Australian Doctor Australian Doctor 3rd November 2017 | Page 11

News Review
FATAL FLAW
Is restricting
GPs’ ability to
prescribe fentanyl
patches the best
approach to
tackling misuse of
the drug?
JOCELYN WRIGHT
M
MANY Australian Doctor read-
ers were bemused when WA coro-
ner Sarah Linton made calls for
restrictions on the remit of GPs
to prescribe fentanyl patches. She
made dark warnings of an unnec-
essary death toll in the community,
when the fatality she was investi-
gating occurred after an operation
at a hospital more than four years
ago.
As reported in these pages, Mar-
jorie Joy Jarick was prescribed a
75mcg fentanyl patch following
surgery for recurrent groin infec-
tions at Waikiki Private Hospital.
Allergic to morphine, oxyco-
done, Panadeine Forte and trama-
dol, the 54-year-old was a highly

‘THERE WAS THIS ERRONEOUS BELIEF THAT
BECAUSE OPIOIDS ARE GOOD FOR THE
TREATMENT OF CANCER PAIN THEY’RE GOOD
FOR THE TREATMENT OF NON-CANCER PAIN.’
— Professor Stephen Schug
University of WA
complex patient to manage in the
post-surgical period, particularly
as she also had chronic pain but
refused patient-controlled analge-
sia.
The fentanyl patch, prescribed
by her anaesthetist to deal with her
underlying chronic pain in the days
after the surgery, was a substantial
increase in opioid exposure and
the resulting toxicity proved lethal.
But after clearing the anaesthe-
tist of any fault in her care, the WA
coroner decided to turn her atten-
tions to what was going on outside
the hospital gates.
“[Limiting] access to fentanyl
patches in the community to only
those patients for whom it is rec-
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ommended 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,”
Ms Linton said in her conclusions.
“Expert evidence consistently
supported some limitation on the
use of fentanyl patches in the com-
munity other than for palliative
care, with a strong preference for
restriction on the ability of general
practitioners to prescribe fentanyl
patches in WA,” she said.
Given fentanyl patches have
been prescribed by doctors for the
past 15 years, what was the rea-
soning? Was Ms Linton another
coroner accepting the reports of
hospital-based specialists, so often
blinded by the select patients they
see to the reality of patients need-
ing care in the community?
The expert evidence at the
inquest came from Professor David
Joyce, professor of pharmacology
at the University of WA, who told
her that the patches were underes-
timated by many patients. He said
they were seen as merely having a
“naturopathic quality” similar to a
“poultice being applied”.
Their innocuous appearance
— tiny bits of skin-coloured plas-
tic — and misconceptions about
the skin’s capacity as a barrier to
toxins, had also given prescribers
cont’d next page
3 November 2017 | Australian Doctor |
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