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Health Speeches | September 06, 2017

Drugs, poisons and controlled substances amendment (real time prescription monitoring) bill 2017 - Second reading

Victorian Parliament - 6 September 2017 - Ms KEALY (Lowan) — It is a great privilege and honour to rise today to add my contribution to the Drugs, Poisons and Controlled Substances Amendment (Real‑time Prescription Monitoring) Bill 2017. This bill will provide the legislative framework to introduce a real‑time prescription monitoring system in the state of Victoria. This system will require doctors and pharmacists to view patients’ records of access to high‑risk addictive medicines before prescribing or dispensing. The information will help doctors and pharmacists make better informed, safer clinical decisions for patients, and it may provide opportunities for counselling and intervention where necessary.

The concept of introducing a real‑time prescription monitoring system in Victoria has been debated for some period of time. From 2012 to early 2016, 20 coronial findings have called for the implementation of a real‑time prescription monitoring scheme. Further, in 2014 the coalition — the Liberals and The Nationals — made an election commitment to deliver a real‑time drug prescription monitoring system for schedule 8 drugs. This commitment was not met by Labor at the time. However, in 2014, the now Premier said the then Minister for Health was receiving advice on the matter and thought that real‑time prescription monitoring required a nationally coordinated response. Fortunately there was a change in position and the government has now put funding aside to make real‑time prescription monitoring a reality in Victoria, and of course we have come further in Australia with the Turnbull government announcing in July of this year that it will invest over $16 million to deliver the national rollout of real‑time prescription monitoring. The Andrews government has advised that the Victorian scheme is more advanced than the federal scheme and therefore has opted for Victoria to go ahead alone. There are some concerns about that, but I will go into further detail about that later in my contribution.

Of course this is the political history of how we came to debate real‑time prescription monitoring and the introduction of legislation around that in this place. There is no doubt that this would not be occurring if it were not for the hard work of some families who have been deeply affected by the impacts of pharmaceutical drug use and drug abuse, particularly the families who have experienced a fatal overdose.

I would like to mention the Millington family. John and Marg Millington from Nhill, who I know personally very, very well, have been amazing campaigners to make real‑time prescription monitoring a reality in this state. The Millingtons have shared the story of their son, Simon, who battled with his own addictions after a very, very tragic accident back in 1994. Simon was in hospital, and I recall hearing Marg tell her story for the first time of Simon’s being in hospital and, as his mother, asking the doctors to give him more pain relief because he was in pain. That is what of course a caring parent would do, not knowing where that may lead to in the future. If we had had clinical professionals who were better educated and more aware of the impacts of the use of high‑risk pain relief medications, perhaps that scenario would not have played out in the same way.

I would like to acknowledge that in no way should the Millingtons take any responsibility for Simon’s challenges with addiction over the years. We can only hold them in high esteem for the work they have done in being brave enough to share their story over and over again. If it were not for them and other families who have seen the difficulties of prescription medicine addiction, and individuals who are addicts and who have seen how the system has failed them over the years, then we certainly would not be at the point we are at today, having this legislation before the house.

I would like to greatly thank the Millingtons, and I would like to take the opportunity to read a letter that was sent to me by John, Marg, Laura, Sallie and little Maddie, the daughter of Simon. It states:

The Premier of Victoria, the Hon. Daniel Andrews MP, Leader of the Opposition, the Hon. Matthew Guy, and all present today.

Thank you for the opportunity to make a statement on this, a most memorable and emotional day not only for us, the Millington Family, John, Sallie, Laura, Maddie and myself, but for all who have campaigned with us, because they too have lost loved ones as a result of a pharmaceutical overdose. To the Andrews government, following the announcement made on Anzac Day 2016 by the health minister, the Hon. Jill Hennessy, to proceed with the implementation of a real‑time pharmaceutical system, we are overwhelmed to reach this point and we thank you. To those who believed and encouraged us in what we were trying to achieve, including the retired member for Lowan, Mr Hugh Delahunty, and his successor, Ms Emma Kealy, MP, and the federal member for Mallee, Mr Andrew Broad, MP, we thank you so much.

