1 JUNE 2015
Australia’s most commonly discarded medicines
The latest issue of Australian Prescriber reveals that over 600 tonnes of medicines are discarded in Australia every year.
The article ‘Safe disposal of prescribed medicines’ discusses an audit of the medicines returned through the National Return and Disposal of Unwanted Medicines (NatRUM) program, which collects drugs to prevent them ending up in landfill and waterways.
The annual cost to taxpayers was $2 million for the 31 most frequently discarded medicines dispensed under the Pharmaceutical Benefits Scheme (PBS). The three most discarded medicines in Australia were salbutamol (for asthma), insulin (for diabetes) and frusemide (a diuretic). Paracetamol was the eighth most commonly discarded medicine, probably due to the large quantities dispensed under the PBS.
The analysis was prepared by the Centre for Medicine Use and Safety at Monash University, Melbourne.
Dr Phillip Bergen says, “The audit of the contents of Return of Unwanted Medicines (RUM) bins shows how hoarding and non-adherence are contributing to waste. Health professionals should inform patients about the importance of completing prescribed courses of treatment and discourage them from hoarding after reaching the safety net threshold on the PBS.”
Over 85% of discarded medicines were scheduled drugs, and prescription medicines subsidised by the PBS made up approximately 70% of the medicines discarded. About 44% of the drugs were still within their expiry dates.
“The true cost of the discarded drugs is likely to be higher than $2 million, as the quantity of medicines disposed of in household rubbish bins is unknown.
“A huge concern with the widespread emergence of antimicrobial resistance is the high return rate of antibiotics combined with the dwindling development of new antimicrobial drugs.
“Health professionals should consider prescribing the smallest pack size of a medicine at the start of therapy.
“Patients need to be educated about returning unwanted medicines to pharmacies so the drugs can be disposed of through RUM bins for the wider potential benefits to the environment and society,” says Dr Bergen.
Australian Prescriber celebrates its 40th year in 2015. See the June issue online at www.australianprescriber.com
Other articles in this edition of Australian Prescriber include:
* Medical management of malignant melanoma
* Complex regional pain syndrome
* New drugs: Vortioxetine for depression
To read full articles and more visit www.australianprescriber.com
1 JUNE 2015
Advances in medical management of malignant melanoma
After 30 years of little progress in the treatment and survival of people with malignant melanoma, there are now several drugs available that may improve outcomes.
In the latest issue of Australian Prescriber, Dr Victoria Atkinson, oncologist at Princess Alexandra Hospital in Brisbane, provides an update on the advances in the medical management of metastatic melanoma. This is the fourth most common cancer diagnosed in Australia and the most common malignancy among 15–24 year-olds. The disease is incurable and results in a significant loss of life (for example, 365 deaths were registered in Queensland in 2010).
The author says that “until 2010, there were no significant advances in improving survival for metastatic melanoma – the median overall survival of nine months had not changed in decades. However in the last few years, several novel drugs have been shown to prevent progression and improve overall survival.”
One of the new approaches involves drugs that target a particular gene mutation commonly found in tumour cells. If the patient’s tumour expresses the BRAF mutation (found in 40–60% of patients), drugs called BRAF inhibitors can block the abnormal proteins and slow the growth of melanoma cells.
Another approach is immunotherapy (where the aim is to control the patient’s own immune response to the tumour cells). New immunotherapy treatments for melanoma are currently being trialled in Australia and are available for limited compassionate use in Australia
To read the full article Medical management of malignant melanoma visit www.australianprescriber.com
2015 is the 40th anniversary year of Australian Prescriber.
Other articles in this issue include:
* Safe disposal of prescribed medicines
1 JUNE 2015
Latest edition of Australian Prescriber & the new Doctor’s Bag app out now
Australian Prescriber celebrates its 40th year in 2015. See the June issue online at www.australianprescriber.com
Quetiapine – a short-acting antipsychotic drug – is subsidised by the Pharmaceutical Benefits Scheme to treat schizophrenia and bipolar disorder. Author Dr Jonathan Brett, clinical pharmacology and addiction medicine specialist at Royal Prince Alfred Hospital Sydney, examines the increasing off-label prescribing of quetiapine for indications such as insomnia that have little evidence to support them. Quetiapine’s use has increased dramatically since 2000. It appears to be the antipsychotic drug that is most commonly bought and sold illicitly. Adverse outcomes from off-label prescribing are more likely to occur in already vulnerable populations such as older people, those with mental health problems and substance misusers. Dr Brett argues that prescribers should be cautious about off-label indications for these groups but acknowledges the difficulties faced by prescribers who may lack access to practical alternatives.
