Real-time prescription monitoring (RTPM), such as Victoria’s SafeScript program, may curb inappropriate use of prescription drugs, but needs to be backed up by mental health and drug treatment services to offset the risk of increased mortality, say Burnet Institute researchers.

Questions about the use of RTPM were introduced into Burnet’s SuperMIX study – a prospective cohort study of about 1300 people who inject drugs – with the aim of exploring the effects of the introduction of SafeScript.

The survey showed that one in five of those who used a medicine monitored by SafeScript reported being refused a prescription by a GP, and most of these people had moderate to severe anxiety and depression disorders.

The researchers, led by Dr Dagnachew Fetene and Professor Paul Dietze, say there may be unmet treatment needs in patients denied prescriptions and it’s important to understand what happens when people are refused prescriptions - what care they receive and whether this care is appropriate for their needs.

“We found that 20 percent of participants who used a medicine monitored by SafeScript reported being refused a prescription by a GP,” wrote the authors in a letter published online by the Medical Journal of Australia.

“One-third of those who have been refused were requesting the prescriptions for the treatment of anxiety and 45 percent were refused two or more times by doctors.”

The study also showed that:

• One-third of participants (15/47) who had been refused a prescription were told this was due to a risky combination of medicines or having multiple providers
• Six out of 241 participants were refused dispensing of a prescribed medicine by a pharmacist, and
• One third of participants (14/45) who had been refused a prescription reported an intention to not seek medication from their doctors in the future.

“Most had moderate to severe anxiety (33/41) and depression (36/41) disorders measured through a self-administered Patient Health Questionnaire,” the authors wrote.

“In the case of refused prescriptions requested for the treatment of anxiety, ten out of 13 patients had moderate to severe anxiety disorder and 11/13 patients had severe depression disorder, suggesting unmet treatment needs in patients denied prescriptions.”

Dr Fetene and colleagues concluded that what happens after a prescription was refused was important.

“It is important to understand what happens when people are refused prescriptions — what care they receive and whether this care is appropriate for their needs,” they wrote.

“Increased mortality following restrictions to prescribed medicines is reported elsewhere. Rigorous research should evaluate the impact of RTPM use in Australia to understand if similar outcomes are observed.”