acknowledge any Aboriginal and Torres Strait Islander colleagues who have joined us online tonight.  I am dialling in from Gadigal country on Sydney's North Shore.  Now to formally introduce to you our speakers for tonight.  Dr Hester Wilson is a GP chief addiction specialist for New South Wales health, Clinical Director for Murrumbidgee Drug and Alcohol and Clinical Advisory to Population and Community Health in South East Sydney Local Health District.  Hester is Chair of the RACGP Addiction Specialist Interest Group, a clinician with many years clinical and teaching experience. He is currently undertaking a PhD focus on GP's experience of patients with chronic pain and prescription opioid use disorder.  So welcome Hester.  Second speaker tonight is Dr Frank McLeod.  He is an addiction medicine specialist, hospital administrator, also works in the Royal Flying Doctor Service and has worked as an established GP.  Frank has also focused particularly on harm reduction with HIV, has been CEO for the prison medical systems in the 80s and has been involved in a number of medical related outlets such as Medical Observer, Australian Doctor, the ABC website and Users News.  Again, we are also joined tonight by the Safe group project team Fraser Drawn and Elaine Chu, who will be explaining and demonstrating the new function of the Safe Script platform.  Just to go over the learning objectives for this evening, by the end of this online CPD activity you should be able to utilise the Safe Script New South Wales system to understand existing and new functionality to inform best practice patient outcomes.  Discuss the benefits of SafeScript New South Wales to reveal real time prescription monitoring for certain high-risk medicines and managing New South Wales approvals to prescribe S8 medicines in New South Wales and discuss the New South Wales approval application process that was introduced in late 2023.  Now we will start off the session with a quick poll.  I am going to just launch this poll now, so the question is “do you currently use SafeScript New South Wales to. manage your previously prescribed medicines that require New South Wales approval?”  I am just going to leave the poll up for a about a minute and doctor Frank McLeod will then discuss the results.
 
DR FRANK MCLEOD
Thanks, Jovi.  Well, it does not really surprise me.  It's good to see the increasing numbers.  I mean, I thought I was going to be a bit low, but lower than that.  I think the middle zone, I use it for real time prescription monitoring. I think it is pretty good given the time that it has been up and  available and I think it's a shame that that so few are registered and let us hope that's going to increase, but I think the majority of general practice are probably going to use this more in checking for safety of prescribing restricted drugs as opposed to these the actual authorities, because in general practice, my understanding and experience was that you do not really do that that much.  It's really handy to know about it, but that's probably the safety side of it's going to be more what's your view, Hester - are you thinking that?
 
DR HESTER WILSON
Yeah, totally.  Look, and I am really pleased that there are 20 people who are, you know, in the room who are not using this, who have come along tonight to learn about it.  So, you know, really encourage them to get registered.  And yes, we are focusing on the approval process for medications, the new use of the safeScript New South Wales tool.  But yes, I would agree in, in general practice, the real time prescription monitoring through SafeScript is really, really handy and most of our software’s in general practice, it's actually integrated, so it will come up on your screen.  So, I am really pleased that people are coming along, some who have got experience, some who have not and really encourage those who have not to actually sign up.  It's super easy and start using it.
 
JOVI STUART
Thanks, Hester and Frank.  We are going to move on to the next poll.  The second pole is “What medicines do you currently regularly prescribe that require New South Wales approval?
 
DR FRANK MCLEOD
It does not surprise me.  I guess the Schedule 8 pain management I would have expected to be the most common use of this sort of application and this sort of drug prescribing.  It would have been nice to see from my point of view, more people involved in OTP because there's a serious dearth of OTP prescribers.  Schedule 8 stuff I guess you know, we have all got the odd psychiatrist who prescribe for under their supervision, but other than that, I do not think that's too surprising and certainly I was not surprised by the very low s-ketamine number at the bottom.  Hester?
 
DR HESTER WILSON
Yeah, totally agree.  I am looking at the question, there may be some people who went, oh, maybe I do not do this regularly, so they might not have answered it.  It might be something you do occasionally, but yes, you know, I mean, certainly what we are seeing in clinical practice, chronic pain is 20% of our patients.  So, it's not surprising that the Schedule 8 pain management process is important, and like yourself, I'd love more people to take on some prescribing through the Opiate Dependency Treatment Program.  There's free training, you know, please have a think about it.  It's really rewarding work that both Frank and myself have done over many years.
 
JOVI STUART
Thank you.  That concludes our two polls.  I will hand over now to Elaine.  To go through the new features.  Thank you Eleen Chiu.
 
