Medicines and poisons

Background

Prescription medicines are an important tool to manage the health of Territorians, however there is growing evidence nationally that particular medicines carry a high risk of dependence, misuse and over-use that is leading to increasing numbers of avoidable hospitalisations and death.

In 2018 State and Territory Health Ministers in conjunction with the Commonwealth Department of Health agreed to participate in a federated Real Time Prescription Monitoring solution based on the Victorian SafeScript model. Under this model all the states and territories will integrate with a national data exchange to enable real time prescription monitoring across the jurisdictions.

Prescription monitoring in the NT

The NT Chief Health Officer has undertaken monitoring of Schedule 8 (S8) Controlled Drugs since 1983, with pharmacies providing a weekly report of dispensed S8 prescriptions. The data was only available directly to regulators working for the Chief Health Officer, with a process for providing patient S8 histories to validated medical practitioners on email or telephone request. The NT Coroner recommended in 2017 that the NT Government implement real time prescription monitoring of Schedule 8 drugs.

The aim of a Real Time Prescription Monitoring (RTPM) system is to reduce the risks of dose escalation, dependence and overdose of select medicines by increasing the sharing of information between prescribers, pharmacists and regulators. RTPMs support clinical decision-making and encourage conversations between health professionals and their patients to identify and reduce the risk of medication related harm.

In July 2020, an agreement was signed between NT Health, the Commonwealth Department of Health and software provider FredIT for the NT to link to the Commonwealth’s federated RTPM and to develop an RTPM system for the NT.

The system is known as NTScript.

What information is collected?

Prescription details collected by NTScript include:

• name and address of the patient
• name and address of prescriber
• details of the practice where the prescriber is located
• date prescription is issued by the prescriber
• medicine details (name, brand, strength, quantity, instructions)
• details of pharmacy which dispenses the medicine
• date the medicine is dispensed

Which medicines are monitored?

“Monitored Substances” are those medicines that greatly increase risk to the patient due to likelihood of dose escalation, dependence, overdose, misuse and diversion.

NTScript replaces the monitoring system for Schedule 8 medicines in the NT that has been in operation since 2004.

S8 medicines include strong pain relievers such as morphine (e.g. MS Contin^®, Kapanol^®) and oxycodone (e.g. OxyContin^®, Targin^®), stimulants used to treat ADHD, narcolepsy and autosomal hypersomnolence (e.g. Ritalin^®, Vyvanse^®), and opioid substitution medicines methadone, buprenorphine and buprenorphine/naloxone.

Some Schedule 4 medicines have a recognised risk of overuse, overdose and death and as such have been recommended by experts to be included in RTPM systems. The additional monitored medicines includes:

• All benzodiazepines not in S8 –  e.g. diazepam (Valium^® , Antenex^®)
• “Z-drugs” – zolpidem (e.g. Stilnox^®) and zopiclone (e.g. Imovane^®)
• quetiapine (e.g. Seroquel^®)
• gabapentin (e.g. Neurontin^®)
• Pregabalin (e..g Lyrica^®)
• codeine combination products e.g. Panadeine Forte^®
• tramadol

Supporting safe medicine use

NTScript does not determine if a medicine can or cannot be prescribed or supplied. If someone is receiving monitored medicines at high dose, high risk combinations or receiving monitored medicines from multiple providers they will be at a high risk of harm. Data in NTScript will be used to determine risk, coordinate care and support the safe and effective supply of medicines.

Identifying risks

The information in NTScript will help prescribers and pharmacists work with their patients to identify and manage risks. NTScript will generate Alerts within the software when criteria known to increase risk are present. Clinicians using conformant software will also see pop-up Notifications at the time of prescribing/dispensing to help identify where there is information in NTScript that should be considered.

Can someone opt out?

NTScript continues the mandatory monitoring in place since 1983 in the NT. It is not possible to opt out as the use and supply of these “monitored of substances” is a major public health and safety concern, to individual patients and to the general community.

How is privacy protected?

All data in NTScript is encrypted and stored in accordance with Commonwealth Department of Defence IT Standards. Access to NTScript is limited to prescribers, pharmacists and regulators. Users log in with multifactorial authentication which greatly reduces the risk of unauthorised access. All access to NTScript by any user is logged and privacy is protected under the NT Information Act 2002 and Commonwealth Privacy Act 1988.

How is patient consent managed?

The final decision to have a medicine prescribed or supplied is up to the patient in conjunction with their treating health professional.  Health professionals should inform their patient when a medicine will be included in NTScript so that patients can choose not to receive the monitored medicine and alternative treatment or referral should then be provided instead.

Who can access the information?

• By law NT Script data can be accessed by certain classes of health practitioner registered with a national board.  The health practitioners are prescribers (doctors, dentists, nurse practitioners, endorsed midwives and podiatrists) and pharmacists. These health practitioners first need to register for NTScript.
• An authorised user is allowed to access NTScript only to aid clinical decision making for providing direct care to a particular person.
• NT Department of Health staff who are responsible for the regulation of medicines on behalf of the Chief Health Officer will also have access as part of their duties.
• Patients can view information held against their details when they are discussing treatment options with their treating health practitioner, provided the health practitioner is registered for NTScript.
• Patients can also submit a Freedom of Information (FOI) request to the NT Department of Health.

Registration access and training

Eligible prescribers and pharmacists can register and access NTScript from the NTScript portal.

Contact details

Medicines and Poisons
NT Department of Health
Email: NTScript@nt.gov.au
Phone: (08) 8922 7341