Practice Policy on the Safe Prescribing of Narcotic, Sedative, and other Psychotropic Medications

 

We do not have any doctors who are willing to prescribe narcotic and sedative drugs to a person who is not known to them (including patients who may already be seeing a doctor at the practice for prescriptions) until such time that there is evidence of clinical need.

To avoid disappointment, please note that GPs at The Doctors Mulgrave Road Medical Centre will not be able to prescribe or supply any monitored medications on your first visit.

The Practice Policy on the ongoing use of Narcotic, Sedative and other Psychotropic medications is that; 

1. It is unlawful for patients to consult a doctor and not reveal the quantities of controlled (Schedule 8) drugs they have received in the two months prior to the consultation. 
2. It is illegal for doctors to prescribe controlled (S8) drugs, or restricted drugs of dependency (S4 drugs such as Tramadol, Panadeine Forte, Panadeine Extra, and benzodiazepines), to a person they reasonably believe to be drug dependent without the prior approval of the chief executive of Queensland Health. 
3. As a matter of policy, this medical practice does not supply controlled substances (S8) drugs, or controlled substances of dependence including S4 medications such as Tramadol, Panadeine Forte, Panadeine Extra, Panadeine, or Benzodiazepines. 
4. As a matter of policy, the medical practice does not supply medications that have been implicated in mixed-drug overdoses – such as Lyrica, Seroquel, Tramadol, narcotic or sedative drugs, Amitriptyline, or other psychotropic medications. 

 

Medical practitioners that overrule the medical practice’s policies must have a valid clinical reason to do so – and enter that reason into the medical records. 

QScript

Monitored medicines have a recognised therapeutic use and can be a helpful part of treatment, but may also present a high risk of physical, mental and social harms. QScript is a real-time prescription monitoring system required to regulate access to and encourage the safe use of monitored medicines.

1. The GP is required to check Q Script online prior to prescribing or dispensing a narcotic, sedative, and other psychotropic medications or giving a treatment dose of a monitored medicine, at each instance.
2. The medicine information in QScript is essential to Healthcare Providers and may promote open discussions with you on the safety and quality use of medicines.
3. It aims to minimise risks by alerting healthcare providers when the patient may be at risk of harms caused by certain medications, for example, if taking too much of the medicine or the medicine clashes with another medicine being taken.

4. QScript keeps healthcare providers informed about certain medicines or combinations of medicines patients have received that can cause significant harm. Some examples of the medicines captured by QScript include:

• opioids that can be prescribed for pain, such as morphine (e.g. Kapanol®), oxycodone (e.g. Endone®), codeine (e.g. Panadeine Forte®) and tramadol (e.g. Tramal®)
• medicines prescribed for nerve pain, such as pregabalin (e.g. Lyrica®) or gabapentin (e.g. Neurontin®)
• benzodiazepines that can be prescribed for anxiety and/or sleep problems, such as diazepam (e.g. Valium®) and temazepam (e.g. Temaze®)
• other types of sleeping tablets, such as zolpidem (e.g. Stilnox®) and zopiclone (e.g. Imovane®)
• medicines used to treat ADHD, such as methylphenidate (e.g. Concerta® or Ritalin®)
• a type of antipsychotic medicine called quetiapine (e.g. Seroquel®)

If patients are supplied with one of these medicines, the prescription information will be automatically recorded in QScript. This information includes patient name, address, details of the medicine supplied (i.e. medicine name, strength and quantity), and the prescriber, pharmacist and pharmacy details. QScript is not an opt-in, opt-out system and patients will not be able to opt-out of having their information added to the database.

 

Prescription Shopping Information Service Hotline

Prior to commencing the use of narcotic, sedative, or other psychotropic medications, the prescribing doctor should discuss the particulars of the matter with the Prescription Shopping Information Service Hotline. 

The Doctors Shoppers Hotline can be contacted on 1 800 631 131 or accessed online via a PRODA account.

Prescription Shoppers may be identified by; 

• The number of doctors they see, or; 
• The number of targeted medications prescribed or dispensed.

 

A list of the current targeted medications is supplied (towards the end of the policy). 

 

Management Plans

Prior to prescribing you will be required to provide your health history and agree upon a health management plan with the GP. Any breach of your management plan will result in the GP no longer being able to prescribe monitored medications. 

1. An appropriate Management Plan needs to be discussed with and provided to the patient and reviewed regularly.
2. A contract of agreement should be developed and agreed upon by both the patient and the doctor.

