It seems that palliative care patients could be the ones to suffer under the Department of Health’s crackdown on doctors prescribing opiates.

The Department’s heightened scrutiny of opioid prescribing has resulted in some doctors stopping prescribing opioids for patients in palliative care, and others have cut back visiting patients in palliative care.

Department’s letter to nearly 5,000 GPs

In June this year, the Department of Health wrote letters to 4,800 GPs drawing their attention to the fact that their rate of prescribing opioids was in the top 20 per cent in the country, and that their prescribing rate would be monitored.

If doctors are found to be prescribing opioids excessively, they could be investigated by the Department.

According to the Department’s website, “In limited cases, where there are concerns of possible inappropriate practice, the Department of Health will consider referring practitioners to the Practitioner Review Program,” the Department of Health website states.

According to a statement from the Department of Health provided to HelloCare, the letters were intended to raise awareness about opioids and to encourage “self-reflection” on prescribing practice.

The letters were sent “in an effort to reduce inappropriate prescribing of opioid medications”, the statement said.

Palliative care-specific items were excluded in determining who would be contacted, so far as they could be identified. But the Department acknowledged that palliative care doctors may have higher prescribing rates that other doctors.

“The Department acknowledges that some GPs may still prescribe general PBS items for palliative care patients and this may be a reason why a doctor’s prescribing rate is higher than their peers. Unfortunately it is not possible to differentiate the types of practitioners or patients from the PBS data,” the Department’s statement said.

Departmental investigation “intimidating, time consuming, expensive”

An Adelaide GP, Dr Peter Ford, told newsGP, that being the subject of a Department of Health investigation would be stressful.

“Extricating yourself from an onerous investigation of you is quite intimidating, time consuming, and expensive. No one wants to go into it lightly,” he said.

Dr Ford said he has stopped prescribing opioids for patients in palliative care and has reduced his palliative care work in aged care facilities after receiving a letter from the Department.

“‘It’s all very well for people in bureaucratic positions to take a superficial view, but when you’re face to face with patients in pain and distress, those who require palliative care require palliative care,” he said.

Appropriate use of opioids

Past president of the RACGP, Dr Bastian Seidel, told newsGP that while the campaign to clamp down on rates of opioid prescriptions was “well intentioned”, some GPs – such as those who work in palliative care and aged care facilities – have legitimate reasons for high rates of prescribing the medication.

“These GPs are therefore more likely to be identified in this campaign as problematic prescribers, when they are in fact providing suitable care,” he said.

The opioid crisis in Australia

The Department told HelloCare the letters were sent to doctors in an effort to prevent Australia’s opioid crisis from worsening.

Approximately two-thirds of fatal opioid overdoses in Australia are now caused by pharmaceutical opioids, rather than heroin, the Department said.

Opioids are now the most commonly misused pharmaceutical group in Australia. The 2016 National Drug Strategy Household Survey found 3.6 per cent of Australians over the age of 14 reported recent misuse of prescription painkillers/analgesics and opioids.

The Department of Health recommends that if any doctors, including palliative care doctors, are concerned about their opioid prescribing, they can contact opioidprescribing@health.gov.au for more information and clarification about their data, and the intent of the Department’s letter.

 

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