SafeScript provides opportunities to identify and properly manage problematic prescription drug use.

October 18, 2019
By Dr. Ferghal Armstrong

The prescription opioid crisis that originated in the USA has reached Victoria. In 2016 more patients died of prescription drug overdoses than died from illicit drug overdoses or were killed on Victoria’s roads. Doctors’ prescribing habits killed more patients than the road toll in Victoria!

SafeScript has been developed to identify three high risk groups of patients: firstly those patients receiving high doses of opioids (oral morphine equivalent doses of > 100 mg daily put patients at an elevated risk of death by up to a factor of eleven), secondly those patients receiving high risk polypharmacy (the co-prescribing of opioids with benzodiazepines puts patients at an elevated risk of death by up to a factor of ten), and thirdly those patients receiving uncoordinated care from more than four prescribers or more than four pharmacists (which has been shown to elevate a patient’s risk of death by up to a factor of six).

For each of these scenarios SafeScript provides a red flag alert. If a doctor sees a patient with a red flag alert it is worthwhile remembering that SafeScript is not about weeding out the “Doctor Shoppers”. Two of the three high risk scenarios deal with iatrogenic harm, whilst only one deals with multiple providers of care. The second important point to make in this regard is that abandoning the patient because they are too high risk is not an option. Instead clinicians should be undertaking a risk assessment for their high-risk patients which should include an assessment of drug risk, physical health risks and risks of prescription drug misuse. Having educated the patient about their risk then it behooves clinicians to put in place a harm minimisation plan. Interventions can include any or all the following:

  • One doctor one pharmacist
  • Opioid antagonist therapy i.e. naloxone therapy
  • Pharmacotherapy in the case of a diagnosis of substance use disorder
  • Quantity of supply reduced e.g. two to five da supply rather than original pack sizes
  • Rotation of opioids
  • Staged supply e.g. daily or weekly pickup
  • Tapering of opioids or benzodiazepines.

For more information contact your pharmacotherapy area- based network.

Dr Ferghal Armstrong is a GP at Black Fish Medical Clinic in Koo Wee Rup. Originally from the United Kingdom, he completed approved substance misuse training from the Royal College of General Practitioners and was involved in setting up and clinically supporting drug and alcohol services in various community, prison and inpatient settings.

Since moving to Australia in 2014 he has completed mandatory training in pharmacotherapy and has established a pharmacotherapy service within his practice at Koo Wee Rup, as well as via outreach, utilising tele-health.

He believes that general practitioners should have a role in providing pharmacotherapy services to their own patients and is committed to supporting his peers to achieve this goal.

Dr Armstrong has now started addiction medicine specialist training at Eastern Health.