ABC 730 ran a story on the Government's crackdown on prescription opioids. Prestantia Health's Dr Paresh Dawda was interviewed for this story. Our views are summarised in this article:
1. We recognise the importance of the public health issue raised by the misuse of opioids.
2. We accept the Chief Medical Officer's (CMO) letter was well intentioned
3. We believe the opioid issue is an extremely complex one and its solution lie in a joined up multi-faceted approach
4. The letter sent by the CMO was simply based on statistical variation. There are two types of variation, unwarranted variation and warranted variation. The letter did not differentiate between these two types of variation. Our understanding is that the granularity of dataset the government has access to is unable to do this
5. The unintended consequence is that many doctors who received the letter were in the group of warranted variation. For example, these were doctors working in aged care and with patients who have limited life expectancy and would benefit most from a palliative care approach. For this group of patients appropriate treatment with opioids not only helps pain management but also the management of distressing symptoms such as shortness of breath in end stage heart diseases and lung diseases
6. Our experience is that many doctors are just refusing to prescribe opioids including for patient groups described above, leaving this vulnerable group unable to receive palliative care, a human right
7. The letter from the CMO acknowledged in some cases may represent appropriate prescribing as in palliative care. It was however followed by a stronger emphasis on the ongoing monitoring of the prescribing and the possible referral of a doctor to the Practitioners Review Committee. There is no current mechanism where the ongoing monitoring can identify if it is appropriate prescribing or not.
Our approach has been to continue to prescribe responsibly and adopt a quality improvement approach. We have a register of patients on opioids. We use a team based approach to review their care which includes our practice pharmacist but also the staff at residential aged care facility. Our practice pharmacist uses multiple sources of information and develops a care plan for our GP to review which once agreed is provided to the facility to incorporate in their care plan.