Australian Doctor Australian Doctor 29th September 2017 | Page 3

‘Stop GP fentanyl patch scripts’
RACHEL WORSLEY
PAIN experts are calling for tighter
restrictions on GP prescribing of
transdermal fentanyl, claiming the
dangers of the innocuous-looking
patches are poorly understood.
The controversial comments were
aired during an inquest into the
2013 death of WA woman Marjorie
Joy Jarick.
The 54-year-old, who was aller-
gic to morphine, oxycodone, Pana-
deine Forte and tramadol, died less
than two days after an anaesthetist
prescribed a 75µg-per-hour fenta-
nyl patch following an operation to
manage recurrent groin infections
and cellulitis.
The WA Coroner found no fault
with the anaesthetist’s care. But she
was told 550 fentanyl-related deaths
had been reported nationwide since
2010, the majority of which were
linked to transdermal patches.
Professor David Joyce, professor
of pharmacology at the University of
WA, told the inquest that the dan-
gers of the patches were underesti-
mated, with many patients believing
they had a “naturopathic quality”
similar to a “poultice being applied”.
Their innocuous appearance
and misconceptions about the
skin’s capacity as a barrier to
PEOPLE who misuse OTC codeine-
combination analgesics are ending up
in hospital, with some taking around
two dozen tablets daily, a review
shows.
An SA study of 99 hospital
admissions for OTC codeine misuse
found that the patients were taking
an average of 28 tablets a day for 20
Staff writers
Not enough new antibiotics in
the pipeline, warns WHO
‘Patches just have
too good a reputation,
and it hasn’t been
sullied enough by fact
yet.’
— Professor David Joyce
Professor of pharmacology,
University of WA
ONLY eight antibiotics and
biological medicines currently in
development are innovative enough
to add value to the world’s arsenal
of antibiotics, the WHO says. The
organisation’s latest analysis of
the antibacterial research pipeline,
released last week, identified 51
new drugs in development to
treat priority antibiotic-resistant
pathogens. But the WHO
classified just a handful of those
as “innovative treatments”, with
the potential to stand up to deadly
diseases such as drug-resistant TB.
Marriage equality could lower
youth suicide rate
toxins had also given prescribers
false reassurance about safety.
“Patches just have too good a
reputation, and it hasn’t been sullied
enough by fact yet,” he said.
Ms Jarick’s pain management
specialist, consultant neurosur-
geon Dr David Holthouse, told
the inquest that GPs shouldn’t be
able to write fentanyl patch scripts
in opioid-naïve patients because
of concerns about variable absorp-
tion and dose accumulation.
The suggestion was accepted by
the Coroner, who officially recom-
mended that authorisation be lim-
ited to approved specialists.
“[Limiting] access to fentanyl
patches in the community to only
those patient s for whom it is recom-
mended by an anaesthetist or pain
specialist would be likely to have the
additional benefit of reducing the
potential for misuse of the patches in
the community,” she said.
“The expert evidence consist-
ently supported some limitation on
the use of fentanyl patches in the
community other than for pallia-
tive care, with a strong preference
for restriction on the ability of
GPs to prescribe fentanyl patches
in WA.”
Patients taking 28 codeine pills a day: review
MICHAEL WOODHEAD
In Brief
months, with an average daily intake
of 327mg codeine, in conjunction
with either 5.6g of ibuprofen or 10g of
paracetamol daily.
The most common reasons for
admission were gastric ulcers,
anaemia and renal tubular acidosis
related to the NSAID ingredients, and
liver toxicity related to the paracetamol
ingredients.
More than 80% of patients misusing
codeine products were female and
most had started taking the OTC
analgesics for back pain or headaches.
Many of the patients failed to
disclose their codeine use, and only
25% had codeine dependence
identified on admission.
The review was undertaken in
the wake of 270mm
the TGA’s decision to
reschedule OTC codeine products
to prescription only from 1 February
next year. The findings highlighted the
dependence problems with low-dose
codeine products that did not offer any
analgesic benefits over paracetamol
and ibuprofen products without
codeine, the researchers said.
Drug and Alcohol Review 2017;
online.
ABOUT 3000 suicide deaths a
year could be avoided if Australia
legalises gay marriage, according
to a coalition of youth mental health
organisations. The figure is based
on a 2017 US study published in
JAMA Paediatrics, which showed a
7% relative reduction in high school
suicide attempts in the 12 months
after individual states introduced
marriage equality.
Hello, possum: Possible
source of flesh-eating ulcer
POSSUMS may be housing the
bacterium responsible for the Buruli
ulcer spreading across Victoria’s
Mornington Peninsula. Public health
experts are collecting possum
faeces from a number of locations
to analyse them for the presence
of the bacterium. A spokesman
for the Department of Health and
Human Services said the field
work followed earlier efforts to
investigate links between possums
and mosquitoes in the transmission
of the disease to humans.
to Zygomycosis.
DDBRemedy_082017_ADG
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29 September 2017 | Australian Doctor |
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