02 OCTOBER 2015
Australian Prescriber
Drugs of addiction – reform and the future
This edition of Australian Prescriber focuses on drugs of addiction and the many issues facing prescribers. “While illicit drugs grab a lot of headlines, the misuse of prescription drugs attracts less attention and is a serious issue to address,” says Dr John Dowden, Editor of Australian Prescriber.
The failure of drug prohibition
Drug control expert Dr Alex Wodak is concerned about the continuing failure of drug prohibition and calls for reform of the drug laws in Australia. “Although the aim of our drug laws is to protect the health and well-being of Australians, deaths, disease, property crime, violence and corruption have increased. Like any other medicine, policy and practice should be based on evidence of its effectiveness and safety – health and social interventions have often had impressive results in reducing harm and dramatically saving on healthcare costs.”
Patients are at risk from misusing benzodiazepines. Over the last 20 years the prescribing volume has become a significant concern. Addiction specialists Drs Jonathan Brett and Bridin Murnion urge prescribers to complete a thorough risk assessment to help prevent and recognise benzodiazepine dependence. The authors give advice on how to manage dependence, including gradual benzodiazepine withdrawal or maintenance therapy.
In Australia at any one time there are approximately 30,000 people in custody – 75% use illicit drugs before their incarceration. An overwhelming number of prisoners also have a history of mental illness and chronic illnesses such as hepatitis C. Dr Stephen Hampton, Donna Blomgren, Jill Roberts, Tobias Mackinnon and Dr Gary Nicholls provide advice on prescribing for people in custody. Patients must be closely monitored and encouraged to manage their health with simple and pragmatic strategies. Caution should be used when prescribing drugs of abuse.
Deaths from prescription drug misuse
Deaths from prescription drug misuse account for a significant proportion of overdose deaths. Dr Danielle Wood, addiction medicine fellow, reviews high-risk drugs such as analgesics, opioids and benzodiazepines and their contributions to overdoses. Prescription drugs can ‘stray’ at any point along the supply chain, from doctors, pharmacists, family, friends or drug dealers, leading to serious implications such as loss of life. Cleaning up drug diversion involves good prescribing practices and training, improved monitoring systems and reformulation of pharmaceuticals.
To read the latest edition of Australian Prescriber visit australianprescriber.com.
1 OCTOBER 2015
CHANGES TO THE NATIONAL CERVICAL SCREENING PROGRAM
From 1 May 2017, changes will be introduced to the National Cervical Screening Program (NCSP). Pap smears will be replaced with human papillomavirus (HPV) testing of cervical samples with partial HPV genotyping, and reflex liquid-based cytology (LBC) on samples testing positive for HPV.
Australian health professionals will receive detailed information on the changes to the program through today’s special issue of the NPS MedicineWise publication NPS RADAR.
Dr Robyn Lindner from NPS MedicineWise says that the main message for health professionals and their patients is that it is business as usual for Pap smears ahead of the change in May 2017.
“Do not delay testing women under the current screening arrangements—women aged between 18-69 years need to adhere to the 2 year screening interval ahead of the change,” says Dr Lindner.
“The special edition of NPS RADAR has been published to let health professionals know ahead of time about the changes to this vital screening program.”
Key changes to the renewed screening program in May 2017 also include:
* Screening will start at age 25.
* The screening interval will be extended to five years.
* Women will be invited to screen until they are 69 years of age, and will be invited to exit the program if they have a further negative HPV test between 70 and 74 years of age.
* To improve participation, self-collection of a cervical sample for HPV testing will be available for under-screened or never-screened women.
* A national cancer screening register will be established to support the new program and invitation and recall letters will be sent out to encourage participation.
*I The new tests will be available on the Medical Benefits Schedule from May 2017 onwards.
HPV-vaccinated women need to be reminded of the importance of cervical screening, because the current HPV vaccine only protects against two HPV types that cause about 70% of cervical cancers.
Australia will be the second country in the world after the Netherlands to incorporate primary HPV testing into their national cervical screening program.
