THE LOCAL medical fraternity say they have always taken a firm stand on the use of the painkiller Fentanyl and other opioids and at a combined meeting on Friday 15 June they confirmed the steps they would take to continue to reduce the opportunities for ‘drug diversion’ and misuse in the local community.
Doctors from the Coonamble and Baradine Aboriginal Medical Services (AMS) and the Castlereagh Health Service joined with local pharmacist Ebram Youssef and Coonamble Aboriginal Health Service senior staff at a working lunch to discuss the issue and reaffirmed that fentanyl “just won’t be prescribed in this community.”
The doctors pointed out that, contrary to the recent media reports, it is unlikely that patients whose medication was being sold, stolen or otherwise diverted had been obtained from local medical practitioners.
According to the doctors present there are only two or three patients currently being prescribed Fentanyl and they are based at either Koonambil or the Hospital’s Residential Care Unit where disposal of patches is tightly controlled, including used patches being locked in a safe.
“I don’t think we have a Fentanyl problem,” Dr Angela Yates said. “Or if we do they are getting it somewhere else.”
Patients of Coonamble doctors who had been on Fentanyl and other painkillers with a risk of ‘diversion’ to addicts seeking the opioid’s ‘high’, have been gradually transferred to alternative medications over the past few years.
“We are partly controlled by what orthopaedic surgeons are doing,” one of the doctors said.
Apparently Fentanyl had been widely prescribed by surgeons for people recovering from joint replacement operations but Coonamble’s doctors had taken a stance “years ago” to not prescribe the drug.
Coonamble may well be in a unique position to address an issue like Fentanyl diversion with the Coonamble Aboriginal Health Service owning and operating both medical practices in the town.
“CAHS now owns both the Aboriginal Medical Service and Castlereagh Health Service,” said CAHS CEO Tim Horan “But the Board has been very clear that they need to operate as separate businesses.”
Despite differing operational procedures it is clear that there is a high degree of agreement between the medical professionals working in both services and in Baradine.
Friday’s meeting discussed issues around their agreement to avoid prescribing Fentanyl including the policy of not interfering with a GP’s professional judgement to prescribe what they felt was best for their patients and extraordinary circumstances where Fentanyl may need to be prescribed.
They agreed that it would be “hard to envisage when it might happen” apart from some palliative care situations, in which case the management and disposal of the medicated patches would be easy to control.
It was agreed that if patches did need to be prescribed then it would be made clear to patients that only one patch at a time would be issued and no further patches released by the pharmacist until the used patch was returned.
Having short-term locum doctors was also identified as a potential area where the local plan to control Fentanyl and similar opioid use could come unstuck.
However Margie Boland who is Practice Manager for all three CAHS-owned medical practices in Coonamble and Baradine, said that the agreed policy to not prescribe these drugs would be part of Locums’ induction and that medical receptionists would also be trained in the policy to reduce the opportunity for patients to influence new Locums to issue Fentanyl.
“This is not just a problem for Coonamble,” said one of the newer GPs. “It was a problem on the South Coast where I worked previously and when I posted on a GP social media site about the issue I had 300 responses.”
With all locally-based doctors, medical practice staff and the town’s only pharmacy in agreement and aware of the arrangement, it is likely that Coonamble is leading the way in the management of this issue.
This is a far cry indeed from the picture painted by the SBS program ‘The Feed’.
