Letters from the Chief Medical Officer (CMO)
Additional information & resources on prescribing drugs of dependence
Data used in the letters from the Chief Medical Officer (CMO)
Practitioner Review Program (PRP) and the Professional Services Review (PSR)
BackgroundOpioid misuse and dependence is rising in Australia. Seventy percent of all fatal opioid overdoses in Australia involve prescription opioids and pharmaceutical opioid deaths now exceed heroin deaths by a significant margin.
Our understanding of how best to treat chronic pain has changed in recent years. There is little evidence for the efficacy of long-term opioid use in persistent non-malignant pain and in trials (up to three months) many patients experienced adverse drug effects. However, opioid analgesics may be appropriate for a limited number of patients experiencing persistent non-malignant pain when other treatments have been inadequate.
General Practitioners (GPs) and Other Medical Practitioners (OMPs) are important partners in our efforts to minimise unnecessary harm or death from the inappropriate use of opioids by helping to limit prescribing to only those clinical situations where evidence shows opioids to be of proven value.
Letters from the Chief Medical Officer (CMO)In June 2018, the Chief Medical Officer (CMO) wrote to GPs and OMPs whose prescribing rates of opioids was in the top 20%. Those doctors working in urban areas were compared to other urban doctors, and those working in regional and rural areas were compared to other doctors in regional and rural locations. The letter used percentiles to show doctors how their prescribing rate compared to their peers in either urban or regional and rural areas.
The intent of the letter is to have GPs reflect on their prescribing behaviour and to see if there are any opportunities in their practice to reduce prescribing where clinically indicated.
It is important to note that the letters themselves do not indicate that a GP is engaging in inappropriate prescribing. They simply show how their prescribing rate is higher than their peers. A GP’s prescribing may be appropriate for their patient group. However, there may also be opportunities to reduce prescribing where clinically indicated.
Links to external web resources on prescribing drugs of dependence.
Information on the data included in the letter, including the calculation of oral-morphine equivalent dosage (OMED), is available.
Practitioner Review Program (PRP) and the Professional Services Review (PSR)Over the next 12 months, the Department will be monitoring opioid prescribing by GPs using Pharmaceutical Benefits Scheme (PBS) data. In limited cases, where there are concerns of possible inappropriate practice, the Department of Health will consider referring practitioners to the Practitioner Review Program (PRP).
The process for the Practitioner Review Program (PRP) is to individually review your Medicare servicing data, which is made up of Medicare claims and Pharmaceutical Benefits Scheme (PBS) prescribing data, to determine if your data differs from your peers. If it does, we review whether the difference may be due to inappropriate practice.
If concerns with possible inappropriate practice cannot be resolved through the PRP, the Department may request the Director of Professional Services Review to review your servicing. You can learn more about PSR on their website.