ELEEN CHIU
Thank you very much Jovi.  I will discuss currently the SafeScript New South Wales features as a majority of you know that the real time prescription monitoring is available for certain high-risk medicines to see, prescribe and dispense events.  And also, the new functionality that has been rolled out gradually is the approval management of S8 medicines, which we will demonstrate.  What is actually currently available if you go through to your landing page is all the S8 approvals that are current for a patient or you hold and also the approvals for the last two years as well.  But what is currently available online is the OTP, S8 psychostimulants, the S8 pain management the S8 benzodiazepine and the s-ketamine for treatment resistant depression.  Applications are available to use and apply online, which we will demonstrate.  Just a reminder that the existing paper and PDF forms will continue to be available.  So that is an option if you are not signed into SafeScript, but hopefully after this demonstration you will feel comfortable to apply online.  Just a reminder that the terminology has been updated from authorities to approvals just to make it easier to distinguish between the Commonwealth PBS authorities. 
 
Just a reminder “what is SafeScript NSW”?  SafeScript NSW is a real time prescription monitoring system that enables both pharmacists and prescribers’ easy access to a patient's prescription history for high risk medicines.  So not only for all the Schedule 8’s, but a select few of non-Schedule 8’s as well.  The information is collected via the Prescription Exchange Service and stored in the SafeScript NSW Repository.   If you are connected in your SIS system, then you can actually access your patient's details, but it does not actually give you direction on whether or not to prescribe or not prescribe, but it just enables you to have that conversation with your patient.  Approval management is the efficient and centralised solution to manage approvals for S8 medicines online and that enables prescribers, so that is medical practitioners and nurse practitioners to submit them online, monitor your application progress.  In a lot of cases you can actually receive approvals immediately and see that confirmation on screen. The ability to cancel or exit OTP directly so you can self-serve and in relation to the OTP, you can update your patient's dosing point information.  So just a reminder that even though this is a GP sort of forum, pharmacists and some New South Wales health employees do have limited access to view a patient's opioid treatment program, information there as well.  In terms of approvals, the key considerations are that an approval is distinct from a PBS authority.  The PBS authority is really just a cost subsidy available from the Commonwealth Government, but an approval is the poisons the Therapeutic Goods Act enables the prescriber to actually prescribe or supply legally to a patient in New South Wales.  Also, the key considerations for general practitioners are that if you prescribe a S8 medicine under a co-management arrangement with the treating specialist, we do consider that and that's specialist directed care, and an example of that is, the psychiatrist directs you to provide prescriptions to a patient for their psychostimulant applications.  You answer those questions or those details within the system, then that will enable that to be considered and possibly be immediately approved.  Also, OTP applications are very popular as well as indicated by the poll.  A significant proportion immediately approved and the next couple of slides are for your reference after this webinar.  It shows you what is eligible for immediate approval.  In OTP it talks about who's accredited or if you are not accredited, you know what the considerations are and in the next couple of slides it talks about when you need an approval.  Is an approval required?  What is the considerations that the ministry takes into account when they receive your application?   
 
If we move on to through these couple of slides onto the next one which is the current prescribing dispensing alerts.  If you are connected to the real time prescription monitoring through your clinical information software, you will probably have been receiving these notifications.  These are a list of the current ones that were available before the prior release and I will just explain a little bit about the new alerts and notifications that have been added. 
 
With this slide it takes into account those patients that are enrolled in opioid treatment program, as well as what you are proposing to prescribe or supply.  A red alert is a high-risk alert.  You can actually get the notification if you are connected, but also if you log in separately through the portal, you can actually click on the alert and get the relevant details.  It will tell you why there is an alert.  So, in this case, enrolled in OTP, you are prescribing something that is considered a high risk.  The medium risk is the Amber alert - the orange alert.  A patient has a current OTP approval.  The prescriber is authorised under that approval, but you are considering prescribing a CNS depressant or a sedating medicine.  So that's an example of a new alert.  And another new alert is that the medicine requires approval.  So that is commonly a psychostimulant.  You may not hold a current approval for that medicine, but you have put that into your clinical information system and that gives you that alert.  These slides will give you a little bit more detail and you can peruse them and maybe ask questions about it later. 
 
JOVI STUART
Thanks so much, Eleen a everyone will also get a copy of the slides to your email tomorrow morning.  Now we will now move on to the case studies, which Hester and Frank will lead and over to you, Hester.
 
