Real-time prescription monitoring comes to South Australia

South Australia is the latest state to introduce real-time prescription monitoring (RTPM) in a nation-wide effort to curb addiction, overdose and death.

The new ScriptCheckSA system was introduced at the end of March to help prescribers and pharmacists assess the safety and appropriateness of monitored medicines use. 

It is now available and voluntary for all prescribers and pharmacists across the state, with a mandatory expectation to integrate the system within a 12-month period predicted.

South Australian Minister for Health and Wellbeing Stephen Wade said the rollout of ScriptCheckSA would help to address prescription medicine dependence and misuse.

‘Nation-wide, the supply of prescription medicines is increasing, as is the rate of overdose and accidental death,’ Minister Wade said in a statement.

‘ScriptCheckSA will expose inappropriate use of high-risk [medicines] and reduce “doctor shopping”.’

The Department for Health and Wellbeing’s Drugs of Dependence Unit (DDU) Manager Kerin Montgomerie added that ScriptCheckSA will help prescribers and pharmacists make informed clinical decisions about the supply of the listed medicines.

‘The aim of RTPM is not to limit people’s access to their [medicines], but to provide health practitioners with accurate information to support their professional decision making,’ she said.

‘When a treating clinician is alerted through ScriptCheckSA, they may ask their patient for more details about their prescription use, discuss the potential risks, and suggest alternative treatment options or more specialised care.’

Casting a wide net

Helen Stone MPS, PSA State and Territory Manager for SA and the Northern Territory, who also provided stakeholder feedback on the system to the SA Department of Health, said that the list of medicines included in ScriptCheckSA is vast, including Pharmaceutical Benefits Scheme-subsidised and private prescriptions.

‘They system is comprehensive, with as few exemptions as possible, and we’ve gone really broad in what we can look at,’ she said.

Along with all Controlled Drugs (Schedule 8), Prescription Only Medicines (Schedule 4) medicines that increase the risk of harm when co-prescribed with drugs of dependence will be monitored, including:

• all S4 benzodiazepines
• all codeine-containing S4 medicines
• gabapentin and pregabalin
• zolpidem and zopiclone
• quetiapine
• tramadol.

Ms Stone said that while this doesn’t necessarily mean that the DDU will look at all of the listed medicines, it will have the ability to do so.

If an emerging risk is detected when a Schedule 4 medicine is co-prescribed with drugs of dependence, it might be tracked in the system.

‘It’s a unique opportunity for pharmacists because it gives us a really broad look, in real time, at what people are taking,’ Ms Stone said.

There are existing problems in the SA population relating to all of the medicines listed.

‘People are getting themselves into trouble with prescription medicines,’ Ms Stone told Australian Pharmacist.

‘When we talk to people in various regional areas, one might have a problem with pregabalin and another with codeine – so SafeCheckSA will give us a comprehensive view of the issues.’

Registration and training

The system’s access process is quite straightforward and user-friendly, Ms Stone said, with users required to visit the ScriptCheckSA website and follow three steps:

• Health Practitioner Registration
• Health Practitioner Training
• Health Practitioner Login.

‘I’d encourage all SA pharmacists to actually register, do the training, log on and start using SafeCheckSA as soon as possible, before it becomes mandatory,’ Ms Stone said.

And the more users the system has in this early stage, the better it will operate down the line.

‘If there are any bugs in the system, we’d like to find out,’ she added. 

‘While it has been user tested, we’ll keep working on ironing out any further identified issues.’

SA is the fourth state to commit to promoting medicine safety through RTPM. Tasmania, the ACT and Victoria all have systems in place, while Queensland is developing its own. 

In New South Wales, the government committed to implementing an RTPM system in its 2020–21 budget. Western Australia and the Northern Territory have not yet developed RTPM systems.

Falling through the cracks

While RTMP systems are designed to flag any potential problematic use of prescription medicine, prescribers and pharmacists should balance the information provided with appropriate clinical decisions.

In a recent ABC article, concerns were raised by addiction specialists that Victoria’s SafeScript was not doing enough to help people recover from addiction, as there is no further collection of information about the patient and what happens to them after being flagged.

While the alerts in SafeScript are intended to enhance clinical decisions for patient care, addiction specialists think more could be done to offer drug support services, initiate medicine tapering or engage consumers with pharmacotherapy.

CEO of Harm Reduction Victoria Sione Crawford said this inaction could lead people with drug dependencies to fall through the cracks in the system, and end up turning to the black market.

‘Being flagged should really only be one component of a multi-faceted response to a complex issue for people,’ he said.

‘And instead, we are seeing it being applied very bluntly and used either as a warning or a rejection towards people rather than an opportunity to be engaged.’

In a follow-up article, Dr Ines Rio, chair of general practice at the Victorian branch of the Australian Medical Association, said on-the-spot care needed to be provided to these patients, with the help of government support.

‘The issue is that [a doctor] is now aware of a situation where a patient might be red-flagged, but what do you do about it?’ she asked.

‘You need a whole lot of strategies to decrease it over time, it’s a complex issue and we have a limited amount of resources to refer to.’