Prof Danchin is a consultant paediatrician at the Royal Children’s Hospital and Clinician Scientist, University of Melbourne.Mary O’Malley, Chloe Hava, Ruth Cooper and Jennifer Cooke
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[post_content] => An expert weighs in on the legitimacy of adult attention-deficit/hyperactivity disorder (ADHD) diagnoses and where pharmacists fit into the equation.
Diagnosis of ADHD in adults has skyrocketed in recent years. According to a recent briefing conducted by the federal Department of Health and Aged Care, published under freedom of information laws, ADHD diagnoses and prescriptions for ADHD medicines have more than doubled over a 5-year period.
In 2022, 3.2 million prescriptions for ADHD medication were issued to 414,000 patients – a sizable jump from the 1.4 million prescriptions issued to 186,000 Australians in 2018.
Could new diagnostic criteria and guidelines, including the Australian Evidence-Based Clinical Practice Guideline For Attention Deficit Hyperactivity Disorder (ADHD), be helping undiagnosed adults finally receive the care they need?
Or is the condition being overdiagnosed and overmedicated – as some Australian psychiatrists fear – spurred on by social media trends and the COVID-19 pandemic?
And why are women so commonly diagnosed with ADHD in adulthood, when the condition is thought to be more prevalent among males?
Advanced Practice Pharmacist and PSA SA/NT Branch President Dr Manya Angley FPS, an expert in neurodivergence, answers these burning questions in the first of a series of Australian Pharmacist videos – where we speak to thought leaders about a range of hot topics relevant to pharmacy practice.
https://www.youtube.com/watch?v=75zytncYIjU
Dr Angley will be speaking at CPC24 on Neurodiversity/ ADHD in adults on Saturday, 4 May 2024 9:45–10:15 am. Register here to attend.
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[post_excerpt] => An expert weighs in on the legitimacy of ADHD diagnoses and where pharmacists fit into the equation.
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[post_content] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
Marketing and prescribing of oxycodone fuelled the opioid epidemic in the United States, still raging almost 30 years after the drug was first introduced.
To understand the previously unmapped associations between Australia’s oxycodone use and sociodemographic factors, UNSW researchers from the Medicines Intelligence Centre of Research Excellence and the National Drug and Alcohol Research Centre (NDARC) analysed linked data from 800,000 patients on PBS medicines dispensed, Medicare claims, hospitalisations and emergency department (ED) visits between 2014–2018.
[caption id="attachment_25808" align="aligncenter" width="400"]
Dr Malcolm Gillies[/caption]
While the research centres on oxycodone use in NSW, lead researcher Dr Malcolm Gillies said the findings are representative of the Australian population.
‘There's not much difference between NSW and Victoria in prescribing, which accounts for most of the population.’
Older Australians are more likely to be new users of oxycodone
Initiation rates of oxycodone follow an age gradient, with the average age of new users being 54.7 years of age.
‘Among our oldest age category, which is 85 years and older, patients were started on opioids on average three times more often than those in the youngest age group (18–24),’ said Dr Gillies.
Higher prescribing rates of oxycodone in older patients relate to the higher disease burden in this demographic.
‘For example, there's a higher prevalence of falls and cancer, which are precursors to opioid use,’ he said. ‘But the higher risk of adverse events with opioid use in older patients is something to bear in mind.’
Women are more likely to be initiated on oxycodone than men
An unexpected finding was the ‘definite blip’ of oxycodone use among women of childbearing age (18–44), who have ‘significantly higher’ initiation rates than their male counterparts.
Oxycodone is commonly used after hospital discharge in Australia. But because younger age groups use the opioid less frequently, there’s a distinct reason why prescribing rates are higher among females.
‘Looking at the list of diagnoses in the hospital episodes that precede the start of oxycodone, caesarean sections are quite high on the list.’
Regional and remote use is higher, but socioeconomic status doesn’t factor in
Echoing other research about patterns of opioid prescribing, oxycodone was initiated more frequently in areas outside major cities than in urban areas.
