Dean's message

December 2011                                                                                                                     

Good news – on Sunday 12 February, the Australian Government announced $5 million funding for a national online electronic controlled drug monitoring system.  This follows a successful pilot in Tasmania.  For all types of pain where opioid prescribing is appropriate, both prescribers and dispensing pharmacies will have the ability to review and monitor similar or other controlled drug prescribing for a particular patient.  While one major aim is to identify doctor shopping and similar inappropriate behaviors, its benefits will not necessarily only be related to reducing prescription drug abuse and diversion, even though that is a major goal.  The fact of there being such a problem in itself adds an extra layer of inhibition to the fairly widespread opio-phobia barrier which prevents doctors from prescribing opioids even where they would be appropriate. Using Opioid Risk Assessment tools (eg ORT) and this long awaited monitoring tool should allow increased confidence in decision making after taking a closer look at what has already been dispensed to a particular patient, thus contributing to improved prescribing of pain relief.   However, the government can only do so much – by funding this they facilitate what we as professionals can do – but it will be over to us to make it work and achieve the benefits. The Government’s decision to support this also teaches us that for important matters like this it is necessary to keep chipping away at getting the right messages across. There will be a learning curve once it is introduced no doubt.

It has been no small time since recommendations for such a monitoring system have been made by our Faculty members.  From around 2007-8 the momentum picked up, culminating in this as a major recommendation of the Prescription Opioid Policy released in 2009 by the RACP into which the Faculty of Pain Medicine, ANZCA and the Chapter of Addiction Medicine, RACP were major contributors. Subsequent to that report, both our DPA and immediate Past Dean have, amongst others, submitted on behalf of the FPM to several bodies considering opioids at different levels – funding, authorities for prescribing, and reiterating the messages of the above mentioned policy document.

I first heard of an example prescription monitoring program (PMP) in West Virginia from a conference visiting speaker, having commenced around 1995 (although it did close down for a period).  The growth of the internet and availability of better IT equipment in healthcare environments has now reached a level of maturity enough to make this current project workable.  In NZ serialized triplicate script pads for controlled drugs with a copy going to “Medicines Control” has been useless in halting bad opioid prescribing, except for post hoc investigations. The task of entering data from these into a computer database close to real-time does not appear to have been done. However, we do have a system of rapid internet application for special approvals for high cost medicines – in place for >5 years. Which of course reflects the priority of administrators for a cost-control electronic system as more important than what would be a clinically valuable one such as the Australian Government has just announced.  There is now a challenge for NZ to follow suit!

It begs the question as to why there is a soaring death-rate from not only abuse of (usually someone else’s) prescription opioids, but also accidental overdoses by those for whom they were being prescribed. This amongst non-abusing recipients. Careful prescribing is by no means less important just because there is such a monitoring system. Prescribers must have a high level knowledge about opioid analgesics – something our members can contribute to at undergraduate levels, because without that very little is/has been taught on this subject. 

The Faculty, now in its twelfth year, is entering an exciting period of looking into the future for a vision as to where we will be in 10 years, which will in turn help in development of the 5 year strategy, to be done in parallel with ANZCA’s.  A facilitated workshop on the vision is the starting point, from which more detailed strategies will be developed. The CEO and Policy Unit contributed a comprehensive consultation plan for both internal and external stakeholders.  Consultation at regional committee level had FPM input included. If any of you have burning ideas and have not been able to contribute in the formal processes, please communicate them to any Board member, Helen Morris (FPM General Manager) or myself.  It is not too late to say something.

Re-accreditation is under way, with the mammoth task of preparing the submission which answers the questions regarding the standards set by the AMC.  Both ANZCA and the FPM are undergoing this process simultaneously, as is the Medical Council of New Zealand also going to utilize the same process (unified?). Many aspects of our Blueprinting process directly inform this, so their coincidence time-wise is fortunate. Of course, because MCNZ has not yet completed its first accreditation of the FPM, then re-accreditation of us by them is not for this round. But it does make sense for the two bodies to collaborate and one to accept the result of the other. 

Before long our annual major meeting – the ASM in Perth – will be here. This is a time for re-energising and renewal – hearing of new ways to do things, new topics entirely, new faces and places.   One strategy I use is to try find on the program some topic(s) that I know next to nothing about … so as to get my eyes opened; not to deny going to topics of existing high interest though, since there are always different perspectives and emphases.  I hope each of you who attend will pick up some tip, trick or hint that you can put to good use for your patients back home.   Till then – something the theatre receptionist in my hospital has put up to keep us on track and to help each day go well: “It is nice to be important, but much more important to be nice”.