DR HESTER WILSON
Thank you so much and thank you Eleen for running us through that.  There's quite a lot of information there, so I am really glad to see that we are going to get a copy of the slides, just really making sense of when we need to do this, but it's great that it actually flags it for you.  We have got a few case studies just to think through when we might do this and the first one is for young Eri, who is a nine-year-old boy who's been diagnosed with ADHD.  Very well known.   He is very well known to you and your practice.  His family have been long-term patients, and he's really struggled with attention at school and really struggled in terms of his interactions with some of the other kids, and your thought was like “look, I think there might be some ADHD history in the family”.  So, you referred him to the local paediatrician who diagnosed it and started him on treatment.  He comes in today with his mum and his mum is saying ‘he's brilliant’ and he sits on the chair and you have a good conversation with him.  School grades are better.  He's getting on better with his friends and his mum says, “look, the paediatrician said you could take over prescribing for his methylphenidate”, he is on 10 mg bd and there is a letter that you have from the paediatrician stating he thinks it's appropriate that you can prescribe and he will see him yearly for reviews or more regularly if you need.  Now for us as GP's this is great.  You know it's a really good outcome and we can support the family and continue to see them, not only for the ADHD that he has, but for everything else in the family.  What this is going to allow us through SafeScript is to do, we hope, get that approval very easily.  Frank, did you want to make any comments about this particular presentation?
 
DR FRANK MCLEOD
No.  So, I am pretty good. I could see this happening on a not infrequently in general practice and I think it also always raises your interest and what you to get on top of it.  I think having a good liaison with the paediatrician and/or maybe psychiatrist if it was a child or adolescent psychiatrist that he gets involved and I think the system works really well.  I think, and I include myself in this group, I do not think everybody was aware that if you take over from another specialist in an area, you have to get an independent authority, and I raised my hand because I made a mistake in that just recently, as we both know.  So, it's good to be aware and it's certainly good to do and SafeScript makes it so much easier. 
 
HESTER WILSON
Let us hand over to Fraser who is going to go through how we actually do it.  Thank you so much Fraser.
 
FRASER DRON
Hi, everyone.  I am Fraser.  I am one of the business analysts on the project team.  I have got the SafeScript Health Practitioner portal open.  Here's how we would go about applying for that psychostimulant authority for Eri.  Let us say that he has got what we call a linked record.  That means it's got both parts of the patient record.  The medication history on one side and the regulatory history on the other side.  If I click through, you will see what I mean here.  This is the medication history.  The monitored medicines that's been prescribed and dispensed to our patients.  You will see he's been prescribed methylphenidate.  Just ignore the alert.  It was a bit tricky in the test system to get a prescription from the right specialist going up here.  If I had a paediatrician to prescribe from, I would not have got the alert in this case.  I am going to click through to the patient profile.  This is the other part of the patient record where we have all of the information that is maintained by Pharmaceutical Services.  We have got his identity information up here and other details that we can modify, but the key thing here is down in the approvals area.  Eri does not have any approvals yet, because the if I am correct, the prescribing from the paediatrician would not have required an approval.  We are going to take over as a GP.  We now need to apply.  I am going to click Create Approval and pick S8 psychostimulants and that will bring up the application form.  We have read through the information here about who should be applying and when.  This is all based on what's on the existing PDF forms.  Once I have read the Getting Started information, the clinical advice and the privacy statement, I will tick that I confirm I have read them and then click continue.  Next thing is to pick the clinic that I am prescribing from.  I am linked to one clinic.  This one I am going to be prescribing from today.  There are patient details to review here.  I can click through and view the patient again if I need to.  I will click continue.  Now this is the key question here.  I am going to tick the box to say that I am a medical practitioner applying to prescribe or supply under a co-management arrangement or a transfer of care agreement.  It is a little info icon you can click for the definition of that agreement and that will affect the outcome of my application.  It is important that I tick that in this case.  The systems detected that there's no OTP approval for Eri of course, I ticked No by default.  I can change that if I need to.  And then I need to answer with the whether I consider the patient to be drug dependent.  Again, there is an icon I can click for the definition of drug dependence.  I say no in this case and carry on with the continue button.  Now we are on the drug authorisation details screen, I will click Add Medicine Details.  Here is the relevant medicine here.  That was methylphenidate 10 mg daily oral.  Click Add and that will appear on the application now.  Then I need to choose the indication admission which is ADHD in this case and continue.  Final step here is to review the summary and declaration screen which shows me all the details I have entered.  I can see my applications in the draft status, which means it has not been sent through to Pharmaceutical Services yet.  I can save it if I need to or I can come back later from my approval screen, but for now I am going to continue on.  I see the details of who I am, who the patient is and the questions I have answered through the application, including the medicine details and indication.  It's just a declaration I need to confirm at the end. I confirm that everything is true and complete and, in this case, I need to say that I am someone who has written support from a relevant treating specialist.  I will submit my application.  This application meets the criteria for automatic approval.  So that means I can start treating Eri immediately.  If I click Okay I am taken back to his profile.  I just refresh that?  It will show me that his approval should be active.  If I go back to my approvals screen, I should see that at the top.  Here we go.  This is the list of all of my approvals plus approvals for other prescribers that clinics are linked to.  I have now got that approval at the top.  Eri, methylphenidate and that's approved.  The letter for that approval has been generated as well.  I can get that from my correspondence screen.  That confirmation I can print that from here or download it.   Thank you.  I am going to hand back to Hester and Frank.
 