Injury rates are typically higher in rural areas as opposed to urban locations, which is a key differentiator in opioid prescribing, said Dr Gilles.
‘Those injuries tend to be more severe, with longer-term consequences,’ he said. ‘Specialist services are also harder to access outside cities, including chronic pain services – which are important down the line.’
However, there was one distinct variation. ‘Unlike other studies, we didn't see that oxycodone use varied according to socioeconomic status, once we accounted for where people were living, their gender and age,’ he said.
A proportion of the population will become long-term oxycodone users
Patients were typically prescribed oxycodone post-hospital discharge, after a therapeutic procedure, or ED visit, together accounting for half of all initiations.
‘On the other hand, hospital admission for injury or a past-year history of cancer were less common reasons for oxycodone initiation than surgery,’ said Dr Gillies.
Most of the time (two thirds), patients were only dispensed a single pack of PBS oxycodone. But 4.6% of people had a recent dispensing of oxycodone a year after initiation.
‘Even after a serious operation we would expect the need for oxycodone to relieve pain would be over by 90 days,’ said Dr Gillies.
‘The fact that a proportion of people were taking oxycodone 12 months later underlines the need for early, careful assessment of ongoing pain to maximise appropriate use of non-opioid and non-pharmacological pain control.’
While there was no data available on the reason for dispensing at the 12-month mark, Dr Gillies said it was presumably due to an ongoing need for analgesia.
‘Among trauma patients, persistent use is much more common, which is well known in the literature,’ he said. ‘If you have a serious injury and difficult recovery, that might lead to some form of chronic pain.’
While the research didn’t delve into the appropriateness of use, oxycodone prescribing was more often than not for ‘plausible reasons’, including tonsillectomy, or hip and knee replacements. But this wasn’t always the case.
‘There was more room for variation in some cases, including presentations to ED for backache or acute abdominal pain,’ said Dr Gillies.
Recent research revealed that opioids don’t help acute non-specific lower back or neck pain. Other studies have found that physiotherapy is an effective non-pharmacological alternative for ED backache presentations.
‘That can sometimes mean patients don’t need to receive an opioid,’ he added.
The research doesn't tell the full picture
One shortcoming of the research is that other prescribed opioids, available via private prescription, were not recorded. Codeine was also accessible over-the-counter during part of the study period, said Dr Gillies.
‘That means we couldn't see if people were switching between oxycodone and codeine, for example,’ he said. ‘So we may have underestimated the long-term use.’
Better access to data, including GP data linked to the other data sources such as specialist prescribing, would provide a broader idea of oxycodone use, and improve development of healthcare policy and initiatives.
‘Australia has a fragmented healthcare landscape, so getting data about what happens in every corner is a bit of a jigsaw puzzle,’ he said.
Dr Gillies thinks the difference between city and rural oxycodone prescribing should also be further explored to ensure use is appropriate outside metropolitan areas.
‘We've got a follow-up study coming soon which specifically looks at use after hospital discharge’ he said. ‘So watch this space.’
Oxycodone use is trending downwards
While there was a slight increase in oxycodone prescribing from 2014–2017, use tapered off again from 2017–2018, said Dr Gillies.
‘That includes the level of people starting oxycodone for the first time, the level of people who were ongoing users and the proportion of oxycodone among all opioids.’
This downward trend suggests some of the policy levers which have already been pulled – including PBS-listing changes, prescribing restrictions, and real-time prescription monitoring – are working.
‘We don't know whether they're increasing appropriateness, but they are certainly decreasing use,’ he said.
[post_title] => Landmark Australian study on oxycodone prescribing
[post_excerpt] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
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[post_content] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
The Excellence Awards recognise local pharmacists involved in innovative practice, those who are striving to raise practice standards, and those who, through their professionalism, provide a model of practice which others seek to emulate.
PSA SA/NT President Dr Manya Angley FPS congratulated the award recipients.
