Home' Australian Pharmacist : Australian Pharmacist January 2013 Contents 34 Australian Pharmacist January 2013 I ©Pharmaceutical Society of Australia Ltd.
result in an overdose in a person with
significant heroin tolerance,' he wrote.
'The frequent diversion of prescription
opiates to the injecting drug market has
changed the economics of illicit opiate
supply to a point where heroin is often no
longer the drug of choice for intravenous
users. In Australia, the most recent
data on IV drug use shows prescription
opioids are now the third-most common
drug class injected, after heroin and
'In 2000, the ratio of IV heroin use to
IV prescription opiate use was 14:1; now
for every two heroin users there is one
IV prescription opiate injector,' he said.
This figure points to mounting concern
over the issue, and with that concern there
is an increasing focus on pharmacists and
what actions the profession can take to
help manage the problem.
But Dr Lisa Nissen, PSA Queensland
Branch President, and Professor and
Head of the School of Clinical Sciences
Queensland University of Technology,
says the debate has become too emotive.
'One thing we need to do is take a step
back and look at the language being
used,' Dr Nissen said.
'The terms "addiction/drug seeking
behaviour" and issue of the diversion
and abuse of medications is one of them
versus the patient who is chemically/
physically dependent and has been made
that way through therapeutic prescribing
of these medications for them by
'True addictive behaviour and what is
being discussed here so far happens in a
small proportion of patients prescribed
The government response
The growing problem of prescription
addiction has the Federal Government's
The Minister for Health, Tanya Plibersek,
told Australia Pharmacist that the
Government was concerned about abuse
of prescription medication.
'That's why we are tackling the issue by
rolling out the Electronic Recording and
Reporting of Controlled Drugs (ERRCD)
initiative,' she said.
'ERRCD is a nationally consistent system
to collect and report data on dispensing
of Controlled Drugs, and other drugs of
interest, whether supplied under the PBS
or on private prescription.
'Real-time access to accurate dispensing
information will improve the efficiency
by which state and territory regulators,
prescribers and pharmacists identify
problems of forgery, abuse and
doctor shopping and improve public
Ms Plibersek said the ERRCD system
was based on existing software used
'Significant enhancements have been
made to this system to handle greater
data volumes, share information between
the states, and provide further flexibility,
including tailoring alerts according to
each jurisdiction's requirements,' she said.
'This work was completed
in November 2012.
'The timing of the release
of the ERRCD system in each state and
territory is dependent on executing
licensing agreements between the
Australian Government and each
jurisdiction, timing of any state
and territory legislative changes to
support the initiative, and jurisdictions
undertaking the necessary work to
migrate and integrate the new system
with their existing processes.
'All states and territories have been
offered a licensing agreement.
'Pharmacists will benefit from the
ERRCD initiative beyond real-time
decision support information being
'As part of the initiative, pharmacists'
current manual reporting of Controlled
Drugs to their state regulator will
'In addition, specifications developed
for a national Controlled Drugs register
will see pharmacy dispensing software
vendors introduce electronic versions
of the "DD Book", subject to state
approvals,' she said.
When the ERRCD system was introduced
in their state, pharmacists would be
able to access information on a patient's
dispensing history for Controlled Drugs
and other drugs of interest that were
subject to significant abuse potential
(e.g. alprazolam), Ms Plibersek said.
'Having this information will help
pharmacists and prescribers make
clinical decisions that support the
quality use of medicines. In the case
of pharmacists, this will provide better
evidence than available now to support
a decision not to supply prescribed
medicines beyond clinical need, and to
support conversations with prescribers
on prescription issues.
'It's important to note that while state
and territory regulators will set the level
of access for users such as prescribers
and pharmacists, the system is not an
opt-in system for consumers,' she said.
'The misuse of
frequent amongst users
of other illicit drugs...'
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