DR HESTER WILSON
Thank you so much.  That's really, really brilliant, Fraser.  We are just going to go on to the next case study but so easy, so super easy and so quick, so different to how it was in the past with filling in forms and faxing or posting and waiting for them to come back.  But let us look at Case Study 2.  Felicity, who's a 58-year-old.  She has previously been on opioid dependency treatment on methadone and completed treatment, cut down a dose, stopped, been doing really well and stopped 18 months ago, but she relapsed back to oxycodone and heroin use through informal markets a couple of months ago.  So, she's come back early saying, “look, you know, I have got myself into trouble”.  She has some very important multi-morbidities, including Type 2 diabetes and long-standing chronic pain, back pain and severe right knee osteoarthritis and says, “look, I just want to get back on treatment, you know. I have lost control of it.  I really want to get back on treatment”.  And this is totally appropriate.  We talk about the options whether she wants to go on methadone, whether she wants to try a buprenorphine, some of the buprenorphine formulations, whether that be the sublingual or the long acting injectable.  And she says, “look, I was good on methadone before.  I do not want to stay on it long.  I just need to get things back on track again”.  And so, you think, okay, yep.  That sounds like a good plan.  I know her very well.  I want to request authority through SafeScripts.  So, Frank, any comments on that case study at all?
 
DR FRANK MCLEOD
This resonates with the patient that I have had in the past and obviously she's basically coming in at a late stage, basically from the street and this is where certainly it's got to be an authorised prescriber that's going to start this off.  Obviously, she's going to benefit from methadone if that's her choice, and I believe strongly that the patient should have a choice in their choice of medication once they go into the program.  I think this one is quite typical.  I think the good thing about SafeScript, you can see if she's been doing it, any doctor shopping in the background and checking up her prescription history for some time going backwards.  So again, it's an added level of safety for us to use that resource.
 
HESTER WILSON
Certainly, her history is that she's obtained this informally rather than from prescription.  So, you know, it's possible that you might not see any oxycodone on her SafeScript, but very important to check that.
 
DR FRANK MCLEOD
It is also a good sign that a patient fesses up to what they have been doing if they have been getting off the street, because that's always the problem and SafeScript is not omniscient, as good as it is.
 
HESTER WILSON
I think the good thing about Felicity, is that she has some knowledge of methadone and she's come back only after two months of relapse, which is really, really positive that she's recognised that this is not working for her and needs to get back into treatment.  That's a really common history, Frank, as you say, for people to relapse, it's a chronic relapsing condition.  She did well, she was able to complete treatment, but now she's had a setback.  So, it may be that she does not need to continue on this very long, and certainly I absolutely agree with you that there is nothing in this history that makes me concerned about methadone for Felicity and patient choice in terms of what they want to try is really important, if methadone is available in their area.  So, let us move back to looking at how this gets done on safe script. 
 