3. Prescribing medical practitioners must ensure that the information they are acting upon is up to date. 
4. Two independent appropriately qualified and experienced registered medical practitioners should discuss, agree, and sign off on an appropriate short and long-acting treatment regime prior to initiating (or continuing another doctor’s treatment of) narcotic drugs for the treatment of non-cancer pain. 

1. A doctor may, at their discretion, issue a prescription for a limited number e.g. seven (7) tablets of sedative or narcotic drugs for the treatment of non-cancer pain. 
2. Prescribing doctors are reminded that; 

• Because they act centrally, narcotic, sedative and other psychotropic medications are commonly associated with unwanted adverse side-effects, even whilst in the therapeutic range. 
• The unwanted adverse side effects of narcotic, sedative, and other psychotropic medications include agitation, confusion, psychosis, impaired decision making, respiratory depression, accidental overdose, and death. 

 

Prescribing doctors should always; 

• Check the validity of the underlying condition or conditions being treated; 
• Make sure that the patient has an accepted clinical reason (according to current therapeutic guidelines) for narcotic, sedative, and other psychotropic drugs; 
• Operate within safe limits; 
• Ensure that their patients meet timely reviews. 
• Refer the patient to ongoing allied health or specialist service providers, as required.

 

Medicines captured by QScript

QScript captures a comprehensive list of medicines that have a recognised therapeutic use but may also present a high risk of physical, mental and social harms. The Medicines and Poisons Act 2019 refers to these medicines as ‘monitored medicines’ which includes:

• all schedule 8 medicines (e.g. opioids, alprazolam, nabiximols, dexamphetamine)
• the following schedule 4 medicines:
• all benzodiazepines
• codeine
• gabapentin
• pregabalin
• quetiapine
• tramadol
• zolpidem
• zopiclone

The list of monitored medicines has been determined based on local and international research and incorporates the recommendations of a multi-disciplinary working party. Numerous factors were considered when determining whether a medicine was suitable for inclusion in the list, including the evidence of harm (on its own or in combination with other substances) and trends in prescribing, misuse, and abuse.

Ongoing research and trends in prescribing medicine will inform any future changes to the monitored medicines list

Medications can be toxic, or lethal when used in combination with alcohol, recreational drugs, illicit substances, and other prescription drugs. 

The presence of other agents may heighten the activity and toxic side effects, of narcotic, sedative, and other psychotropic medications – which may lead to an overdose of mixed medications, with potentially lethal side effects. 

When used in combination, narcotic, sedative, and other psychotropic medications can have particular toxic or lethal effects. 

 

Notations

Prescribing doctors are reminded that patients seeking narcotic, sedative, or other psychotropic medication may present with genuinely distressing, and eminently believable stories – that do not accurately present the facts. Those may ultimately be found to be partially or completely untrue. 

Prescribing doctors are also reminded that even with the best systems in place, patients may have alternate sources of recreational, illicit, and prescription drugs – for example, family, friends, or the general public at large. 

Prescription medications are commonly bought and sold. 

 

 

The list of medicines currently being targeted by the Doctors Shoppers Hotline (Prescription Shopping Information Service) in generic terms, not trade names, includes;

 

Acamprosate Alprazolam Amitriptyline Asenapine Atomoxetine Bromazepam Buprenorphine Buprenorphine + Naloxone Bupropion Citalopram Clonazepam Clozapine Codeine Desvenlafaxine Dexamphetamine Diazepam Dothiepin Doxepin Duloxetine

Escitalopram Fentanyl Flunitrazepam Fluoxetine Fluvoxamine Gabapentin Hydromorphone Lisdexamfetamine Lithium carbonate Methadone Methylphenidate Mianserin Midazolam Mirtazapine Modafinil Morphine Naltrexone Nicotine

Nitrazepan Olanzapine Oxazepam Oxycodone Oxycodone + Naloxone Paracetamol + Codeine Paroxetine Phenobarbitone Pregabalin Quetiapine Reboxetine Sertraline Tapentadol Temazepam Tramadol Varenicline Venlafaxine Zopiclone

Suggestions regarding the manner by which the Practice’s Narcotic, Sedative and other Psychotropic Medication Policy can be forwarded to:

Dr Evan Nicholls

Medical Director and Program Manager

Cairns 24 Hour Medical Centre, Townsville GP Superclinic, The Doctors Mulgrave Road Medical Centre, Nicholl Holdings Pty Ltd