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Health Speeches | September 07, 2017

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

Victorian Parliament - 7 September 2017 - Ms KEALY (Lowan) — I rise to continue my contribution to the Drugs, Poisons and Controlled Substances Amendment (Real‑time Prescription Monitoring) Bill 2017. During my contribution yesterday I outlined the main provisions of the bill and also some of the areas of concern that I had around the bill, and I would like to go into further detail around those concerns.

It is important that we get this bill right. We know that last year we lost 372 people to fatal pharmaceutical overdoses. This is a serious issue when you compare this number with the number of people who died of, say, heroin overdoses — 172 last year. I believe we lost about 195 people to the road toll.

So this is a significant issue for Victoria, and it is overdue that we do something to help support doctors, to support pharmacists and to support the people who are battling addiction of pharmaceutical drugs. Eight out of 10 of these fatal pharmaceutical overdoses involved benzodiazepine. We do need to do more to educate doctors about the risks of prescribing benzos. This is a high‑risk, highly addictive drug, and I think that the medical community needs to take more responsibility in trying to avoid people becoming addicted in the first place.

In terms of what this program will deliver, it really will only help support doctors where there is already a history of dependence on pharmaceutical drugs. It will not deter people from actually getting on those drugs and being prescribed those drugs in the first instance. I think that the medical community and the pharmaceutical community need to take greater action, more affirmative action, to try and reduce the number of original prescriptions of these high‑risk, highly addictive pain relief drugs. We need to also ensure that alternatives are provided wherever possible because of course if people are not addicted to these substances in the first place, then they are not going to have an accidental fatal overdose.

When we talk about these numbers, the 372 lives that were lost last year, it is easy to think about this as just another statistic — that is the risk of how we speak about things as politicians and how the media discuss them as well. But at the end of the day these are individuals — these are people who have absolutely struggled with their own addictions. And it does not just impact on the individuals who are no longer with us today — there are thousands of Victorians who currently have a pharmaceutical medication addiction. We think about the impacts on not only these individuals but also their families, their friends, their colleagues and the wider community. Pharmaceutical drug addiction runs deep across the state, and while the real‑time prescription monitoring system will help to better manage the prescription and dispensation of these drugs, we need to provide better support to make sure that these people who are looking to access drug therapy and drug treatment are able to do so.

Currently there are a number of drug rehab centres across the state where you have to wait in excess of 12 months to get drug treatment. It is simply unacceptable. Unfortunately, when the Labor government first came into power in 2014, they scrapped funding that the Liberal and National government had put in place for three residential rehabilitation centres. As a result we have seen drug use skyrocket and we have seen access to rehabilitation wait lists grow. People are falling through the cracks and out of the system. We are facing a drug crisis in the state. Drug crime is also escalating. It is deeply concerning to see those statistics and to think that we are really not offering enough for these individuals.

That brings up another issue around the introduction of real‑time prescription monitoring system. We may be cutting off supply of pharmaceutical drugs for a number of people who already have an addiction. We need to ensure that we have an alcohol and other drugs (AOD) sector that is equipped to be able to deal with what may be an influx of people who have a pharmaceutical drug dependence and a requirement for urgent treatment.

We also need to ensure that we provide better support to clinicians and pharmacists within those clinics and pharmacies because there is no doubt — and I have seen it firsthand — when somebody who has an addiction to a pharmaceutical drug comes into a medical clinic it is their expectation they will leave with a script for that drug. They can become highly agitated if they are unable to get access to that drug, putting clinic staff at risk, putting medical staff at risk and also putting the wider community at risk. They become quite desperate at that point in time. The police are usually involved. It is a crisis. I am concerned that we will not be providing enough educational support about the risks of implementing this system in terms of how it will operate in clinical settings in real life.

Other concerns that I have are around a system that only imposes a financial penalty to doctors. I realise this is out of bounds of what is able to be put in place in legislation, but I think it is incumbent upon the Australian Health Practitioner Regulation Agency (AHPRA) to better provide support for clinicians who have been overprescribing addictive medicines, and that there is not just a slap on the wrist for wrongdoing but serious sanctions put in place for doctors who are found to be overprescribing these drugs or who are found to have not been appropriately checking the database to see whether somebody has a significant history of doctor shopping or frequently accessing prescriptions for these drugs.

Unfortunately I think that often AHPRA falls on the concept that doctors have a right to maintain their business and that AHPRA cannot take steps to block them from earning an income. But there are dodgy doctors out there, there are doctors who are not doing the right thing and they should be sanctioned or, if they are found to be breaching this legislation, they should be deregistered. It should be beyond a financial penalty. I urge AHPRA to support the intention of this bill to weed out those dodgy doctors and to encourage doctors to do the right thing and to avoid prescribing these high‑risk, highly addictive medicines where it is possible.

We also need to ensure that there is seamless interaction and a seamless transition to the national scheme. As I stated yesterday, I do not want politics to mean that we have gaps in the system whereby the Victorian system does not fully integrate with the national system. The electorate of Lowan is on the border, and I think that communities that are along the Victorian–South Australian border and the Victorian–New South Wales border are most at risk.

These are rural communities where there is often a shortage of doctors. There are doctors who have been trained overseas and may not be aware of the requirements around checking the database in Victoria and in Australia. We need to provide these doctors with the support they need so they understand the system. Also, we need to make sure that people who do have pharmaceutical drug dependence do not automatically float out to the regional areas where there is the least ability to provide support for them.

Already we have critical doctor shortages. In Horsham we have a challenge where Lister House, the main clinic in town, has gone from 30 GPs down to just six GPs in a little over eight months. We need better incentives to attract doctors to rural and regional areas of Victoria, and putting pressure on them by people moving towards the borders if there are any gaps in this real‑time prescription monitoring system across Australia would be negligent on the part of the government. I urge them not to play politics with this issue but to make sure that they work closely with the federal coalition government so that we do not have any gaps. It will save lives if they choose to go down that path.

I have concerns that there is no outline of the minimum requirements or a minimum number of identifies that a doctor must use to search the database. I am concerned that a doctor could simply type into the database ‘John Smith’ and say, ‘I couldn’t find the one that we were looking for’, and use that as an explanation or a reason to get out of receiving any financial penalty or sanction. I think we need to look at that, perhaps through the regulations — that is, a minimum expectation of how somebody would try to find a patient within the database. We need to look at the next steps for the database and how it can better integrate into some of the more common practice management systems such as the MedicalDirector or Zedmed. We need to support clinics to transition to those systems.

I would like to go back and refer to the individuals and the families who really have made this happen. I would like to acknowledge John and Marg Millington, who have made the effort to come into Parliament again today to hear the contributions from both sides of Parliament around the introduction of this legislation. John and Marg have nothing but my absolute respect and support for all they have done in sharing Simon’s story and tirelessly advocating for over a decade to make this happen. They have achieved that. We have achieved that today. I have outlined some concerns but in no way is that disrespectful to what they are seeking to achieve.

I refer back to the extremely moving letter that the Millingtons supplied to me and that I read into Hansard yesterday. For people reading through this contribution, I strongly encourage them to read through my contribution yesterday so they can refer to that letter and understand the heartfelt contribution from the Millingtons and what this legislation means to them. I thank the Millingtons for tirelessly pursuing this matter, all the other families who have assisted to raise awareness about how important it is that governments take action to deal with pharmaceutical drug dependence and also of course ScriptWise, the Wimmera Drug Action Taskforce and the other groups that have approached me and engaged with me to ensure that we have a system such as real‑time prescription monitoring introduced in the state of Victoria.