Michelle Lensink

Controlled Substances Act

I seek leave to make a brief explanation before asking the Minister for Mental Health and Substance Abuse a question about the Controlled Substances Act.

The Hon. J.M.A. LENSINK: The government, I understand, has made a decision to shift the Drugs of Dependence Unit from the Department of Health into DASSA and, in so doing, has made decisions in relation to withdrawing authorisations for certain medical practitioners to prescribe or supply drugs of dependence. In relation to a particular practitioner, the opposition has been inundated with letters of support from patients to which I would like to refer.

One letter states: Dr (X) is the best doctor in the world and h e' s helped me with pain in my leg more than any other doctor, and my life has improved since I've seen Dr (X). Now I have a house, job, car, family and no more pain in my leg, thanks to Dr (X).

Another one states: At the date of this writing I still have not found any suitable doctor willing— with that word underlined— to treat me. Most are very scared of trouble with the Health Dept . for trying to do the right thing. A further one states : I have been a chronic pain sufferer for a back injury for almost a decade that was caused by an injury while working ... Dr (X) has helped me regain quality of life, to some degree, and I feel indebted to him to offer any help that I can to his cause. My GP referred me to him for the exact reasons he is fighting. Namely, fear of doing something wrong and have a ton of bricks fall on him for overprescribing, while I was essentially poisoning myself with paracetamol - based over the counter supplements to my prescriptions. I assume that that is referring to this particular individual self-prescribing to manage his own pain. There are a number of other testimonials that I will not read out because they are much too lengthy. This doctor's authorisation was withdrawn on 18 December last year.

My questions are:

1. What is the rationale for the withdrawal of authorisation and the rationale for the shift from the Department of Health into DASSA?

2. Has the minister met with any of the patients of this particular individual, who was also referred to in an article in The Independent Weekly?

3. Will the minister outline for the council what pain management exists within DASSA and how many doctors are authorised to prescribe or supply drugs of dependence, as an alternative for these 40 or more patients?

The Hon. G.E. GAGO (Minister for Environment and Conservation, Minister for Mental Health and Substance Abuse, Minister Assisting the Minister for Health) (14:39): I thank the honourable member for her important question. Indeed, the specific case that the member refers to has been before the courts and, for that matter, may still be before the courts, so it is something that I am not able to comment on, in terms of any specifics, in relation to that case. However, I can talk in a general sense about DASSA's policies around authorities that are given to enable physicians to prescribe drugs, particularly those of dependence.

There is a system available which requires a particular authority and which in turn requires a particular level of scrutiny and monitoring of drugs of addiction that are prescribed over a long period of time. Only certain doctors are given that right. If a basic GP has a client who requires those sorts of medications for a longer period of time, they need to go through this authorised system. It is a way of not only protecting the community but also offering a higher level of public and professional scrutiny in relation to drugs of dependence. The authorities to prescribe are withdrawn if there is a belief or perception that the conditions around those authorities have not or are not being met.

There is a process that is then put in place to investigate that and, as always, it involves due process. In the case of a doctor who has had prescribing authority rights in the past but who has a changed condition, their clients are all attended to and alternative arrangements are made for the ongoing management of the problem or condition, and drug or medication management is also referred to another suitably qualified person. So, clients are not just left in the lurch to make do: they are, in fact, cared for quite well. As to the other part of the question, chronic pain management is a very complex issue. Chronic non-malignant pain is one that continues for more than two to three months. It is quite a common condition and occurs in about 20 per cent of our population at some time in their life. Pain is complex and has different components. Patients may need to be assessed by a multidisciplinary panel in a pain management unit, and a range of treatments may be used for the treatment of chronic non-malignant pain.

These include non-drug treatments, such as physiotherapy, weight control, surgery or transcutaneous electrical nerve stimulation machines. There are drug treatments, such as anti-inflammatory drugs; membrane stabilisers; antidepressants; non-opioid analgesics, such as paracetamol; and opioid analgesics, such as morphine. In terms of the use of opioid drugs, in some cases these are essential drugs for the treatment of severe pain. However, they are also subject to inappropriate medical use, which can lead to abuse, misuse and, in some cases, diversion back onto the black market. Treatment of chronic pain can be as complex as chronic non-malignant pain. It may evolve into a chronic pain syndrome, and I am sure that each and every one of us here knows of examples where it has destroyed a person's quality of life.

There are also complex chronic non-malignant pain patients who make very heavy demands on their prescriber's often limited time. They may be uncooperative and aggressive as their pain is not controlled or poorly managed. Chronic non-malignant pain patients may resent the controls on drugs and the dosages that they feel are warranted. So, sometimes there is a difference of opinion in terms of what dosages the patient might believe they need and what their trained and educated professional might believe, and sometimes tensions occur there. So, there is a range of different treatments, as I have outlined. It is a very—

An honourable member interjecting:

The Hon. G.E. GAGO: Well, I was asked the question about pain management regimes that are in place, and I have answered that part of the question. Drugs of dependence are more often or regularly used for the treatment of chronic long-term pain, so that is why I have outlined the sorts of courses of action that we currently provide for those often complex clients who suffer great difficulty.

Members interjecting:

The PRESIDENT: Order!

The Hon. J.M.A. LENSINK (14:46): Arising out of the answer and the minister's reference to alternative suitably qualified persons, can she advise the council of how many medical practitioners are, in fact, authorised under section 55 to prescribe or supply drugs of dependence?

The Hon. G.E. GAGO (Minister for Environment and Conservation, Minister for Mental Health and Substance Abuse, Minister Assisting the Minister for Health) (14:47): I will need to take that question on notice and bring back a response. I do not have the actual number with me at present.

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