FRASER DRON
I have got Felicity set up on SafeScript.  Let us have a search for her record.  First has to mentioned we do not have any oxycodone showing up on her record, as it was all informally obtained, but we do have a record of her last methadone prescription from 2022.  To click through to her profile and see the dosing point that she was attending up until November 22nd and that approval for ATP which was exited at the start of November 22nd.  To get her back on the program, we are going to click on Create Approval OTP.  Again, reading through the Getting Started screen with all the relevant information for an OTP approval.  You will note that my OTP patient limit is shown up here.  The prescriber logged in as has an OTP accreditation set up.  So that affects the outcome of the application.  It also means that I can prescribe OTP up to 300 patients.  If I did not have the accreditation, then I'd see the separate limits for methadone and buprenorphine shown here.  I am going to click ‘I confirm’ that I have read and understood everything here.  Continue on.  We have got our prescriber clinic and patient details.  Nothing to change here.  Click Continue and the OTP, we have got a bit of additional information we need to fill out.  Click the relevant options.  Under primary opioid drug of dependence add the relevant drugs here.  The heroin been the primary opioid drug defendants and other drugs.  No other drugs of concern were mentioned.  The patient's current opioid treatment status shows up here.  This is again automatically filled by the system.  We know that she's been on ODP in the last two years, so I cannot change the answer to that one.  Date of last dose.  Let’s say was the 1st of November 2022.  Now I need to Methadone as the OTC drug she is going onto.  I will click ‘Add Medicine’ details.  OTP applications are all defaulted to the highest non-high dose maximum daily dose.  So, for a high dose anything over 200mg of methadone, I think it's 32mg of buprenorphine daily, you'd need to submit an application via the PDF form.  So that's a small number of applications, but the majority would be through SafeScript and would go to that standard maximum dose.  Enter the proposed starting date - put today.  The expected the starting dose.  Click ‘ADD’.  Medicine shows here.  If that's all okay, you will click ‘Continue’.  Again, we get a summary.  I can take the declaration.  Click ‘Submit’ and again, that application was a straightforward one.  It's been approved automatically.  When I click ‘Okay”, you will notice that it's just asking to check the patient's dosing points.  It's going to take me to the patient profile.  I can scroll down to the dosing point area and click ‘Add Dosing Point’.  Here I can search for the organisation that I have already contacted and arranged for the patient to be dosing at.  When I choose it, it gets added to her profile with a start date of today.  Before I save, I can change that start date if I need to, if I need to make it in the future, but let us keep it to today for now and of course the end date we will leave open for now.  You can end a dosing point of the patients ending and moving into a different one or if they are exiting OTP entirely.  I will click ‘Save’.  That saved the dosing point for the patient record.  Anyone can now see that the patient is on OTP this approval with my prescriber from today.  Thank you and back to Esther and Frank for our next case study.
 
 
HESTER WILSON
Thanks so much, Fraser.  That's brilliant.  Once again, it's just super easy.  I think, Frank, you are going to lead us through a poll.
 
DR FRANK MCLEOD
I think Jovi is going to kick it off as I understood it.
 
JOVI STUART
Are you aware you can see prescribing/dispensing history and previous approvals in SafeScript in New South Wales?
 
DR FRANK MCLEOD
I will be predicting a high response to that.  It is pretty much as I expected.  I am surprised still that there's one in five people that are accessing or can have can access, or weren’t aware of SafeScript that this facility has there because it is very helpful.  It is very safe.  It gives you an idea about doctor shopping also gives you an idea about the patient's past history.  I saw a bloke just recently and I found out he'd done a whole lot of jail and been on a whole lot of prescribing with a whole lot of subscribers before I met him, and that was information I did not have and it was not volunteered at the time I took his history.  So, there's a lot of information to be gleaned from SafeScript.
 
HESTER WILSON
The answer is Yes.  You can see prescribing dispensing history in previous approvals.  So, it is really useful.  That's fantastic.  So, let us move on to the next case.
 
Steph is a 45-year-old with chronic pain.  Steph has a history of opioid use disorder in the past and was treated with sublingual buprenorphine over six years.  Once again completed and ceased treatment two years ago and has been very stable since.  She suffers chronic pelvic pain and Gynae review has excluded all definitive treatments.  Her pain specialist has seen her and suggested Targin, with a low oral morphine daily dose to help her manage her pain.  So, you are very happy to do this for her to trial this treatment.  She has seen the pain specialist.  You know, you need to apply for authority because she actually has that history and is a drug dependent person under legislation.  Frank, any thoughts about this one for you?
 
DR FRANK MCLEOD
I think this one would slide past a lot of people because of the dose that's recommended and probably not being aware of the definition of drug dependency in terms of the rules.  This would be, and not wishing to sound like the grandfather, but this would be a trap for young players that could easily get past you, and like everything else, if it does not go wrong, it does not go wrong, but if it goes wrong, bloody hell it goes wrong.  So, this is one of those situations where you must be aware of what the rules are and the definitions.
 
DR HESTER WILSON
And once again doing this through SafeScript and the approval process makes it so much easier than with the paper forms.  Let us hand over to Fraser and have a run through it.
 
