Over 1 million warnings triggered by Victoria’s SafeScript program

An alert system to warn doctors and pharmacists about potentially lethal doses of prescription drugs has smashed the expectation of experts.

A staggering 1.28 million alerts in just two years have urged the state’s doctors and pharmacists to reconsider prescribing potentially lethal drugs to people at risk of overdosing.

The number of warnings triggered by Victoria’s SafeScript program has never been released, but the Herald Sun can reveal there were 609,727 “red notifications” in 2020, and 672,373 in 2021.

The computerised tracking system issues green, amber and red notifications when it detects patients as being prescribed high-risk drugs in high doses, for prolonged periods, by multiple doctors, or in combinations that might be dangerous.

Red notifications are triggered only when a doctor, pharmacist or nurse prescriber is planning to provide a ­patient with a potentially ­lethal or severe-risk course of opioid painkillers, benzodiazepines, or other addictive drugs.

The huge number of red flags issued – about four times more than experts working in the drug treatment sector had expected – exposes the shocking scale of Victoria’s pharmaceutical drug crisis and the importance of introducing compulsory, real-time prescription monitoring.

It has also increased fears that as a result of being flagged and cut off from prescribed medications, vulnerable ­patients endure dangerous withdrawals or turn to illegal drugs.

Red notifications are triggered only when a doctor, pharmacist or nurse prescriber is planning to provide a ­patient with a potentially ­lethal or severe-risk course of drugs.

Paul Grinzi, a GP whose practice focuses on drug treatment, acknowledged the red notification numbers were “surprising” and “stark”, but said doctors would have been unaware of the extent of the issue before SafeScript, which was rolled out in 2018 and ­became compulsory in 2020.

“It gives you a cause to pause and think ‘OK, what are we really doing here and how can we help?’ rather than just going through what would have been a routine practice running blind from a lot of these risk factors,” he said.

While the red notifications do not prevent a clinician providing medication, they do ­require them to examine the patient’s prescription and medical history to reconsider whether it is safe, or whether other measures are required.

The Department of Health revealed SafeScript had also uncovered the use of false prescriptions and stolen prescription pads in cases it referred to police. Those cases include people seeking opioids such as fentanyl and oxycodone, or benzodiazepines such as ­alprazolam (Xanax), to be sold on the black market.

“Evidence shows our Australia-first statewide rollout of SafeScript is saving lives,” the department said in a statement to the Herald Sun.

“Prescription medicine dependency can happen to anyone, and we’re making sure all Victorians, no matter who they are and where they live, can get the help they need.”

Kim Cooper died from an overdose of the medicines doctors had issued her just 57 days after SafeScript became mandatory for all Victorian prescribers. Picture: Facebook

But some drug treatment experts have criticised the Safe­Script system for failing to keep track of what happens to patients whose medications are red flagged.

The Herald Sun understands that drug addiction and pain management specialists pushed for the Andrews government to include a second step to SafeScript: to record what actions had been taken following red flags.

These might include gradually decreasing the medication, offering pharmaco­therapy, or referring a person for drug treatment.

While he was grateful the Safe­Script system was saving lives, Victorian Alcohol and Drug Association chief executive Sam Biondo said: “We have heard of people being turned away inappropriately once they’ve been red flagged because of concerns the practitioner had in continuing the relationship with that person’s complex circumstance.

“Depending on their circumstances and level of desperation and the sort of support or assistance that is offered or not offered, it could actually lead them to the black market to continue their substance misuse. That can be a recipe for disaster.”

Overprescription and misuse of drugs including opioids and benzodiazepines saw Victoria’s deaths from pharmaceutical overdoses jump from 275 in 2011 to 427 by 2018.

The mounting toll prompted the Andrews government to introduce the $29.5m SafeScript real-time prescription monitoring program that year.

Prescription drug deaths have since dropped slightly, to 407 in 2019 and 398 in 2020, but legally prescribed medications are still involved in three out of four fatal overdoses.