‘The passion and dedication of pharmacists across South Australia and the Northern Territory is clear. It’s our pleasure to recognise some of them tonight on behalf of the PSA,’ she said.
‘[They] exemplify the highest level of pharmacy practice, from embracing every early career opportunity to driving positive rural health outcomes through to a lifetime of professional excellence.’
Here are the outstanding SA/NT pharmacists who were recognised in this year’s awards.
[caption id="attachment_25798" align="aligncenter" width="600"]
PSA SA/NT Pharmacist of the Year Natasha Downing MPS[/caption]
Natasha Downing MPS, SA/NT Pharmacist of the Year
Natasha Downing is a proud South Australian rural woman. She was born and spent her childhood in Jamestown, SA. After a high school education in Adelaide and completing her university studies, she returned to the area where she has been a community pharmacist since 2007. She has a deep commitment to ensuring all those who call the mid-North of South Australia their home can achieve best possible health outcomes.
Since her credentialing in 2015, Ms Downing has seized every opportunity to advance the integration of pharmacists across service delivery in the wider region. As a local, she has a deep understanding of her patients’ journeys and needs. She came to the attention of the Goyder's Line Medical Practice through her high-quality medication reviews (HMRs and RMMRs), and community pharmacist roles. She was then welcomed to the general practice team through a PHN-funded Pharmacist in GP practice opportunity.
Across all her roles, Ms Downing connects well with patients from all walks of life and delivers the same respectful, caring, flexible and high-quality service to all. She goes above and beyond to meet the needs of patients and ensure they use their medicines optimally while considering the broader context of their healthcare. These skills are best applied in her palliative care role, an extremely challenging time for both the patient and their loved ones, where she ensures her patients can express choice and maintain dignity and comfort.
Ms Downing is both a trail blazer and a quiet achiever within the profession. She is an exceptional role model, especially for rural women, and exemplifies PSA’s mission to embed, equip and enable pharmacists to be at the forefront of healthcare in Australia.
[caption id="attachment_25797" align="aligncenter" width="600"]
PSA SA/NT ECP of the Year Raymond Truong MPS[/caption]
Raymond Truong MPS, SA/NT Early Career Pharmacist of the Year
ECP Raymond Truong is a fierce advocate and true leader, with a particular focus on supporting and elevating the voices of young pharmacists.
Mr Truong is deeply committed to promoting opportunities for ECPs across all practice settings.
He has been an active PSA member since 2016 and has taken full advantage of the leadership and mentoring opportunities on offer, including membership of the SA/NT PSA ECP working group committee in 2021.
Mr Truong joined the ECP Communities of Special Interest Leadership Committee in 2023. In the same year, he became the ECP representative on the SA/NT Branch Committee. He enthusiastically volunteers to represent the SA/NT Branch to showcase its strengths and build interdisciplinary relationships with other professional groups – including presenting at interprofessional collaboration events between pharmacists and dentists (2021, 2023) and podiatric prescribers (2023).
In his community pharmacy roles, Mr Truong has driven vaccination services, administration of other medicines by injection and a broad range of other advanced professional services. He is a COVID-19 vaccination provider, influenza and whooping cough, a Medication Assisted Treatment for Opioid Dependence service provider, and has played a key role in integration of professional services including B12 administration, Take-Home Naloxone, MS-2 dispensing, and expansion of vaccination services in his practice.
He has also held the position of Pharmacist Manager at Terry White Chemmart Paragon (Modbury), and is currently Professional Services Community Pharmacist at Terry White Chemmart Findon and a community pharmacist at Chemist King, Klemzig.
Mr Truong was elected Chair of SA General Practice Pharmacist Peer Network – a Community of Practice of primary care pharmacists.
In October 2023, he became credentialed to conduct medication management reviews and established a private consultancy, Pill Box Education Services. Mr Truong has commenced conducting HMRs and regularly conducts RMMRs at Pennwood Village Aged Care Home, as well as actively participating in Medicines Advisory Committee meetings in preparation to take on a role as an on-site aged care pharmacist when this program rolls out.