Dr Brendan McMullan, infectious diseases specialist, and Mona Mostaghim, antimicrobial stewardship pharmacist, from the Sydney Children’s Hospital, review the prescribing of azithromycin and raise concerns about unfettered use as bacterial resistance is increasing. More than 10% of Streptococcus pneumoniae (pneumococcal disease) infections and over 15% ofStaphylococcus aureus infections in Australia have been reported to be resistant to azithromycin. The authors comment on when azithromycin is preferable to other antibiotics.
Dr Janine Pilcher and Professor Richard Beasley from the Medical Research Institute of New Zealand examine the entrenched culture of routinely administering high-concentration oxygen to acutely ill patients. The routine administration of high-concentration oxygen to these patients has the potential to cause harm. The authors therefore argue that, just like any other drug, oxygen should be prescribed at the appropriate dose. It should be titrated so that the saturation is within a range that avoids unrelieved hypoxaemia (due to insufficient oxygen therapy) and provoked hyperoxaemia (due to excessive oxygen).
Complex regional pain syndrome
Complex regional pain syndrome is an uncommon chronic pain condition that can be difficult to treat. It develops spontaneously or following an injury and is associated with changed and heightened sensitivity of sensory and motor nerves, and skin and bone abnormalities. The syndrome accounts for 2–5% of adults and up to 20% of children attending pain clinics. Associate Professor Greta Palmer, pain specialist and anaesthetist at the Royal Children’s Hospital in Melbourne, examines the pathophysiology, clinical features, prevention and treatment of the syndrome. Clinicians are often faced with anxious, distressed patients seeking a physical explanation for their ongoing pain. Although complex regional pain syndrome can be difficult to treat, Associate Professor Palmer reviews the evidence for interventions that may be helpful.
The Doctor’s Bag is a free app designed to support Australian health professionals during emergencies. It provides recommended doses for drugs in the PBS Prescriber Bag, as well as a step-by-step guide for the management of anaphylaxis, based on the Australian Prescriber anaphylaxis wall chart. Search for “The Doctor’s Bag” on app stores.
Other articles in this edition of Australian Prescriber include:
* Safe disposal of prescribed medicines
* Medical management of malignant melanoma
* New drugs: Vortioxetine for depression
To read full articles and more visit www.australianprescriber.com
26 MAY 2015
JUDGING PANEL ANNOUNCED FOR THE INDUSTRY-FIRST ANTIBIOTIC RESISTANCE SHORT FILM COMPETITION
Tropfest, the world’s largest short film festival, and NPS MedicineWise are pleased to announce a stellar judging panel for#savethescript—the industry-first short film competition created to help raise awareness and fight antibiotic resistance this cold and flu season.
NPS MedicineWise and Tropfest have partnered to encourage creative individuals or groups to help spread a vital health message to Australians that, through misuse and overuse, antibiotics are losing their power.
The independent Review on Antimicrobial Resistance (commissioned by the UK Government) described antibiotic resistance as ‘a global public health threat [which] should arguably receive the same kind of public focus HIV/AIDS received in the 1990s or cancer research receives today’. The #savethescript short film competition provides a new avenue for the crucial awareness raising that is needed now.
The #savethescript judges were invited to be involved in this campaign for their experience in strategic message delivery through medical, marketing, film and television platforms. All judges have donated their time in support of this important awareness-raising campaign.
The judges will vote on which entries have delivered impactful, insightful and creative messaging on this serious health issue. The winning films will share a prize pool of $10,000 in cash prizes as well as global exposure for the winning films via Tropfest’s platforms.
Proudly announcing the #savethescript judging panel:
* Dr Andrew Rochford, Seven Network Health Editor and medical doctor
* Lindsay ‘The Doctor’ McDougall, rock guitarist and radio presenter
* Iggy Rodriguez, Creative Group Head at Leo Burnett
* Dan Uglow, Editorial Director of B&T
* Alyssa McClelland, director and actress
* Michael Laverty, International Managing Director of Tropfest
w Dr Lynn Weekes AM, Chief Executive Officer NPS MedicineWise
Judge Iggy Rodgriguez says about #savethescript, “A great social cause with a timely reminder coming into winter, what better reason to create an inspiring piece of film”. And judge Alyssa McClelland says, “I am thrilled to be involved with a short film competition that carries such an important message. This is an incredibly serious health issue and I cannot wait to see the films that have been entered”.
The good news is it’s not too late to submit a film. Make a short film/community service announcement (CSA) of up to 45 seconds and upload to one of your social media accounts such as Vimeo, YouTube, Facebook, Twitter or Instagram. Make sure the film is available for public viewing, tag @NPSMedicineWise and include the hashtag #savethescript in the description. To find out more, for terms and conditions and to submit your entry visit winteriscoming.nps.org.au
Entries close at 5:00pm AEST on 31 May 2015. Winners will be announced in June 2015.
#savethescript video promo: http://youtu.be/68g_8QNAlMA
For more information about antibiotic resistance, visit www.nps.org.au/antibiotics