FRASER DRON
Similar process again, search for steps record.  Here we go.  We will bring up her profile here.  So, we can see here buprenorphine prescription from 2022.  No more recent prescriptions here.  You click through to her profile.  We can see her past dosing point in October 2022nd and it passed approval that ended at the same time.  In this case we are wanting to prescribe for her pain management indication, so let us apply for the pain management approval type.  Again, we get the Getting Started screen. We put the relevant information for pain management application.  I will confirm that I have read that and understood it and continue on.  Very similar process for all these approval types.  I have got a prescriber clinic and patient details.  Nothing needs to change.  Again, I will tick the Co-management checkbox.  The patients not currently enrolled in the opioid treatment program.  But next question - Do you consider her to be drug dependent?  So, I am going to say Yes in this case.  Given her history.  I will continue.  Under the drug authorisation details, we are applying for oxycodone 1 mg daily dose.  I need to enter the total oMEDD being prescribed and this is for chronic non-cancer pain.  Forgive my lack of clinical knowledge here, I am going to say, because it's a trial, we are doing it for two months.  That may or may not be correct, but just so that we can continue.  I go to Information about the application, About me, My patient.  Questions I have answered and the medicines and indications.  Tick the declaration.  Click submit.   In this case, because we are talking about a patient who we have said is drug dependent, the application is not going to be approved automatically.  It's going to have to be reviewed manually by PSU with their standard time frames.  That should be faster than the seven days which the paper forms take.  Now how do I get notified of the outcome of my application? I can log in to SafeScript and look for the approval showing up on the approvals grid here.  At the moment it's saying submitted.  The status is going to update as it goes through the process until it ends up as approved or not approved.  But the other thing that will happen is that when the approval letter gets generated, someone manually reviews and approves my application, the letter will show up here and I will get an email to my email address set up on my profile - contact email address here.  Just to say that I have a new piece of correspondence to read.  So, it will not tell me who it's about or what the details of that correspondence are.  It will just say log in to SafeScript.  There is something you have not read yet.  And when I do, I will say the letter showing up here and that email goes to two places, it goes to both my email address and also to the email address of the clinic that I am prescribing from, which was this clinic here.  I click through the clinic now.  I just noticed that in the contact details, there is an email field, so that email address there will get the same email just to say that I have got an unread correspondence item to look at.  So that's the mechanism we have for letting people know that they have a response to their approval application.  Thank you.  I will have to hand back now to Hester and Frank.
 
DR HESTER WILSON
Thank you so much, Fraser.  That's really brilliant.   We will leave the poll for a moment Frank.  There was a question around what we would consider, what is a drug dependent person? And there's also a really good question from an anonymous attendee who's saying, look, she completed her opioid pharmacotherapy treatment two years ago.  Do we still consider her to be drug dependent? Is she drug dependent for life? I think these are really interesting questions.  What would you say first of all to, how do we assess what is a drug dependent person?  Under the Act, it is not specified really, it is a drug dependent person.  So how do you go about making that assessment?
 
DR FRANK MCLEOD
From my point of view, sometimes it's really easy, if you have got a person who's doing armed hold ups, who's shooting up half a gram of heroin three times a day and four times on Sundays, there's a fair indication you can say with great confidence that that person is drug dependent in terms of the Act and any common-sense definition you wish to use.  But I have always had trouble with the idea of the Act’s definition being a bit fluffy because it could apply to both people who are iatrogenically dependent, but not addicted in the old use of the non-PC term, but still have withdrawal symptoms and feel very unpleasant when you suddenly stop the morphine they have been having for their fractured femur in hospital.  So, I personally would love to see the whole thing revisited and defined in such a way that those two categories were specified and separated and not put through the blender as I feel they are at the moment.  That's a feeling I have had for a long time.
 
DR HESTER WILSON
Totally.  And when you are talking about the person that's been prescribed opioids and majority of people who have been prescribed opioids for some time will experience a physiological dependence with withdrawal symptoms when they try and stop and maybe the medicine not working as well.  So greater tolerance, but they would not be considered a drug dependent person under either ICD 11 or DSM 5.  They would not be considered to have an opioid use disorder, for example.  But it is tricky.  It really is tricky.  So, I guess, you know, I am of sort of myself as a GP and having done a lot of addiction medicine would be needing to make that decision and if I am not sure, then I'd probably go for an authority or an approval.  Well how would how would you go? Frank?
 
