Doctors cut back on palliative care following opioid crackdown

It seems that palliative care patients could be the ones to suffer under the Department of Health’s crackdown on doctors prescribing opiates.

The Department’s heightened scrutiny of opioid prescribing has resulted in some doctors stopping prescribing opioids for patients in palliative care, and others have cut back visiting patients in palliative care.

Department’s letter to nearly 5,000 GPs

In June this year, the Department of Health wrote letters to 4,800 GPs drawing their attention to the fact that their rate of prescribing opioids was in the top 20 per cent in the country, and that their prescribing rate would be monitored.

If doctors are found to be prescribing opioids excessively, they could be investigated by the Department.

According to the Department’s website, “In limited cases, where there are concerns of possible inappropriate practice, the Department of Health will consider referring practitioners to the Practitioner Review Program,” the Department of Health website states.

According to a statement from the Department of Health provided to HelloCare, the letters were intended to raise awareness about opioids and to encourage “self-reflection” on prescribing practice.

The letters were sent “in an effort to reduce inappropriate prescribing of opioid medications”, the statement said.

Palliative care-specific items were excluded in determining who would be contacted, so far as they could be identified. But the Department acknowledged that palliative care doctors may have higher prescribing rates that other doctors.

“The Department acknowledges that some GPs may still prescribe general PBS items for palliative care patients and this may be a reason why a doctor’s prescribing rate is higher than their peers. Unfortunately it is not possible to differentiate the types of practitioners or patients from the PBS data,” the Department’s statement said.

Departmental investigation “intimidating, time consuming, expensive”

An Adelaide GP, Dr Peter Ford, told newsGP, that being the subject of a Department of Health investigation would be stressful.

“Extricating yourself from an onerous investigation of you is quite intimidating, time consuming, and expensive. No one wants to go into it lightly,” he said.

Dr Ford said he has stopped prescribing opioids for patients in palliative care and has reduced his palliative care work in aged care facilities after receiving a letter from the Department.

“‘It’s all very well for people in bureaucratic positions to take a superficial view, but when you’re face to face with patients in pain and distress, those who require palliative care require palliative care,” he said.

Appropriate use of opioids

Past president of the RACGP, Dr Bastian Seidel, told newsGP that while the campaign to clamp down on rates of opioid prescriptions was “well intentioned”, some GPs – such as those who work in palliative care and aged care facilities – have legitimate reasons for high rates of prescribing the medication.

“These GPs are therefore more likely to be identified in this campaign as problematic prescribers, when they are in fact providing suitable care,” he said.

The opioid crisis in Australia

The Department told HelloCare the letters were sent to doctors in an effort to prevent Australia’s opioid crisis from worsening.

Approximately two-thirds of fatal opioid overdoses in Australia are now caused by pharmaceutical opioids, rather than heroin, the Department said.

Opioids are now the most commonly misused pharmaceutical group in Australia. The 2016 National Drug Strategy Household Survey found 3.6 per cent of Australians over the age of 14 reported recent misuse of prescription painkillers/analgesics and opioids.

The Department of Health recommends that if any doctors, including palliative care doctors, are concerned about their opioid prescribing, they can contact opioidprescribing@health.gov.au for more information and clarification about their data, and the intent of the Department’s letter.

 

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  1. How ironic that at the same time of the upcoming Royal Commision into Aged Care many Doctors are either not treating Palliative Care patients or cutting back on Nursing Home visits to treat dying patients who of all people require adequate pain management.!

    I gather from the Dept of Healths perspective that to allow people to slowly die in pain is not abuse?

    Considering the increasing numbers of older people dying in Nursing Homes as there are very few Hospice beds this equates to nothing but the most extreme form of neglect and abuse!

    As a RN I can confirm that its been a struggle for years due to lack of care from some GP’s to obtain an adequate level of pain management but from now on it seems this is going to greatly exacerbate.

    This is nonsensical and downright criminal that the Dept of Health is not going to specifically differentiate between opioids prescribed for Palliative Care and general practise.

    Most Doctors are already overly concerned to protect themselves from time consuming investigation but from now on this will obviously be their no 1 concern.

    I just can’t believe the ignorance of the Dept of Health that somehow they equate addiction to dying people.!

    Just another obvious example of beaurocracy gone mad!

    The entire Aged Care system in general will never improve while we have people at the top ignorant of the real world making the decisions

  2. Did it ever occur to the people who regulate OxyContin that just maybe there are multiple reasons why people are in pain ? Some people overdose because they want to die. Other people overdose when they combine other drugs like alcohol with OxyContin and finally many people are socially isolated and do not have much support. Everything is worse when you are alone and sadly loneliness is endemic. Loss of employment and structural change are making health outcomes worse for some groups of people. Why aren’t these issues being addressed ? OxyContin use is a rational response to an irrational situation and it is little wonder that societies in decay like the US have such a drug ‘problem’. What people need is a biopsychosocial approach to pain that is supportive rather than punitive. Palliative care patients need advocacy because the current approach by DHS is not working.

  3. Unfortunately the Department of Health fails to make the time and resources available to properly investigate issues that impact upon individuals lives. They use population based data to issue broad sweeping statements about making the lives of GP’s miserable if they do not conform to the ” preferred ” prescribing profile for opiod based medication.

    That might be ok if all GP ‘s had the “preferred” patients !

    The role of opiods for pain relief cannot be abandoned because they are also abused.

    Alcohol is abused, lets see how the Department of Health goes investigating the providers of alcohol who exceed safe limits. No chance, alcohol purveyors have power. They are safe.

    Not so chronic pain suffers, the elderly, those in palliative care and others who are sick and use opiods legally and effectively. They have no power. The Department of Health can feel good about its clumsy attempt to save the world, while the powerless lose the medication that works and their GP’s tell them to find another Doctor, so the current GP does not fall foul of the regulator.

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