States, Territories & Cth. review+overhaul to chronic pain mgmt (opioid use/ m/marijuana)
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Despite medical marijuana laws passed by the Federal Parliament, Victorian Government, and likely others throughout Australia; many GP's and Pain specialists alike are unaware of their ability to:
- Prescribe the medicinal marijuana medication(s)
- What medication is available in Australia, including the one (Sativex) currently approved by the Federal Therapeutic Goods Administration
- What permits must be obtained from the Commonwealth and State alike? (e.g. a Schedule 8 permit from DHHS, and a category two import permit from the Office of Drug Control for 'unlicensed' (Non-TGA - Therapeutic Goods Administration) "poisons"
- Are there other additional administrative burdens for prescribers, does the Federal Office of Drug Control require any ongoing communication or notifications, compliance monitoring reporting?
- Do the Victorian Department of Health and Human Services, in particular, require anything over and above those as mentioned earlier for the doctor to prescribe ongoing treatment?
The above is NOT known by most health practitioners I have encountered in VIC, and I can only assume from the responses thus far, this is the case nationwide.
While the necessary information is publicly available, after an in-depth investigation, the government isn't doing enough to give comfort to GP's: who could be tapering patients down from dangerous levels of opioids, gabapentoids and other adjuncts. I acknowledge, and respect that not all health practitioners are supportive of medicinal cannabis as a form of treatment for chronic pain, which moves to me to the second segment of my request.
The current strategy for long term pain management in Australia is not working. This being the use of multiple pharmaceuticals including opioids (which are being forcibly removed in some cases - despite their being effective for some chronic pain patients), benzodiazepines, antidepressants, anti-epileptics and many others with "off label" indications. Many of these drugs have unacceptable side effects and leave patients in dissociative states barely able to function, yet they still suffer; often in silence. This silence is driven from fear, stigmatisation (Many doctors and pharmacists behaviour toward Chronic Pain patients issued with strong pain killers is on the verge of abusive) and a belief they have reached the end of the line in treatment. Chronic pain often co-exists with depression, due to the ongoing struggles in daily life, and thus, these additional burdens have the potential to drive people over the edge.
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Since additional controls (SafeScript) have been introduced throughout Victoria in effort to reduce patient harm and drug diversion, this has, without intent; resulted in yet further stigma on those who use opioid therapy to maintain a reasonable quality of life.
Pharmacists have refused to dispense legitimate prescriptions due to fear of audit, deflecting blame to the DoH/DHHS (Instead of having an informed discussion with the patient). The new RAG (Red Amber Green) warning system within SafeScript play a significant role within this behaviour
Patients are often unaware they are then flagged due to the dose of the medication they are taking, or in the instance of a flare-up of an existing condition, should they need additional medication - this is likely to result is a Red flag in the system.
Doctors are reluctant to prescribe because of the new "MED" (Morphine equivalent dose guidelines /Amber/Red Flag in Victorias SafeScript), as well as warning letters sent out nationally from the Federal Health minister informing them their opioid prescribing is being watched (This led to some patients being 'dropped and left without ANY medication).
Whilst this may, in some instances, help patients, or detect where interventions are required, at present, it's causing undue suffering across the chronic pain community. I would ask that rather than simply following suit of the CDC (Centers for disease control) in the USA for dosing guidelines, we use an individualised approach to chronic opioid therapy based on Australian evidence & input from the chronic pain community, health professionals and the like.
The fact that death by rapid opioid withdrawal is 7-14x more likely than death by opioid overdose is overlooked (7x for mild chronic pain, 14x for severe). Not to mention the fact that risk of suicide is already 3-4x higher in pain patients, and doubles in response to stigma, cannot be overlooked when making such profound legislative moves across Australia.
There is conflicting advice from many specialists in their field as to whether medical marijuana should be considered to treat patient's suffering with chronic pain. However, my stance is this, and if it allows the patient to achieve a high degree of pain relief and further, removes or reduces their need for long term opioid therapy, I would consider it a profound success (with medical supervision).
There have been a number of jurisdictions worldwide who have instituted programs and seen astonishing results.
I would ask that both the federal and states & Territories Governments work together to:
A. Help deliver education to the primary care network on GPs ability to prescribe, and the current medicinal marijuana medications available. This should include all legislative requirements the practitioners must adhere to.
B. Commission a report on the effectiveness of medical marijuana for chronic pain. This study should include those already receiving treatment in Australia but more so, include an in-depth analysis of other jurisdictions laws, patient profiles and results on the reduction of opiates and other medications or in many cases total elimination (based on available data sets).
C. Consider developing/uplifting a centralised Long term strategy that aligns with all states and territories, or one of which they can draw from and subsequently legislate ensuring that our most vulnerable citizens feel empowered despite their medical condition(s). This needs to include Medical Marijuana.
D. Invest a great deal more in chronic pain management, an area without much support or funding (especially in mental health), new Medicare item numbers should be an option, especially with regard to trial treatments of medical marijuana. Look at the real statistics from opioid use (most opioid-related deaths were due to heroin, an illicit drug - not prescribed by any medical professional in Australia) and always remember that these medicines are often a tool used by patients to achieve a relative quality of life and maintain being contributing, Tax Paying members of our great nation, Australia.
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