DR FRANK MCLEOD
I think this is where you have got to be sensible and consider looking after your own professional integrity.  Like I said before, if it does not go wrong, it does not go wrong and everything's good.  But if it goes wrong it goes wrong badly.  And then you could have the sharp end of the pointed stick pointed at you by the Coroner or the ACCC.  So, my advice would always be ‘er’ on the caution.  There is no downside and you are also supporting yourself legally and medico-legally, but you are not limiting the treatment to the patient.  So, you have got all bases covered.  In the end of it, it really comes down to it's a label and it should not really change the way you treat the patient.
 
DR HESTER WILSON
Yes, that is totally true.  I guess one of the nice things about doing this approval process is it does flag to the person that these medicines do have risks and we are doing a trial and we are going to see how it goes.  It's a low dose.  If it's effective then we can continue it on.  We are going to continue working with the pain specialist.  So, it's just setting up those support structures for that person.  I think it's a tricky one, the whole drug dependent issue, get advice, get support, have a talk to DASAS, which is the 24/7 drug and alcohol specialist advisory service or your local drug and alcohol team or your local addiction specialist, if you are not sure to get some support in this area.  But absolutely, Frank, we should not be thinking that because someone has a history of drug dependence or opioid use disorder in the past, that they should not be able to access the medicines that they need that potentially can actually help them.  It is a high-risk medicine, we need to be thinking about the risk and the benefit in everyone that we see and working collaboratively with our patients to actually get the best outcomes if we can.  Do you want to move on to the pole or have you got final words there, Frank, that you want to add?
 
DR FRANK MCLEOD
I guess let us see what people say.  Let us see if what we intended and what the aims were and pick a target.  Well, that's pretty positive.  We got you know, almost two thirds positive, well, more than two thirds when we add in the very prepared as well.  So, I guess that's credit level I think Hester isn't it. 
 
DR HESTER WILSON
Yes, totally.  And look in terms of using SafeScript NSW for those people that perhaps have not used it before, this was quite a focused webinar looking at the approvals process, not the whole of SafeScript.  I would flag that there there's very good information on the SafeScript on the SafeScript website and there are past webinars through the College and there is also some online training that's available as well.  There's also a 24/7 number, not only the DASAS, which is the Drug and Alcohol Specialist Advisory Service, but also a 24/7 number for any clinical issues that you want to discuss with someone about SafeScript. and there is also technical advice if you need that as well.  So, you know, really great that we have seen that that the majority of people feel that they are they are prepared and able to use the SafeScript NSW, particularly the approval page after watching the really useful really great presentations by Eleen and Fraser.  Thank you.
 
DR FRANK MCLEOD
One of the other things that is a really good idea is to get on the site, search on one of your own patients and have a look around.  Unless you submit anything, nothing is going to happen, but get used to where the pull-down arrows are because I had trouble with that.  Some of the labels of the different activities are not necessarily as visually obvious as you might hope, but have a look through it.  There is an awful lot to be gained by becoming quite facile with this tool - and that's what it is.
 
DR HESTER WILSON
The other thing just to remember, most of the GP medical software’s will actually embed it.  But you need to actually make sure that, I think you have got to click a button somewhere in the administration in in your best practice or medical director.
 
DR FRANK MCLEOD
You do in the set up, but the problem is, if you do, I was going to bring this up after, but this is now relevant.  If you do a lot of S4 or S8 prescribing, it will drive you berserk, because it clicks on and says go to SafeScript, you have got to go through the whole procedure.  What I do because I am a one trick pony and I only do this sort of thing, is I have it open as a tab on my browser. So, I click out of My Best Practice I go into tick, put in my pin and I am there already.  And it saves you a lot of drama through the day and I open it when I log in in the morning and I kill it when I go to bed at night.
 
DR HESTER WILSON
So that's the online portal that you can access independently and, I use that in one of my jobs as well where you just click between the two, it's really, really useful.  I have to say that certainly for me SafeScript has been nothing but useful.  Being able to see what my patients are doing and for the vast majority of them, they tell me exactly what's going on. and I can confirm that on SafeScript, and also the approval process is really, really fantastic.  So, there are a number of key resources which I kind of went through a little bit there.  You know, as Frank says, go and have a look, have a play with it.  You know, really do get yourself onto it.  It's a really great tool and it's been really thoughtfully put together by New South Wales Health with a lot of thought and a lot of hard work around making it as good a technical tool as it can be.  It cannot make your decisions for you, nor should it, but it it’s a tool to help you make those decisions.  You as the person that's seeing them, who's done their assessment and their reviews and knows them best, are best placed to make those clinical decisions and this is a tool that can support it, and I have to say the online approval has just been brilliant.  Makes it so quick and easy.  There are some situations, as Fraser said before, where you do need to do paper approvals and processes, but for the vast majority it's super easy through this site.
 
