Open Access
Therapeutics clinic

Real-time prescription monitoring: how it can help safe prescribing of high-risk medicines

Open Access
Therapeutics clinic

Real-time prescription monitoring: how it can help safe prescribing of high-risk medicines

HESTER H.K. WILSON, ANDREW HARGREAVES

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© Kubra Cavus/istockphoto.com
© Kubra Cavus/istockphoto.com
Dr Wilson is a Staff Specialist in Addiction Medicine at Drug and Alcohol Services, South East Sydney Local Health District; Conjoint Lecturer at the School of Public Health and Community Medicine, UNSW Sydney; and a GP in Sydney, NSW. Mr Hargreaves is Program Manager, Real Time Prescription Monitoring Program, eHealth NSW, Sydney, NSW.

Abstract

Real-time prescription monitoring (RTPM) of  high-risk medications such as opioids and benzodiazepines is available or in development around Australia. Six case scenarios explore how RTPM can help GPs prescribe safely, including responding to a new patient or inherited patient requesting opioids and reassessing their own patient taking high-risk medications.

Real-time prescription monitoring (RTPM) is being implemented around Australia, under the oversight of state and territory governments. These programs seek to decrease the risks and harms of high-risk prescription medicines such  as opioids and benzodiazepines. RTPM can help prescribers  and pharmacists make informed decisions about prescribing and dispensing. It can also inform clinical decisions about the level of support patients require to help manage their medical conditions. 

This article focuses on prescriber experience and presents common case scenarios of patients prescribed high-risk medicines. These scenarios are designed to help prescribers think through their approach to management with the assistance of RTPM. 

Case 1. A new patient requesting opioids 

Josephine, aged 49 years, is new to your practice and arrives late on a Friday afternoon as a ‘walk in’. She says, ‘I know you’re busy, doctor, and I won’t take much of your time. I just need a repeat script for my oxycodone’. 

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She explains she had to travel without notice to assist her father, who is unwell, and her prescription has run out. Her GP in her home town is not available to help. She has a letter from a medical specialist in another city, listing her medications as:

  • oxycodone 5 mg as required, one to two daily
  • oxycodone modified release (MR) 20 mg twice daily
  • fentanyl 12 mcg/h transdermal patch
  • diazepam 5 mg three times daily
  • pregabalin 150 mg twice daily.

Your heart sinks as you hear her story and read the list. It is too late in the day to ring the specialist, and you have no idea how safe her medication use is. 

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Many GPs have experienced the ‘heart sink’ that occurs with a case such as this. Although the prescribed medicines may be appropriate, when the patient is unknown, corroborative information is often limited to help make an informed prescribing decision. 

Around the world, drug-induced deaths from prescribed and nonmedical use of high-risk medicines have increased.1 In Australia, opioids caused three out of five drug-induced deaths in 2020, and benzodiazepines were also often implicated in these deaths.2,3 Most of these deaths were accidental.2 Overdose risk is increased by concurrent use of other sedatives, including benzodiazepines, stimulants, sedating antidepressants, antipsychotics, gabapentinoids and nonpharmaceutical sedatives such as alcohol.2,4 Some of these deaths resulted from unco-ordinated supply of medicines, including prescriptions for multiple high-risk medicines obtained from multiple prescribers.2,5,6 

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Prescribers often find themselves in a difficult position with not enough information to assist their prescribing decisions. The national Prescription Shopping Information Service (PSIS), although helpful, provides information on only a small number of patients who are obtaining a large amount of PBS medicines from multiple prescribers.7 Further, this information is often incomplete and out of date.