Dr Lindner says the change offers Australian women best practice, as “cervical screening with HPV testing detects the primary causal agent for the vast majority of cervical cancers, to enable early detection and closer monitoring of women who are at risk of progression to cervical cancer.”
“The high negative predictive value of the HPV test allows for screening every 5 years for HPV-negative women, without compromising the safety of screening.”
The special edition of NPS RADAR: Changes to the National Cervical Screening Program, will be available at www.nps.org.au/radar.
NPS RADAR provides health professionals with timely, independent, evidence-based information on new drugs and medical tests and changes to listings on the Pharmaceutical Benefits Scheme.
Also published today is the latest NPS MedicineWise Medicine Update, providing corresponding information for consumers on the upcoming changes to the cervical screening program, available at www.nps.org.au/medicineupdate.
29 SEPTEMBER 2015
NOW IS THE TIME FOR A NATIONAL CONVERSATION ABOUT APPROPRIATE HEALTH CARE
Last night’s ABC Four Corners program investigating unnecessary testing and treatments was a timely reminder of the need for both clinicians and consumers to question low-value care in the Australian health system.
While the recently announced MBS Review will undertake an important and comprehensive examination of the alignment of publicly-funded services with contemporary and evidence-based clinical practice, the recent establishment of the health profession-led initiative, Choosing Wisely Australia®, provides a forum for clinicians and consumers to improve conversations and decision making about unnecessary and potentially harmful healthcare.
Since launching in April 2015, 13 professional medical colleges and societies have joined the Choosing Wisely Australia movement and have released or are developing lists of five tests, treatments and procedures to question based on evidence of low or no value for consumers. A consumer resource—‘Five questions to ask your doctor’—is designed to support more informed conversations and decision making.
Modeled on international approaches, Choosing Wisely Australia is guided by an advisory group comprising health professionals and consumers and including Associate Professor Adam Elshaug who featured on the Four Cornersprogram.
The Four Corners investigation covered the rapidly rising costs to the health system of imaging for low back pain. Concerned about the impact on the health system of unnecessary testing for low back pain, the Royal Australian and New Zealand College of Radiologists (RANZCR) highlighted this test as one that clinicians and consumers should question.
“Low back pain is the third most common health complaint seen by Australian general practitioners. Imaging for acute low back pain is one of the tests to feature on our list—it is not recommended for patients with non-specific low back pain, which are the majority of these patients,” says Professor John Slavotenik from RANZCR.
“Imaging is only indicated initially if the patient has indicators of a serious spinal condition, spinal canal stenosis or sciatica. Adopting this recommendation on lower back pain, as well as our other Choosing Wisely Australia recommendations on imaging will result in improved imaging access to appropriate and quality tests and better patient care.”
Another recommendation already listed by Choosing Wisely Australia and examined in detail by Four Corners is PSA testing. The Royal College of Pathologists of Australasia (RCPA) recommends not performing PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than seven years.
“Choosing Wisely Australia is stimulating informed conversations about the right care, with the ultimate goal to ensure delivery of high-quality healthcare for Australians by reducing inappropriate care. The investigation by Four Corners highlighted the high costs of low value care. Choosing Wisely Australia will continue to proudly lead the conversation on appropriate care, with the initiative gaining momentum and further lists of tests, treatments and procedures to question due for release in 2016,” says Dr Robyn Lindner, NPS MedicineWise spokesperson.
Twenty five recommendations from colleges and societies along with the five questions that consumers should ask their health professional are located on the Choosing Wisely Australia website at www.choosingwisely.org.au. Morerecommendations will be available in early 2016.
About Choosing Wisely
Choosing Wisely Australia® is enabling clinicians, consumers and healthcare stakeholders to start important conversations about tests, treatments and procedures where evidence shows they provide no benefit and in some cases, lead to harm. The campaign is led Australia’s medical colleges and societies and facilitated by NPS MedicineWise. Join the conversation on twitter @ChooseWiselyAU or email choosingwisely@nps.org.au