ELEEN CHIU
There are key support resources available on the SafeScript NSW website.  We have got this website written up on the slide so you can refer back to it when you look at the slide pack.  There are quick reference guides, information about the record types if you have questions about that.  We do get frequently asked questions, something that you find might need further explanation.  Probably somebody has asked before, so those are available and there are some short how to videos that will talk you through the process, but as you can see with the approval process, there are little information icons prompting questions and you will see that the application process is nice and short.  And while you logged into SafeScript NSW, there is a Help little button at the top near where your login is on screen.  You can always click on that and there are topics to look up as you go.  If you come across something that's a bit sort of difficult or you want some more information on.  So hopefully after this demonstration we have shown that the approval management functionality is easy to use.  You can improve your workflow practices and hopefully fits in how you actually see your patients.  They save time.  A significant proportion of these applications are immediately approved, so that enables you to treat the patient there and then and I think that's a big advantage that, you know, we have certainly heard from a lot of prescribers.  If you have not registered for SafeScript, please register and I will hand over to Hester and Frank for final words.
 
DR HESTER WILSON
Final word from me is I think I have already said it, but I will say it again.  If you are not registered, do it is really simple.  Takes five minutes and it's really useful, and I find it a really positive experience.  I talk to my patients and let them know that I am checking SafeScript and why I am, that it is around ensuring that what we are doing is safe and I talk through with them what's on there.  The vast majority of my patients, it is exactly what they have told me, for some there are some surprises, and so that can be the start of constructive conversations around what's going on and how you want to ensure that they have the best possible and safest management.  Frank, did you want to have a last word?
 
DR FRANK MCLEOD
One of the things that I would suggest is, is that you do learn this thing, but remember there are a lot of drugs that we have not discussed tonight that are on the so-called two-month list that you should be aware of.  You can find it if you do a search and Google on NSW and S8 and it will take you to the page and list those drugs.  If you are going to prescribe these drugs for more than two months, you need to get an approval and SafeScript is your friend in this sort of circumstances.
 
JOVI STUART
That is all we have time for this evening.  I'd like to thank all our speakers Frank, Hester, Fraser, Eleen and everyone that has joined us online tonight.  We do hope you enjoyed the presentation, and just to remind that as this is a CPD accredited activity and to be allocated your CPD hour, you must complete the survey following this webinar. 

Other RACGP online events

Originally recorded:

9 April 2024

SafeScript NSW is a real time prescription monitoring system for monitored medicines. The system is available to all prescribers and pharmacists in NSW.
 
NSW Health is continuing to improve the efficiency of regulation and monitoring of certain high-risk medicines.
 
NSW Health has extended SafeScript NSW functionality to help manage NSW approval applications to prescribe certain high risk medicines. The new functionality became available in November 2023 to allow prescribers to submit approval applications online (and in some cases, be issued approval immediately) and track application progress in efforts to reduce the turnaround time to receive an approval.  

Learning outcomes

  1. Utilise the SafeScript NSW system to understand existing and new functionality to inform best practice patient outcomes.
  2. Discuss the benefits of SafeScript NSW to review real-time prescription monitoring for certain high risk medicines and managing NSW approvals to prescribe S8 medicines in NSW.
  3. Discuss the NSW approval application process that was introduced in late 2023.

Speakers

Dr Hester Wilson
BMed(Hons) FRACGP FAChAM MMH

Dr Wilson is a GP, Chief Addiction Specialist for NSW Health, Clinical Director for Murrumbidgee Drug and Alcohol and Clinical Advisor to Population and Community Health in South East Sydney LHD. She is chair of the RACGP Addiction Special Interest Group, a clinician with many years clinical and teaching experience, she is currently undertaking a PhD focused on GPs’ experience of patients with chronic pain and prescription opioid use disorder.

Dr Frank Mcleod
Physician and Addiction Medicine Specialist

Dr Frank McLeod has lead an extensive medical career specialising in addiction medicine, working as an established GP, specialist, hospital administrator and even in the Royal flying doctor service to name a few of his achievements. Dr McLead has also focused particularly on harm reduction with HIV, has been CEO for the prison medical systems in the 80’s and been involved in a number of medical related media outlets; such as the Medical Observer, Australian Doctor, the ABC website and User’s News.

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