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Australia Medical association calls on government to help doctors dealing with addicted patients

02:07  14 april  2021
02:07  14 april  2021 Source:   abc.net.au

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The chair of general practice at the Victorian branch of the Australian Medical Association says doctors need more on-the-spot support to help patients addicted to drugs and alcohol.

Dr Ines Rio's comments come after the ABC aired serious concerns from drug experts about gaps in Victoria's multi-million dollar prescription monitoring system SafeScript, with some patients being cut off from medications or being kept on them despite doctors and pharmacists being aware of multiple red flags warning them their patient was being prescribed a high dose of addictive medications.

Dr Rio said the SafeScript was "well overdue" but admitted the system fell short.

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"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 as GPs."

Dr Ines said she wanted the state government to fund drug and alcohol specialists to provide targeted advice to general practitioners who are faced with a patient potentially addicted to prescription medications.

"That would be a really wonderful thing. GPs have been crying out for secondary referral models," she said.

"Often the GPs are frightened; it's beyond our skillset to know what to do. And we can respond really well when we have the right advice, when we have someone holding our hand."

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Standing in the way of such a relationship forming, she said, were "brick walls" in government funding; the majority of funding for GPs comes from the federal government, while drug and alcohol specialists are funded by the state.

"It's something the federal and state governments need to sort out," she said.

"The state government doesn't have a good relationship with general practice, they don't have good communication. Their (the state government's) communication goes to hospitals and they don't really understand general practice."

Dr Rio said if drug and alcohol experts in hospitals had a requirement through their funding to train and provide support to GPs, it would stop people with prescription drug addiction ending up in emergency rooms.

She said it's a model working in the United States, where secondary services provided by specialists to family doctors has led to a decrease in referrals to outpatient services by 30 per cent.

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More doctors need training on opiate replacement therapies

Paul MacCartney is a community doctor in Melbourne who helps GPs when there's an alert on SafeScript, but he says the uptake of the service "has been slow" and few doctors even know the service exists.

"There's a few factors: people being aware of the service, and knowing how to call us, and GP time; when a GP is confronted by an issue they often don't have time to reach out," Dr MacCartney said.

He said it didn't help that on average just one addiction specialist was trained per year in Victoria, and that so few doctors were willing to prescribe pharmacotherapy — medications any doctor can prescribe to help replace addictive medications.

Dr Rio agreed with Dr MacCartney that more doctors in Victoria needed to prescribe pharmacotherapy, which is currently only prescribed at the doctor's discretion.

"Unfortunately, over the years, not many GPs have subscribed to the training and support system for opiate replacement therapy and there is a great need to escalate that up," Dr Rio said.

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"And SafeScript brings that to a head."

A spokesperson for the Department of Health said the government had "engaged with funded partners to enhance referral pathways, increase training and reform policies to support increased opioid replacement therapy access for consumers".

"The department encourages all prescribers and pharmacists to provide clinical care in line with best practice, including providing follow-up treatment and care. However, some patients may not visit the same doctor or pharmacist for many legitimate reasons and it would be difficult for the doctor or pharmacist to follow up if they don't return."

Dr Rio said Australia's system of seeing a doctor also did not support the best treatment for a patient with addiction.

"We aren't supporting the right system of general practice — general practice works well when you have a long-term holistic relationship with a patient. We don't have a system in Australia where that is supported through funding where you have one, nominated GP where you go to one GP and you're only funded (through Medicare) to go to one GP."

Dr Rio said if this "structural problem" was addressed, doctors would be more willing to be held accountable to all their patients.

"People with drug and alcohol problems aren't necessarily going to the same GP all the time. So some GPs may feel there is no accountable relationship between them, so they don't help the person."

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