Providing Support in the Battle against Opioid Painkiller Dependence, Prescription Drug Overdose [Interview][Transcript]

henry_acosta_international_overdose_awareness_dayGuest: Dr. Richard Kidd
Presenter: Henry Acosta
Guest Bio: Dr Richard Kidd is a GP owner/principal of Nundah Doctors Surgery. Chair of the AMA Council of General Practice, Board member and councillor of Federal AMA and AMA Queensland, and a past President of AMA Queensland, Richard chairs the AMA Queensland Real Time Monitoring Committee and sits on Department of Health and DVA committees including the My Aged Care Gateway Advisory Group, Practice Incentive Payments Advisory Group, the Health Care Homes Payment Mechanism Working Group, and the Health Sector Group in the Attorney General’s Department. A Board member of Scriptwise and of Peach Tree Perinatal Wellness, he is Co-Founder of Doctors for Refugees.
Richard is the Brisbane North PHN Clinical Lead, a member of the Queensland Clinical Senate, GP Alliance, Brisbane North Health Alliance, and Metro North Health and Hospital Services Committees.

Segment overview: In today’s Health Supplier Segment, we welcome Dr Richard Kidd here to discuss the importance of adopting of a compulsory national real-time prescription monitoring system to save lives in time for observing International Overdose Awareness Day. Those who are battling opioid painkiller dependence, and their families, are encouraged to access support via a recently launched website called turntohelp.com.au

Transcription
Health Professional Radio – Battle against Opioid Painkiller Dependence

Henry Acosta: Hello it’s your host for today, Henry Acosta. Thank you for tuning with us and welcome to Health Professional Radio. Today we have Dr. Richard Kidd, he’s a Clinician who regularly treat people with addiction on opioids and prescribed pain killers. We’re here to talk about the International Overdose Awareness day and what he’s trying to achieve with the organization he’s advocating such as Scriptwise and Turn to Help. So hi Richard good morning and how are you?

Dr. Richard Kidd: Hi, I’m not too bad and yourself?

H: I’m good, thank you. How did you get into your practice and long have you been doing it?

K: I’ve been a General Practitioner for over 30 years and I’ve had a long standing interest in mental health, chronic disease management which falls for some chronic pain and as any GP also often deal with situations in which people have acute pain from injuries.

H: I see and how did you start getting involved with organizations such as Scriptwise and Turn to Help?

K: Over the last several years I’ve become intrigued and involved in national government committees for a range of things, a national prescription service for aged care facilities trying to get a standardized medication chart that can be used across all of the facilities and that’s something a bit like what’s used in hospitals, done a lot other work on things like the problems that patients have faced, palliative care in particular of being in palliative care Australia’s National Committee particularly around the palliative approach and aged care facilities. Through the Australian Medical Association I’ve been involved in various committees that work towards developing policy and position starting from to support doctors and others in various aspects of health delivery including prescribing of opioids and benzodiazepines and other medications that carry risks.

H: I see and but what I have so far is Scriptwise is looking to get the National Real-time Prescription Monitoring System mandated all around Australia. What is the Real-time Prescription Monitoring System and why is it needed to be implemented nationwide?

K: Real-Time Monitoring System is one way where it might easier to give you an example, imagine a person who is going to more than one doctor and maybe more than health service like emergency departments or whatever and getting prescriptions for a strong opioid or maybe benzodiazepine and now with Real-time Monitoring if that person has gone to a pharmacist five-ten minutes before his appointment with one of those prescribers with Real-time Monitoring they prescribe or we’ll be able to see ‘Oh, this person’s just gone into a lot of prescription pills and these things’ and might well have been be able to start of a conversation and say ‘Look I can see you’ve just had a prescription filled, can we talk about this?’ And it provides an opportunity to perhaps help the person in the stages of maybe becoming addicted, medications like opioids and benzodiazepines often create dependency in people. That dependency isn’t the same thing as addiction, addiction is where the person’s behavior changes and they start trying to get more of the medication than what’s really safe for them and they might try going to more than one doctor or prescriber to get it and that’s where Real-Time Monitoring can intervene. It can help by intervening early in a constructive helpful supportive way and help people not go down on that path where many sadly die.

H: That sounds great and I hope that it gets implemented soon. So can we talk about the International Overdose Awareness day and how can we get more info on it?

K: The International Overdose Awareness day is a really important focus each year and if you think of the sorts of things I just said, to put some names to the sorts of accidental overdoses that have happened where people have not realized that they are taking too much or perhaps taking something up that they shouldn’t take with this like alcohol, there been tragic outcomes and we can think very recently of Prince, Michael Jackson, Heath Ledger, a number of very high-profile, very creative people who were contributing so much to our society and were sadly taken from us through an accidental overdose and the International Overdose Awareness Day really helps focuses on how this is happen, what can we do to prevent such tragic loss.

H: I see. And what are the steps that we can do to help raise awareness for International Overdose Awareness Day and Substance abuse?

K: I think if we can help people understand that there are all sorts of medications that can lead to some dependency and then bigger problems, that will be the most important thing. I think the average Australian doesn’t realize that when they go and buy things from the supermarkets or over the counter at the pharmacy, they’ve got codeine in them, they could end up becoming dependent. And we see problems even from people just buying those sorts of medicines over the counter and they end up needing to take more and more and more to get the effect that they want from the codeine not that they understand that that’s what’s happening and then they get poisoned by the other things that are in those medicines whether it’s paracetamol or whether it’s an anti-inflammatory and they can sometimes kills them as well. So we need to really help people understand that medicine, these are the ones you buy over the counter have risks and people really need to understand what it is they taking and they should really talk about medicines with their doctors, understand what it is, how it supposed to be used, what they can expect in terms of benefit and very much they need to understand what the risks are and how to manage the medicine safely and what things they can and can’t take with it. Often they should not take alcohol with it.

