By Suzanne Greenwood, Executive Director
Community pharmacists are increasingly concerned at the growing number of opioid-dependent patients in the community. These vulnerable patients need help and pharmacists can at times feel frustrated at not being able to do enough for them.
It is depressing to see that this problem is growing not only internationally, but here in Australia.
Australian Institute of Health and Welfare data shows that in Australia between 2016 and 2017 (the latest data available), 3.1 million people had one or more prescriptions dispensed for opioids.
In addition, more than 40,000 people used heroin, and about 715,000 people used painkillers/analgesics and pharmaceutical opioids for illicit or non-medical purposes.
Further, the research show there are nearly 150 hospitalisations and 14 emergency department presentations involving opioid harm every day in Australia, and every day there are three drug-induced deaths involving opioids.
This data represents a massive growth in opioid-related harm over the past 20 years, and this trend is continuing to have an impact on our communities.
The Pharmacy Guild of Australia and community pharmacists are committed to working closely with patients to help reduce the health, social and economic costs of substance misuse in Australia, recognising the significant public benefits of the treatment programs and their capacity to assist individuals to be productive members of society.
One of the vehicles available to provide this help is through opioid dependence treatment (ODT) programs.
But an issue is that ODT programs were implemented to help treat dependence on illicit substances, such as heroin, and today the nature of drug dependency is changing.
Today we are seeing increasing examples of the misuse, abuse, and diversion of prescription opioids such as oxycodone and fentanyl.
Despite this change in drug dependence, ODT remains an effective policy in reducing the health, social, crime and economic burden of opioid misuse. However, the Commonwealth Government does not recognise prescriptions for PBS-listed ODT medicines for dispensing and remuneration as a pharmaceutical benefit. Neither does the Commonwealth directly fund or administer ODT service programs or have a direct role in the delivery of these services, delegating responsibility to the States and Territories.
At the Guild we believe action on this problem is overdue and we have developed a strategy, which we have put to the Government in our pre-Budget submission, to help address the problem.
Our solution is straightforward and involves the Federal Government funding a National Opioid Dependence Treatment Program under the Pharmaceutical Benefits Scheme (PBS).
It makes sense that the prescribing and dispensing of prescriptions for ODT medicines should be aligned with that of other PBS medicines, a move which will help to ensure that treatment is accessible and affordable for the vulnerable patients.
At present there is something of a dis-incentive for patients to seek help. ODT medicines are dispensed on a private (non-PBS) prescription, which means the consumer payment for dispensing and dose management do not go towards meeting the PBS Safety Net.
Our strategy would change that with approved prescribers writing a PBS prescription for up to one-month treatment and five repeats that could be dispensed at a consumer’s preferred pharmacy.
Approved pharmacists would be remunerated for dispensing the prescription as a pharmaceutical benefit, inclusive of daily dose management for oral ODT as well as in-pharmacy administration (or delivery to the patient’s clinic) of injectable ODT.
Consumers would pay the relevant PBS co-payment which would contribute to the PBS Safety Net Record.
The benefits of this approach are clear but foremost among them are that it would ensure equity of access and limit the consumer costs for this essential service to some of the most vulnerable and financially disadvantaged members of our society.
Another benefit would be that there would be data on national ODT which would help in determining policy requirements for more targeted management strategies of this growing problem.
In short, the Guild’s strategy makes good sense. We cannot simply hope this problem goes away – it won’t. We have to adopt a pro-active approach which is both accessible and pragmatic. The Guild’s proposal ticks all the boxes.
