Dr Richard O’Regan explains how a drug and alcohol support service for WA doctors is helping patients and reducing doctor-shopping.
The Drug and Alcohol Clinical Advisory Service has been operating in WA for 18 months, providing WA clinicians across the state with support and advice in the management of alcohol and other drug (AOD) use.
The DACAS addictions specialist can assist GPs, hospital clinicians, psychiatrists, AOD counsellors and psychologists in a wide range of clinical situations, including:
- A 63-year-old single patient who lives alone wants to stop drinking three-quarters of a bottle of spirits a day. She has had withdrawal seizures previously. Where can she go for help?
- A 21-year-old male recovering from alcohol intoxication-related road trauma wants to enter residential rehabilitation. How much does it cost and how does he get in?
- A 38-year-old mother of three has completed a home-based alcohol withdrawal and wants help staying off alcohol. Is there any medication that can help? Where can she access supportive AOD counselling?
- A 47-year-old roof plumber with chronic pain has presented early for script renewal on four occasions, and the local pharmacist called to say three GPs are now prescribing oxycodone, tramadol and diazepam. The Department of Health has requested that a specialist support the opioid prescribing. How do I proceed? Is there anything I can do to help keep him safe?
- A 25-year-old woman, who was recently released from prison after serving 22 months for stealing, says she has begun using heroin again and wants to stop. She also says she is pregnant. How can I help her? What services are available to support her through the pregnancy?
In addition to expedient access to specialist AOD advice, callers will be offered summaries on a range of addiction medicine issues.
Epidemiological data indicates that the prevalence of many substance use disorders is higher in the rural and remote areas than it is in metropolitan Perth. It can be a challenging task for GPs to manage complex problems associated with AOD use in their communities without support from specialist addiction services.
DACAS now offers telehealth support to WA clinicians including videoconferencing to discuss a specific patient or addiction medicine topics.
Real-time prescription monitoring
RTPM will create a demand for AOD clinical advice on chronic pain management and associated substance use issues, as a number of patients are likely to be identified as oversupplied or drug dependent. The capacity of WA GPs to manage these patients will be increased through access to expert AOD advice.
How it might help doctors
A 65-year-old man has been under your care on the ward since admission eight days ago following a deliberate medication overdose in response to a strained relationship with his wife. On presentation his history included use of prescribed oxycodone modified-release at a dose of 40mg TDS, oxycodone immediate-release 5mg TDS, oxazepam 60mg TDS, pregabalin 300mg BD, quetiapine 100mg BD and venlafaxine 300mg daily. He has a vague and distant history of pain “everywhere” with severe anxiety, and reports that he attends at least three different medical practices for scripts. Where do you take this? How can this man’s medications be rationalised, and prescribing made safer with a view to his discharge?
By calling the Drug and Alcohol Clinical Advisory Service (DACAS, phone 6553 0520), you will immediately be in contact with an addiction specialist for advice and receive the following recommendations:
- Call the Medicines and Poisons Regulation Branch (MPRB, 9222 6883) for advice about the authorisation for long-term, high-dose Schedule 8 opioid prescribing. (You later discover that in the past three months, six practitioners from four medical practices have all prescribed oxycodone for the patient, and that a single prescriber has DoH authorisation to do so.)
- Make contact with the Prescription Shopping Information Service (PSIS – 1800 631 181) to determine the extent of medication access. (You later do so and are advised the patient fulfils the criteria for doctor-shopping.)
- Make contact with the man’s GP to discuss the information provided by the DoH and PSIS.
- Plan to safely manage future medications through staged supply via a single nominated pharmacy. (You agree that a second daily collection is reasonable at this point).
- Refer to a sample opioid and benzodiazepine dose reduction regime
- You are provided with details for community support and referral via the local Community Alcohol and Drug Service.
- Finally, the addiction specialist recommends you provide the man with take-home naloxone and discuss its use with the patient and his partner.
A short time later you receive several summaries via email, including Coming off opioid medication (an information sheet for patients), Management of Opioid Withdrawal in General Practice, and Naloxone advice for practitioners. You decide to keep the DACAS contact details handy for future reference!
ED: Dr Richard O’Regan is clinical services director with the Mental Health Commission’s Next Step Drug and Alcohol Services.