Patients who require long-term treatment of chronic pain with opioids will still be able to access larger pack sizes and prescribers will be able to prescribe repeats where they meet the new restrictions requirements.
For chronic pain, increased quantities and/or repeats may be authorised by Services Australia where the patient meets the restriction requirements. Increased quantities to extend treatment up to one month may be requested via telephone/electronic authority request, and up to 3 months’ supply (up to 1-month quantity and up to 2 repeats) may be requested via an electronic/written authority request.
To be eligible for treatment with high strength opioids such as morphine, patients will need to be unresponsive or intolerant, or have achieved inadequate relief of their acute pain, following maximum tolerated doses of other lower strength opioid treatments.
These new arrangements apply to all PBS listings for opioid medications and therefore there will also be amendments to the tramadol and paracetamol/codeine restriction requirements.
All new and amended restrictions will be updated on the PBS website (pbs.gov.au) from 1 June 2020.
What does this change mean for prescribers?
The new opioid listings for reduced pack sizes will provide a simplified way for prescribers to prescribe smaller quantities of immediate release opioids for acute, short-term treatment.
Prescribers must ensure that patients meet the relevant restriction criteria when prescribing opioids under Restricted Benefit and Authority Required (STREAMLINED) PBS listings. The ‘streamlined authority code’ is located on the relevant PBS listing on the PBS website. To prescribe an Authority Required (Telephone/Electronic) item, the prescriber is required to request authority approval from Services Australia through the Online PBS Authorities System or by calling 1800 888 333.
To ensure appropriate use of opioid medicines for the management of pain, patients must be referred to a pain specialist or alternative prescriber for clinical review if opioid use exceeds or is expected to exceed 12 months. The date of the review and name of the medical practitioner consulted must be provided for every authority application.
So from June 1:
If these addictive narcotic medications are required, your GP may prescribe smaller packs for your use
Please please please speak to your GP about any issues you are having – we have lots of options including counselling, physical therapy, diversional therapy, physiotherapy, non-drug therapy, other medications, and referrals to non-GP specialists for complex problems
We still care, we still want to help, we want to be safer and better for you
If you are on medications for 12 months or more, you will need to have a formal consult with another GP or specialist in addition to your usual GP to keep getting medication on a PBS (subsidised) prescription.
We are only a phone call (with video if needed!) away if you need more information.
SA has guidelines – the roadmap back!
And in the future
Did you also know that we can Test You for COVID 19 / Coronavirus if
Unexplained fever / chills Unexplained cough/sore throat/short of breath High risk settings:
Aged care and other residential care facilities Healthcare settings Military – group residential and other closed settings, such as Navy ships or living in accommodation Boarding schools and other group residential settings Educational settings where students are present Childcare centres Correctional facilities Detention centres Workplaces where social distancing can’t be readily practised Remote industrial sites with accommodation (e.g. mine sites) Aboriginal and Torres Strait Islander rural and remote communities, in consultation with CDCB Settings where COVID-19 outbreaks are occurring, in consultation with CDCB
Testing at Australian Clinical Labs 670 Anzac Highway Glenelg IN YOUR CAR
Thanks to Dr Michael Clements and NewsGP from the RACGP for highlighting the needs for aged care 👍🏼
Dr Michael Clements
9/12/2019 3:14:11 PM
The Government’s recent funding injection has to be specifically targeted to address the problems GPs, staff and patients face within residential aged care facilities, Dr Michael Clements writes.
‘Mrs X was found wandering at night in the carpark, can you please prescribe medication?’
This was how one recent residential aged care facility (RACF) interaction began for me.
After meeting with the staff and ruling out delirium or biochemical causes, and noting a worsening in the behavioural aspects of dementia, I suggested the patient move to the restricted ward or have extra supervision.
But my request was declined due to lack of beds and I was specifically asked, once again, to commence a medication to prevent the patient from wandering.
The situation was clear: under-staffing in this facility led to pressure to prescribe sedative medications that would keep the patient compliant and allow staff to attend to other residents.