[caption id="attachment_25796" align="aligncenter" width="600"]
PSA SA/NT Intern of the YearChloe Hall MPS[/caption]
Chloe Hall MPS, SA/NT Intern Pharmacist of the Year
Chloe Hall’s intern year has been a case study in the power of self-belief. She started her intern year with plenty of fundamental skills and a desire to achieve, but maybe a little self-doubt. As the weeks went by, she continued to extend herself beyond her comfort zone, leading training, embracing opportunities for complex conversations with patients, collaborating with doctors and conducting new pharmacy services.
The more she did these activities, the more evident were her abilities. As she came to quietly recognise this herself, Ms Hall’s practice leapt to an exceptional level. By the end of her internship, the quality of her work, initiative, knowledge and skills made Ms Hall the pharmacist that patients were asking for and to whom more experienced pharmacists would consult and confer with.
[caption id="attachment_25800" align="aligncenter" width="600"]
PSA SA/NT Lifetime Achievment Award recipient Peter Halstead FPS[/caption]
Peter Halstead FPS, SA/NT Lifetime Achievement Award
Over his 40-year long career, Peter Halstead has made a sustained contribution to the pharmacy profession and associated organisations, dedicating himself to developing and advancing Australian pharmacy practice. Through these activities, Peter has made a significant contribution to patient care. He has been an advisor, mentor and friend to many members of our profession and epitomises the values of PSA.
After graduating in 1980, Mr Halstead worked as a community pharmacist and was instrumental in developing new areas of practice, becoming a pharmacist adviser to the Department of Veterans Affairs, the Drug and Alcohol Services and The Family Planning Unit at SHINE SA.
In 1996, Peter joined the School of Pharmacy as a research fellow involved with Professor Andy Gilbert and others in the development of new pharmacist roles, particularly in the area of aged care services.
Between 2000–2001, Mr Halstead was the Education Officer of the Pharmacy Board of South Australia. From 2001–2010, he was the Registrar of the Board, a position he held with distinction until the formation of the National Pharmacy Board. During his tenure, Mr Halstead developed and implemented systems and procedures that allowed the formal assessment of the competency of recent graduates and others seeking registration as pharmacists in SA.
Mr Halstead was a Director of the Australian Pharmacy Council from 1996–2010, and since 2010 has been the Senior Pharmacist for the APC involved in the development of assessment processes for intern pharmacists as well as pharmacists from overseas seeking registration with the National Pharmacy Board. He actively supported many overseas pharmacists who were going through the formal process of seeking registration and became a mentor to many.
Mr Halstead was appointed as the General Manager of the Pharmacy Regulation Authority, South Australia (PRASA) in 2010, a position he held for 12 years until his recent retirement. During this period, he continued to engage with the Pharmacy Board of Australia on many issues affecting Australian pharmacy practice.
[caption id="attachment_25795" align="aligncenter" width="600"]
Pharmaceutical Society Gold Medal recipient Amelia Thompson[/caption]
Exceptional student recognised
The PSA also awarded the Pharmaceutical Society Gold Medal, recognising the University of South Australia student with the highest grade point average in the Bachelor of Pharmacy (Honours) above 6.25.
Given the stringent criteria, PSA’s most prestigious student award is not awarded every year. Recipient Amelia Thompson joins a very impressive and select group of pharmacists.
[post_title] => Pharmacists recognised for excellence
[post_excerpt] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
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[post_content] => Measles cases are skyrocketing worldwide. Despite being declared ‘measles free’ since 2014, more than 28 cases of measles have been recorded in Australia this year, including recent alerts in Sydney and South Australia.
This is more than the number of cases recorded in 2023 all together. Is this just a reality of more overseas-acquired cases following increases in overseas travel, or is Australia’s measles-free status at risk?
Professor Margie Danchin, group leader of the Murdoch Children’s Research Institute’s Vaccine Uptake Group, shares seven things pharmacists need to know about measles.
