Between 2011 and 2015, there were 2,616 deaths in Australia from opioid overdose, an increase from 1,364 deaths between 2001 and 2005. In 2015 alone there were 499 opioid deaths, as compared with 1,253 road accident deaths.
There has been significant professional and public debate about opioid use, both in Australia and overseas, including suggestions that the level of opioid use, including in Australia, constitutes an ‘epidemic’.
MIGA’s experience in opioid matters
Our claims solicitors regularly provide advice and assistance to our members and clients on medico-legal issues in relation to opioids including around evolving and limited clinical guidance, doctor-shopping, managing aggressive or difficult patients, stolen prescription pads and difficulties in accessing specialist services.
Issues around opioid prescription are frequently seen in disciplinary matters which have been increasing. We are aware of more than 100 published disciplinary decisions involving opioid prescription since 2010 alone. Such cases can have very significant impacts on the doctors involved, both personally and for their practice.
Given what we have been seeing on behalf of our members and clients, particularly the challenges they face in managing chronic pain patients, and what is happening more broadly in Australia, MIGA has initiated significant advocacy and education efforts around opioid issues.
In the last 12 months we actively engaged with our members, clients and with medical stakeholders to both highlight issues and advance discussion.
MIGA advocacy – boardroom dinners
In recent months MIGA held a series of boardroom dinners with key stakeholders, including representatives from governments and the medical profession, addressing opioid use.
Our CEO and Managing Director, Mandy Anderson, presented and led discussion on the human and claims costs associated with opioid use, both here and overseas, examining how these are being managed and what can be done through stakeholders working together to improve the situation.
MIGA advocacy – parliamentary and government inquiries and consultations
MIGA has recently made detailed submissions to a number of inquiries and consultations addressing opioid prescription, including:
- Therapeutic Goods Administration consultation on strong opioid use and misuse
- Victorian parliamentary inquiry into prescription medication misuse
- Victorian Health Department consultation on real-time prescribing.
In these forums and more broadly, MIGA has been advocating for:
- A national real-time prescription monitoring system – we have identified problems around obligations on doctors and integration with existing systems
- Enhancement of the Medicare Prescription Shopping Program
- Further education on evolving opioid clinical guidance, prescribing requirements, opioid alternatives, potential patient misuse and available services and resources
- Initiatives to improve access to pain management services, both outpatient and advisory
- Harmonising Schedule 8 prescribing regimes across Australia.
We oppose restricting opioid prescription to particular prescribers or classes of patients. Instead we believe the better approach is to provide the right tools for doctors to make appropriate treatment decisions, including access to patient information, specialist advice and education.
Pleasingly the Victorian Parliament supported further clinical guidance and both professional and community education on opioid prescription, endorsed progress towards real-time prescription monitoring and recommended improved access to specialist treatment services.
We await the outcome of the other consultations.
MIGA education initiatives
Over the last year, MIGA ran interactive hypothetical sessions entitled “Who dunnit? – A Poison Pill”, a mock coronial inquest exploring prescribing challenges and risks of harm from prescription drug toxicity. It covered potential for medication misuse, addictive medications and complex patient presentations. Many of our members participated in these sessions, which were highly valued.
Through MIGA’s new REO online learning system, we are launching new interactive education modules on opioids and medication prescription, which include a range of videos, polls, quizzes and case studies with expert commentary and guidance. We encourage you to consider undertaking these modules. More details are available at www.miga.com.au/education.
In the coming years, we hope to see clear professional and community understanding of the role of opioids in pain management, improved access to and resourcing of specialist services, harmonised regulatory regimes and less punitive regulatory approaches, focusing on education and remediation, not discipline. We are hopeful that through governments, the profession and community working together we can achieve positive progress and improved patient outcomes.