H: I see and so are there certain degrees of addiction an everyday person like me will not be aware of and if ever is there a way to identify them?

K: Well yes, I think the best way to identify them is I would love to see those things that contain codeine actually taken off of the over the counter exits and maybe from the over the counter in the pharmacy exits because I think all too often people have no idea and we need to have an opportunity to inform people about what these medicines really do and what some of the harms might be and so that means really putting it back into a doctor-patient interaction because the doctor is the best person to say ‘Look, I’m prescribing this for you because I wanted to do this and this for you that you do need to be careful because it could also do these other things and it can sometimes create problems around dependency and even addiction so we need to work on this together and stay in touch’ and it’s that collaborative approach that will keep a lot of people safe.

H: Alright, what do you think is the best way to treat addiction to those already addicted or dependent on prescribed substances?

K: The first thing is on helping people understand that they actually do have an addiction and that it’s something that they can be helped with in a non-judgmental, supported constructive way. The example I gave before of people just buying one of these compounds over the counter that’s got codeine and some other medicine in it, a lot of people wouldn’t realize that they’ve actually become addicted, that they’re buying a large of amount of it week by week and they need to actually become to understand that there is an issue there, that something they’re doing that could have a very bad effect on their health. So that level of addiction which is not the sort that gets people into trouble with the police but then you’ve got at the other end of the scale people who’ve become severely addicted to quite often opioids and sometimes benzodiazepines and their behavior can change to the point where they are breaking the law to in order to get hold of these sorts of drugs illegally or they are breaking the law by going to multiple prescribers and getting medicines so there’s no very, very tight regulations around them and by not being honest with the prescribers they are doing themselves a disservice and also possibly the prescribers if the prescribers are not taking proper care they’re risk losing their medical license or their pharmaceutical license it’s an area that we all have to be very careful and but there’s a range of ways of how been people who’ve got addiction. As I said the low end of the scale and quite often just realizing that they have become dependent on something, a lot of people are able to just stop so not everyone needs to go and see an addiction specialist for help but there are people who’ve got very severe difficulty trying to stop behaviors that are going to get them into trouble and they really benefit from seeing an addiction specialist, particularly one that is involved in a team that have got like psychologist, social worker, other people that can help the addicted person in a variety of ways because sometimes the addiction isn’t just about the medicine, the addiction can be because of a variety of other things going on in that person’s life that they could be helped with.

H: I see and so what would you like our clinical audience to know as a result of this interview?

K: I think it’s very important that clinicians as well as the public have a much greater awareness of the extent of the problem when we talk about people dying from overdose in Australia and four Australians do die each day from drug overdose, more than 4 out of 5 of those deaths involve prescription medicines so clinicians need to be always mindful when they’re prescribing any opioids including the low strength codeine compound and benzodiazepines and we need to approach our patients in a caring, non-judgmental support of way to help inform them and support them if they are starting to have difficulties and hopefully by having that kind of open approach we may prevent a lot of dependency and addiction.

H: Alright and what’s the biggest misconception on what you guys do and what are your responses to these misconceptions?

K: I think the biggest misconception is that the Real-time Monitoring program would in some way become punitive particularly for the clinicians who are prescribing, that’s not the intent at all. If we have a good Real-time Monitoring program it’s an early warning system that aids the clinicians to provide the best possible care. It’s not about punishing clinicians, it’s about giving them information in a very timely way so that they can better assist patients who might be not fully disclosing the extent to which they’re going to other doctors and prescribers, it may well have saved the life of someone like … the GP was prescribing appropriately but has no idea that she was obtaining opioids from many other prescribers, more than 30. Real-time Monitoring would have given that GP and the other prescribers early warning and she might have been given some help that might put her down in different path and she might not have died. The other thing that clinicians should know about is the website, turntohelp.com.au it’s a very useful website for clinicians and particularly for patients.

H: I see and can you give us details on how our listeners can get in contact with you?

K: With me? Certainly, I’m one of the newer Board members of Scriptwise, I’m a General Practitioner in Queensland. My surgery is the Nundah Doctors Surgery, people can either contact me through the surgery which is 07 3266 8488 or email me on [email protected]

H: And for our last question is can you give us details on how to sign-up for the organizations such as Scriptwise and Turn to Help?

K: Scriptwise has got a website it’s very easy to find and it will be great if people join up and support Scriptwise. There’s a lot of work to be done to actually achieve Real-time Monitoring that is interruptible across all of the states and territories. The federal government passed an Act in 2010 but the state says it still got to make them legislative changes and we need some investment to make this happen and the sooner we can make it happen, the better for our patients and for us.

H: You’ve been listening to HPR and our guest is Dr. Richard Kidd. He is a member of the organization such as Scriptwise and Turn to Help, he’s also a clinician who treats people who are dealing with problems in substance abuse. It’s been great having you here Richard.

K: Thank you very much.

H: And to everyone out there listening, thanks for sticking with us. We have a transcript and audio available on hpr.fm and you can listen to our podcast on iTunes.