​Half of all unintentional polysubstance deaths in Australia have involved pharmaceutical opioids during the five years to 2019.

Preliminary data has shown that in NSW there were 555 unintentional drug induced deaths in 2019.

Source: Penington Institute, 2021.

Responding to pop-up notifications and alerts in SafeScript NSW

In general

• Check SafeScript NSW each time a monitored medicine is prescribed or dispensed. Include SafeScript NSW in opioid treatment agreements.
• Review your patient's history and consider the indications for use of each medicine.
• Explore the potential to reduce the dose of monitored medicines with your patient if you determine the risks are greater than the benefits.
• Consider staged supply or supervised dosing of monitored medicines.
• If you decide to prescribe, comply with regulatory requirements.
• Discuss the treatment plan with your patient and dispensing pharmacist.
• Discuss the risk of opioid overdose with your patient e.g. respiratory depression and death.
• Consider prescribing or providing take-home-naloxone to all patients using opioids.

Exceeding opioid dose threshold

Where the average daily dose exceeds 100mg oral morphine equivalents over a 90-day period, excluding medicines used for the NSW Opioid Treatment Program (OTP):

• Discuss decreasing opioid doses with your patient. If considering weaning visit ACI Pain Network.
• To better understand the oMEDD (Oral Morphine Equivalent Daily Dose) for your patient, visit opioid calculator.

High-risk medicine combinations

For concurrent prescribing of potentially harmful substances — for example certain long-acting opioids (fentanyl and methadone) and benzodiazepines:

• Consider the risks and benefits of each medicine and avoid concurrent prescribing of monitored medicines where possible.
• Discuss the potential harms associated with drug interactions with your patient.
• For more information visit SafeScript NSW pop-up notifications and alerts and open the 'Alerts about high risk clinical situations' drop-down box.

Multiple providers

Where a patient has received prescriptions for monitored medicines from four or more prescribers (from different practices) within the last 90 days:

• Consider the clinical context and whether having multiple prescribers involved in the patient's care is appropriate (e.g. collaborative care arrangements).
• Contact each prescriber and inform them of the situation.
• Negotiate an agreement with your patient for a single prescriber and pharmacy for all monitored medicines to be prescribed and dispensed.
• Enquire whether, considering this information, the prescribers identified in SafeScript NSW deem it safe and appropriate for you to prescribe further or continue to have the prescription dispensed at the current dose and quantity.

Responding to a patient history of concern

Prescribers and pharmacists may still prescribe and dispense monitored medicines when there is a notification or alert if they believe it is clinically safe and appropriate to do so.

If you decide that a medicine at the current dose is no longer the safest treatment, good clinical practice involves ensuring appropriate continuity of care is provided for the patient. Abruptly stopping high-risk medicines after long periods of use is contrary to patient safety.

Consider referral or seek advice from specialist colleagues.

Consult HealthPathways for services in your area. Some statewide directories are available to assist:

• Chronic Pain Services Directory — Agency for Clinical Innovation (nsw.gov.au)
• Contact Information, support and treatment services — Alcohol and other drugs (nsw.gov.au)

Confirm that the information in SafeScript NSW is correct.

Check for potential data entry errors, use of a maiden name or of a pseudonym including nickname, or possible identity theft to obtain prescriptions.

Assess for a possible substance use disorder.

Comply with regulatory requirements for prescribers and pharmacists.

Offer or arrange referral for evidence-based treatment (through the NSW OTP with buprenorphine or methadone in combination with behavioural therapies) for patients who meet criteria for opioid use disorder. For referral and advice visit Contact information, support and treatment services — Alcohol and other drugs (nsw.gov.au)

In NSW, general practitioners who are not accredited in OTP can manage a limited number of patients on the opioid treatment program with support from an accredited prescriber. For information, visit NSW Opioid Treatment Program (OTP) — Medical practitioners.

Discuss any areas of concern with your patient, by emphasising your interest in their safety.