Provision of care within RACFs has become more complex and time-consuming as the population ages and rates of dementia rise. Unfortunately, funding models have not kept pace, even as clinical governance requirements in RACFs have increased and nurse autonomy reduced.
This has led to a situation for many GPs who work within RACFs in which countless night-time phone calls, form-signing, box-ticking and compliance measures now form the largest part of their care. It has also led to an overreliance on anti-psychotic medications for the behavioural aspects of dementia, as understaffed facilities come under pressure to medicate their problems away.
GPs have been looking forward to the Royal Commission into Aged Care, Quality and Safety because they, along with RACF staff, have seen cost-cutting measures applied in facilities, with reductions in numbers of trained staff, greater reliance on lower-skilled assistants, and decreased activities and programs.
Staff across the aged care sector want to see better diversionary activities and care services, nursing numbers, and funding to allow GPs to spend more time with patients and their families. This is felt most acutely in rural and regional areas, which are already experiencing aged care staff and GP workforce shortages.
However, the latest promise of extra funding from the Federal Government does nothing to address the reasons behind the increased use of anti-psychotic medications for the behavioural aspects of dementia; it is simply ‘shooting the canary’ and will have no impact on the gas leak in the coalmine the canary has been screaming about for the last five years.
What RACFs need instead is funding targeted towards sufficient numbers of appropriately trained nursing staff, for GPs to provide comprehensive team-based care, and for tertiary services to get out of hospital grounds and into RACFs to work with GPs.
Novel solutions are required to the problems faced in residential aged care, and each facility will need to find one that reflects their community workforce and need.
But some general steps that will be helpful across the board include:
additional money injected into the system from federal and state health budgets
patients getting used to private fees for GP services
nurses and nurse practitioners being allowed to practice at their full scope
GP-led rather than GP-delivered care being utilised where possible.
The message should be clear: fund RACFs and GPs in order to enable them to provide the care that is so desperately needed.
Introduction by Croakey: Emergency departments are often thought of as the canary in the coalmine, but what do we do when the canary is clearly in distress?
Dr Simon Judkins, President of the Australasian College for Emergency Medicine (ACEM), started a much-needed conversation about Australia’s overburdened emergency departments back in September with a post to coincide with national RUOK Day.
In response, an anonymous emergency clinician penned this searing, heartfelt account of the very real pressures ED workers face every day. If you haven’t yet read it, we’d very much encourage you to do so.
While only one person’s story, it resonated with and captured the experience of many, reflecting a system underresourced and overwhelmed, according to Judkins, who wrote an open letter in reply — below — calling for courageous reform.
‘If you could put a message on a billboard, to be seen by millions (or billions) of people, what would you say?’
I was lucky enough to have an opportunity to answer this in real life when a journalist from Coles contacted me. They wanted to know a GPs views on Men’s Health. The article we produced is here (and reproduced below). This is in the Coles Health and Beauty magazine – they have printed 500,000 copies of this! What was that one message I wanted to get across?
A boy born in Australia in 2010 has a life expectancy of 78.0 years while a baby girl born at the same time could expect to live to 82.3 years old. Right from the start, boys suffer more illness, more accidents and die earlier than their female counterparts.
Men take their own lives at four times the rate of women (that’s five men a day, on average). Accidents, cancer and heart disease all account for the majority of male deaths.
Seven leading causes are common to both males and females, although only Ischaemic heart disease shares the same ranking in both sexes (1st). Malignant neoplasms of prostate (6th), Malignant neoplasms of lymphoid, haematopoietic and related tissue (7th) and Intentional self-harm (10th) are only represented within the male top 10 causes.
The above figures are taken from the Australian Bureau of Statistics. Furthermore, there are specific populations of marginalised men with far worse health statistics. These marginalised groups include Aboriginal and Torres Strait Islander men, refugees, men in prison or newly released from prison and men of low socioeconomic standing.
Men’s Health Week has a direct focus on the health impacts of men’s and boys’ environments. It serves to ask two questions:
What factors in men’s and boy’s environments contribute to the status of male health as indicated in the table above?
How can we turn that around and create positive environments in men’s and boy’s lives?
We’re going to ask and answer those questions this week. Stay with us online and in person – we’ve got your back!