The scope and uptake of Tasmania's real-time prescription monitoring system should be expanded, the state's coroner has found, following her investigation into the prescription drug-related accidental death of a 44-year-old man.
Coroner Olivia McTaggart made the recommendations for changes to Tasmania's webpage-based information system – the Drugs and Poisons Information System Online Remote Access (DORA) – in her report into the 2014 death of Michael Allan Steer.
McTaggart found the ex-Navy submariner died in his home in Newnham, Tasmania, of mixed drug toxicity, with a post-mortem showing quetiapine in the toxic range, as well as codeine, diazepam, fluoxetine and paracetamol.
Many of these drugs are Schedule 4 drugs and are not recorded in DORA.
The coroner said changes were required to prevent harm from doctor shopping in cases in which patients have been reported or diagnosed as drug dependent or drug seeking.
“I recommend that the real-time monitoring system ... be reviewed with a view to including a requirement for dispensing pharmacists to record the dispensing of Schedule 4 drugs of a high abuse potential on the system at the time of dispensing,” McTaggart wrote.
Since February, pharmacists have been obliged to report the supply of Schedule 4 opioid analgesics, such as tramadol and codeine, for inclusion in DORA.
“However, doctors prescribing non-Schedule 8 drugs of dependence such as benzodiazepines (such as diazepam) or quetiapine are not required under the Poisons Act to obtain an authority to prescribe, as would be required with the Schedule 8 substances,” the coroner said.
“Further, pharmacists are not required to report through DORA the dispensing of such substances so as to enable real time monitoring of dispensing.”
McTaggart also said DORA could be much better used by doctors and pharmacists.
“Approximately 60 per cent of medical practices and pharmacies have access to DORA since its initial release in 2011,” she wrote.
“Evidence from the United States would suggest that ensuring DORA is used regularly by all prescribers and suppliers of these high-risk substances as a clinical decision support tool would result in a reduction in high-risk medication over-utilisation.”
The criticisms come as Victoria's RTPM system, SafeScript, goes online in the state's west.
SafeScript records all Schedule 8 medicines and some Schedule 4 medicines, including all benzodiazepines, quetiapine, codeine and ‘Z-drugs’ such as zolpidem.
Launching the platform, Victoria's Health Minister Jill Hennessy said it was Australia's “first comprehensive RTPM system”.
“We promised the most comprehensive and cutting-edge real-time prescription monitoring system in Australia and that’s exactly what we’re rolling out,” she said.
More than 400 sites across the Western Victoria Primary Health Network catchment are part of the initial SafeScript roll out.