As you now know, our 34‑year‑old son Simon died of an accidental overdose of OxyContin in 2010 after battling his pharmaceutical addiction for 16 years. He suffered life‑threatening injuries in a single car accident and his ongoing treatments led him to becoming dependent on pharmaceuticals.

Whilst struggling to keep Simon alive, we were dismayed that doctors prescribing copious amounts of medications for him had no way of knowing what he was taking, how often, how much or from where he was receiving the scripts. How could this happen in the 21st century, with the technology already available? I was amazed and at times angered, to receive emails from supermarkets telling me when my favourite products were on sale. They must have had a national database recording my buying habits but I could not convince anyone of the necessity for something similar for pharmaceuticals, something with the potential to save lives. Meanwhile I knew we were losing our Simon.

We had to do something. I vowed never to give up until this was achieved. We were not going to be deterred because I believed in what we were trying to do. There were gaping holes in the pharmaceutical system; it was broken and out of date with the number of prescriptions being dispensed. I was worried about lives but what were the inadequacies of such a system costing the governments in financial terms? The more I advocated the more aware I became of how many families were living our nightmare.

We officially commenced our campaign for a ‘real‑time database’ in 2007 at a joint parliamentary inquiry into the use and misuse of pharmaceuticals, particularly benzos. Those present were shocked to hear Simon’s story and the sadness of our situation trying to save him from an inadequate system.

Living in the remote rural town of Nhill, my biggest weapon has been the postage stamp, as I have written hundreds of letters, even to many of you here present, your predecessors, and I have also written to most federal members of Parliament, and there have been many, over many years, telling them our story whilst urging them to act. Sadly, it is not our Simon who will benefit from this legislation today but it will certainly go a long way in the prevention of ‘future Simons’.

I am sure, due to the many talks we have given, not only in Victoria but in other parts of Australia, doctors are more aware of the harmful effects of some medications and exercise vigilance when prescribing. This new system will prevent lethal interactions of various medications by providing a complete picture of what a person is taking. Coroners see this all too often and wonder why. They too are on our side. With this in place, responsible doctors will now be able to prescribe appropriately. It will also assist in helping those already caught in the web of pharmaceutical dependence, allowing doctors to discontinue certain drugs and offer counselling and alternate ways of pain management or treatments. This is imperative.

Most importantly, though, we must give those already affected by pharmaceutical dependence hope, hope for a drug‑free future! We must advertise that there is help for those who really want it! Thank you to Matthew McCrone, director, real‑time prescription monitoring taskforce and your hardworking team who are making this happen and have led us to this point today! We appreciate the inclusion and the consideration shown to us throughout this journey. I admit it certainly hasn’t been as simple as I first thought. It has been a complex, complicated and expensive process.

Whilst it was heartening to hear the federal health minister, Greg Hunt, commit $16 million for a national response to prescription drug misuse in August, I hope all states and territories can see the urgency of following Victoria’s example by implementing an RTPM, which in turn would be connected to a nationwide ‘freeway’. It is imperative that this should be mandatory in all states as our borders are porous; Simon crossed them often. We will simply have a leaking bucket if all don’t follow the Victorian example! I also urge governments to provide more treatment facilities for drug users rather than building more jails with their ever‑revolving doors. They are not the solution! We always struggled to find one at the appropriate time.

Simon didn’t want to die, nor did Heath Ledger or the hundreds of other Australians probably; it was an accident, partly due to an inadequate system. Despite trying and succeeding many times, sustained recovery was so hard. He, like us, was powerless over his addiction, even though he had every reason to live. He was our son, Maddie’s father, a brother to Sallie and Laura and a friend to many. This can happen to anyone and it is happening today as I write.

As I said earlier, today is filled with emotion. I never wanted to go on this journey but our lives sometimes take us to places we may never want to travel, but in our hearts we know we must.

In conclusion may I say it is seven years since Simon died; it never gets any easier. Days like today remind me of what we lost to drugs, to legal drugs. I still miss the warmth of Simon’s smile, his caring manner, his sense of humour, even the smell of his favourite aftershave but mostly, I miss his love. He was a real person and his life mattered!

We, who have lost loved ones to pharmaceutical overdose, thank all here present for committing to change through this legislation, for finally listening to our cries for help, when to us, it was obvious. We have acted in Simon’s memory so his death will not have been in vain.

