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What SafeScript will monitor

Opioid painkillers

Opioid painkillers are derived from the opium poppy or chemically synthesized to mimic the effects of chemicals from the opium poppy.2 Legal forms of opioids include drugs such as morphine, codeine and oxycodone. Illegal forms
include drugs such as heroin.2

Opioid painkillers are regularly and legally used
by Australians for two reasons:

  • pain management after an event such as surgery or dental work
  • to treat opioid dependence using a technique called ‘opioid substitution therapy’ through the prescription of methadone (a synthetic opioid).3

One of the key risks associated with opioid use is the potential for developing dependence. When used over a longer period, people can develop a tolerance of the effects and therefore require increased amounts to feel the same effects.2,3 Over time, this effect can make it harder for the person to stop using opioids.

Benzodiazepines

Benzodiazepines are also known as mild tranquilisers (common brand names include Valium© and Xanax©). These drugs are typically prescribed for managing conditions such as acute stress, anxiety and insomnia in the short-term.4 Benzodiazepines can be short-, intermediate- or long-acting.

Common side effects associated with benzodiazepines include risk of dependence, poor concentration, dizziness, daytime drowsiness and lack of coordination. Short-acting benzodiazepines carry some additional risk associated with dependence as their
effectiveness reduces over time.5 This means that withdrawal symptoms and cravings can occur with extended use. Research clearly shows that benzodiazepines are not an effective long-term treatment for stress, anxiety and insomnia.4,6

Poly-drug use

Poly-drug use is when someone takes different drugs at the same time. Poly-drug use can compound the risks associated with individual drug use and therefore lead to an increased risk of harm. Opioids, benzodiazepines and alcohol are depressant drugs, which slow down the messages traveling between the body and the brain (alcohol use is not recorded as part of Real-Time Prescription Monitoring).5,7 When taken together, these drugs increase the risk of overdose.7 A Real-Time Prescription Monitoring system would provide critical information to prescribers and pharmacists when a patient is already taking a specific drug. For example, if someone is already prescribed benzodiazepines, the prescriber will take this into account if they also require pain management medicine. They can then discuss the risks associated with taking these medications alongside lifestyle choices such as drinking alcohol.

Why are these drugs included in Victoria’s SafeScript?

In 2016, benzodiazepines were the drugs most commonly involved in drug-induced death in
Australia, followed by prescription opioids. Of the 1,808 drug-induced deaths across the country, benzodiazepines were present in approximately 36.7% of cases, while opioids were present 30% of the time. Over 70% of drug-induced deaths in 2016 were a result of accidental overdoses.7 The data also clearly show that the majority of drug-induced deaths involved the use of more than one drug. In the instance of drug-induced deaths involving benzodiazepines for example, over 96% of these deaths also involved the use of other drugs such as alcohol.

In Victoria, data from 2017 indicate that 414 Victorians died from overdoses involving prescription medications.8 This number has been higher than the Victorian road toll since 2012, by an average of 27%.8

Two key risks associated with benzodiazepine and opioid use

Dependence

Dependence includes a combination of physiological, behavioural and cognitive factors that can create an overwhelming desire to take a specific drug.9

Dependence includes the following signs and
symptoms:9

  • a sense of compulsion to take a drug
  • experiencing difficulty in controlling the regular use of a drug
  • tolerance to the drug
  • the presence of withdrawal when a person stops taking the drug.

Dependence is complex. It can vary depending on the drug in question and how it affects the person taking it. When someone is having difficulty with the use of prescription medication, there are steps that can be taken to prevent harm. This process should include consultation with a medical professional.

Overdose

If someone takes a large amount of a depressant drug, the messages traveling between the body and the brain will decrease, which means that vital activities such as breathing and heart rate reduction.10 If someone takes a combination of depressant drugs such as benzodiazepines, opioids or alcohol, the risk of overdose is increased. The signs of a depressant drug overdose include:

  • vomiting
  • being unresponsive, but awake
  • limp body
  • pale and/or clammy face
  • bluish fingernails and/or lips
  • shallow or erratic breathing, or not breathing at all
  • slow or erratic pulse (heartbeat)
  • choking sounds or a gurgling noise
  • loss of consciousness
  • death.11

If you or someone you know has any of these symptoms after taking these drugs, call 000 urgently. Emergency services do not have to involve the police and can provide medical advice on how to support you or a person in your care until paramedics arrive.

pharmacutical pills
References
  1. Victorian State Government. (2018). About SafeScript. Retrieved Febuary 28, 2019
  2.  World Health Organisation. (2019). Lexicon of alcohol and other drug terms published by the World Health Organisation. Retrieved Febuary 28, 2019
  3. Australian Institute of Health and Welfare. (2018). Opioid Harm . Retrieved Febuary 28, 2019
  4. NPS MedicineWise. (2015, July 8). Benzodiazepine dependence: reduce the risk. Retrieved Febuary 28, 2019
  5. Brands, B., Sproule, B., & Marshman, J. (1998). Drugs and Drug Abuse (3rd ed.). Toronto: Addiction Research Foundation.
  6. ScriptWise. (2019). Prescription Benzodiazepines. Retrieved Febuary 28, 2019
  7. Australian Bureau of Statistics. (2018, May 16). Drug-Induced Deaths in Australia: A changing story. Retrieved Febuary 28, 2019
  8. Victorian State Government. (2018, Febuary 6). RTPM Regulatory Impact Statement and regulations. Retrieved Febuary 28, 2019
  9. World Health Organisation. (2019). Dependence Syndrome. Retrieved Febuary 28, 2019
  10. Penington Institute. (2018). Overdose Basics. Retrieved Februart 28, 2019
  11. Harm Reduction Coalition. (n.d.). Recognizing Opioid Overdose. Retrieved February 28, 2019
  12.  Jauncey, M. E., & Nielsen, S. (2017, August 1). Community use of naloxone for opioid overdose. Retrieved February 28, 2019
  13. Australian Pain Management Association. (2018). Medication. Retrieved February 28, 2019
  14. Australian Pain Management Association. (2018). Psychological Approaches to Pain Management. Retrieved February 28, 2019
  15. Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., . . . Malione, M. A. (2017, April). Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Analysis of Behavioural Medicine, 51(2), 199-213.