The huge number of red flags issued is about four times more than experts working in the drug treatment sector had expected.

As a member of the Department of Health’s SafeScript expert advisory committee, Pharmaceutical Society of Australia state manager Jarrod McMaugh said it was vital prescription monitoring worked as a guidance for prescribers, not a directive.

He warned the commonwealth government’s previous practice of sending “nudge letters” to GPs identified as prescribing the highest doses of addictive drugs led to many people being cut off from legitimate medications or facing dangerous withdrawals.

“Anybody who’s actually ended up with a substance use disorder, especially from prescribed medicines, hasn’t wanted to get there,” he said. “But that’s where they’ve ended up.

“So, from that perspective, it (SafeScript) has been 100 per cent very, very effective.”

Health minister Mary-Anne Thomas said the colossal number of red alerts issues proved the SafeScript program was working.

“Obviously, people with drug addictions and prescription drug addictions is a cause for concern, but we’ve got the data and that’s going to help us to tackle the problem,” Minister Thomas said.

“The red flag is obviously the key piece of reform that the safe script program has implemented, and it enables a timely conversation between either a medical practitioner or their pharmacist in relation to these drugs.”

WARNING SCHEME WORKS, BUT TOO MANY FORCED TO SELF-MEDICATE

Everyone from suburban mums and dads to city professionals may be battling with drug dependencies, and even turning to illegal alternatives.

Frontline drug treatment workers have told the Herald Sun they have had to save people suffering seizures or other dangerous withdrawal symptoms after being suddenly cut off from long-term painkillers or antidepressants.

Other patients have contacted health services after resorting to the black market to buy fake benzodiazepines, opioids or other illicit drugs that are responsible for a growing number of overdose deaths.

And despite hundreds of thousands of Victorians now being flagged for potentially inappropriate medication use, Dr Tamsin Short said it was difficult to know how many received help because the Safe Script system did not monitor patient outcomes.

Five years ago Dr Short’s Access Health and Community received federal funding to establish a Medication Support and Recovery Service, placing it perfectly to cope with an anticipated flood of detected cases when SafeScript was introduced in 2018.

“We expected to see when SafeScript was introduced that lots of people were going to have their problems flagged and we’ll start getting lots of referrals, but we haven’t had that happen,” Dr Short said.

“I would love to see that if there is a red flag some sort of other pop-up box or something in the system says ‘What are you doing? What’s your next step? Has the ­patient been told about available services? Or have you discussed pharmacotherapy?’

“There’s a fear for people that have been cut off because it can have really significant medical consequences, but it (the system) also doesn’t support the person in any way.”

Janet Shaw, who manages benzodiazepine treatment service Reconnexion, said SafeScript was successful in driving GPs to seek advice or refer dependent patients.

Reconnexion treatment service manager Janet Shaw. Picture: Supplied

“There’s been some helpful effect from SafeScript but at the other end of the scale are those doctors who just freak out and go ‘that’s red, I’m not prescribing’. And that’s really putting their patients at risk,” she said.

“If you set something up as a traffic light system, people will see it as a traffic light system. There’s no other way to read that but ‘green is OK, go ahead’, orange is ‘here’s a problem’ and then red is ‘just don’t do it’.”

Benzodiazepines have killed 1436 Victorians in five years, more than the combined total for all illegal drugs, which stands at 1335 deaths.

Many patients need to be weaned off benzodiazepines, putting some doctors under pressure from constant red flags. As a consequence, Ms Shaw said Reconnexion’s support line was increasingly ­receiving calls from younger people finding dangerous illegal and fake benzodiazepines online.

Ms Shaw said most people with dependencies were suburban mums and dads and professionals with no idea they had a problem until flagged.

“They’re almost universally ordinary middle-class folks who went to their doctor ­either with anxiety or with ­insomnia and their doctor gave them a prescription for benzos,” Ms Shaw said.

“They’re only supposed to be prescribed for two to four weeks after you’ve tried other things. But we routinely have people coming to us who’ve been prescribed regularly by the same doctor for many years.”