Did you know that here have been some big changes with the pack sizes of immediate release opioids/narcotics under the PBS as of June 1?

Me neither!

What does this mean in English? It means that doctors will be unable to prescribe large packs of addictive medication without ringing the government and asking for permission (with good reason!).

Why?

Some good information can be found here

But to summarise:

The drugs work in the short term – but they don’t keep working
We have better and safer options
These drugs kill people

These changes haven’t been well publicised…but here they are:

And:

Patients who require long-term treatment of chronic pain with opioids will still be able to access larger pack sizes and prescribers will be able to prescribe repeats where they meet the new restrictions requirements.

For chronic pain, increased quantities and/or repeats may be authorised by Services Australia where the patient meets the restriction requirements. Increased quantities to extend treatment up to one month may be requested via telephone/electronic authority request, and up to 3 months’ supply (up to 1-month quantity and up to 2 repeats) may be requested via an electronic/written authority request.

To be eligible for treatment with high strength opioids such as morphine, patients will need to be unresponsive or intolerant, or have achieved inadequate relief of their acute pain, following maximum tolerated doses of other lower strength opioid treatments.

These new arrangements apply to all PBS listings for opioid medications and therefore there will also be amendments to the tramadol and paracetamol/codeine restriction requirements.

All new and amended restrictions will be updated on the PBS website (pbs.gov.au) from
1 June 2020.

What does this change mean for prescribers?

The new opioid listings for reduced pack sizes will provide a simplified way for prescribers to prescribe smaller quantities of immediate release opioids for acute, short-term treatment.

Prescribers must ensure that patients meet the relevant restriction criteria when prescribing opioids under Restricted Benefit and Authority Required (STREAMLINED) PBS listings. The ‘streamlined authority code’ is located on the relevant PBS listing on the PBS website. To prescribe an Authority Required (Telephone/Electronic) item, the prescriber is required to request authority approval from Services Australia through the Online PBS Authorities System or by calling 1800 888 333.

To ensure appropriate use of opioid medicines for the management of pain, patients must be referred to a pain specialist or alternative prescriber for clinical review if opioid use exceeds or is expected to exceed 12 months. The date of the review and name of the medical practitioner consulted must be provided for every authority application.

Moving Forward

So from June 1:

If these addictive narcotic medications are required, your GP may prescribe smaller packs for your use
Please please please speak to your GP about any issues you are having – we have lots of options including counselling, physical therapy, diversional therapy, physiotherapy, non-drug therapy, other medications, and referrals to non-GP specialists for complex problems
We still care, we still want to help, we want to be safer and better for you
If you are on medications for 12 months or more, you will need to have a formal consult with another GP or specialist in addition to your usual GP to keep getting medication on a PBS (subsidised) prescription.