As I try to write this I am distracted by my beautiful little one‑year‑old grandson, Oskar. I am reminded that we cannot change the past but we must look to the future with hope. Simon would want us to do that. After today I feel I finally can; this has given me permission to do so.

We all have a purpose in life. Perhaps this was his and ours. Simon would be proud to know we have achieved this in his memory. Rest in peace, Simon, knowing how much you are loved and missed by so many.

Our sincere thanks and gratitude to all who have helped this legislation become a reality.

Margaret Millington, OAM
John Millington, OAM
Sallie, Laura and Maddie

I would like to thank the Millingtons for that very moving contribution. It is a great privilege to be able to read it into Hansard today.

To move on to the main provisions of this bill, it does require a prescriber or dispenser of high‑risk drugs to review a patient’s previous use of high‑risk drugs and requires prescribers and dispensers to update records of a patient’s access to high‑risk drugs on a database. This of course puts a lot of pressure on doctors to enter data into the system. It means that they have to do what we expect them to do anyway, and that is to review a patient’s clinical history to make sure that the first time they prescribe pain medication for a new patient they actually consider what other alternatives may be available. In many ways this is holding doctors and pharmacists to account for doing what they should be doing in any case.

The bill allows exemptions from the requirement to review a patient’s previous use of high‑risk drugs — for example, for hospital inpatients, residential aged‑care patients, palliative care patients and prisoners, for whom prescription shopping would be difficult and unlikely. Patients in emergency departments who are being discharged are included in the scheme, so there is a requirement for doctors and pharmacists to review the database for patients who present to an emergency department.

The bill includes penalties for the misuse of the database or failure to properly maintain the database. There are also arrangements in place for schedule 8 treatment permits, which will be reviewed and streamlined and will remove some other administrative burdens. These will be rolled out from 1 August 2018 over an 18‑month period via selected geography. They will not be put in place across the state in one go; they will be slowly rolled out across different regions. For the two to three months preceding 1 August 2018 and throughout the 18‑month grace period it is envisaged that the database will achieve a critical mass of information so as to be valuable to the prescribers and dispensers.

Of course we do need to make sure that we provide additional support. We need to educate our medical professionals, we need to ensure that the public is aware of how this system will work and we need to ensure that people are trained so that they can use the database. This is essential, particularly when you consider some of the challenges that face our doctors when somebody who has an addiction comes to a new clinic. These people can be extremely aggressive and unpredictable when demanding medication, particularly if a doctor refuses to prescribe in that instance.

There are some concerns around this legislation. Firstly, we are looking at rolling out a national scheme in the near future. Areas such as Nhill, where the Millingtons are from, are very close to the South Australian border. It would be very straightforward for somebody to visit either a GP or a pharmacy simply by travelling for an hour or so and gaining access to a whole new range of drugs, so it is essential that we move to a national scheme but most importantly that there are seamless linkages between the Victorian scheme and the national scheme.

I again note that there was a shift by Labor to supporting a national scheme before a Victorian scheme was put in place. We need to make sure that Victoria puts in a true effort and that politics do not play a part in putting barriers in place. We also need to ensure that these schemes are absolutely seamless and that a real‑time prescription monitoring scheme can in fact be national to avoid those cross‑border challenges.

We also need to make sure that we have got appropriate support services in place. Somebody who is addicted to certain pharmaceutical medications should be referred to an alcohol or other drug service to help them get off those drugs. It is simply inappropriate not to provide those additional supports and just force somebody into being unable to access the medications they are addicted to. That is a huge risk when we have already got a drug treatment system which is completely overburdened and the demand is far too great.

There are a number of other concerns I have, including access to the software and ensuring there is training in place. There is the fact that codeine is not included even though it will be declared a prescription‑only drug as early as February next year. We have no detail around the exemptions, which have not been detailed in the bill and are likely to appear in regulations. We also have concerns around disqualification for doctors —

The DEPUTY SPEAKER — Order! I apologise to the member for Lowan and to our guests in the gallery. The time appointed for me to interrupt business has now arrived. The member for Lowan may take the call when the bill is next before the house.

Business interrupted under sessional orders.