About our expert
|
‘To prevent outbreaks of measles, we need coverage of about 95% for two doses.' Professor margie danchinWith the borders now open, international travel resumed, and a dramatic increase in measles cases globally – the biggest outbreak risk is the importation of measles cases from travellers into Australia. ‘Outbreaks are coming, we will see them this year,’ she said. ‘We know coverage is low in many regions, so it's only a matter of time.’ Along with being highly infectious, measles also has a significant morbidity rate in children under 5 years and older adults. About 1 in a 1000 people or 0.1% will die from measles. ‘It can cause inflammation of the brain, seizures, and respiratory complications such as pneumonia,’ said Prof Danchin. If pregnant women contract measles, babies can be born prematurely or have low birth weight. However, because MMR is a live vaccine, it cannot be administered in pregnancy. ‘Women contemplating pregnancy, travel, or both need to think about their MMR status before they get pregnant,’ she said.
‘Outbreaks are coming, we will see them this year.We know coverage is low in many regions, so it's only a matter of time.' Professor margie danchin‘If pharmacists are aware an adult is travelling, they should ask about polio, measles, and whooping cough vaccination,’ she said. ‘Parents might also come in for some travel medicine or talk about travel, and pharmacists can say “please make sure your children have their measles vaccine if you're going overseas”.’ Children under 12 months (but over 6 months) of age travelling to an area where measles is circulating can receive one dose of the MMR vaccine to ensure some protection against the virus. However, the child will still require two doses of the MMR vaccine at 12 and 18 months of age for a sufficient immune response.
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[post_content] => Case scenario
Elli, 25 years old and 18 weeks pregnant, presents to your pharmacy asking if there is anything she can safely use in pregnancy for hay fever. Elli’s main symptom is significant daily nasal congestion, and she used beclomethasone nasal spray prior to pregnancy with good effect. Elli would prefer to use the beclomethasone again, if possible, as she knows it works well for her. She has not been using anything since finding out she is pregnant, due to safety concerns, but is now desperate for some relief.
Introduction
The Therapeutic Goods Administration (TGA) uses a categorisation system for prescribing medicines in pregnancy that was developed based on the available evidence of the risks associated with taking prescription and over-the-counter medicines during pregnancy.1
This system is used by healthcare professionals, in addition to other evidence-based references, to aid decision-making and to support the safe use of medicines in pregnancy.1
While the current categories present as a simplistic grading system, they do not always accurately communicate clinical risk, or always consider all important factors, such as dose, gestation at the time of exposure, or route of administration. There may also be more current safety and risk information that has become available since the categorisation was issued.2-4
This article discusses the current system, potential issues relating to its use, and the key considerations when determining if a medicine is safe to use by a pregnant person.
Learning objectivesAfter reading this article, pharmacists should be able to:
|
Overview of the categories 
Category B3
These medicines ‘have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.’1
A specific example of how navigating category B can be difficult is aciclovir (both oral and topical), which remains a category B3 medicine despite extensive human clinical experience having demonstrated no associated increased risk of congenital malformations and it being considered safe to use by specialised references.1,6
Category C
This category includes medicines that ‘owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details’.1
Metformin is an example of a category C medicine. Evidence-based resources indicate that metformin has not been found to be associated with an increased risk of malformations or adverse pregnancy outcomes; however, some studies have suggested it may contribute to increased subcutaneous fat or body mass index and adverse metabolic profiles in the child. Monitoring of both the pregnant person and fetus is recommended when it is used.1,6
Category D
This category includes medicines ‘which have caused, are suspected to have caused, or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details’.1
Medicines in category D are not absolutely contraindicated during pregnancy.1 The use of a category D medicine in pregnancy may be justifiable in some cases where the benefits of treating the maternal condition outweigh the relative risks associated with the medicine for the developing fetus. The category D grading of a medicine may also not be relevant at all stages of a pregnancy or at all doses/dose forms.
An example of this is nicotine replacement therapy (NRT). Despite being category D, it can be considered for use in pregnancy when non-pharmacological management is unsuccessful, as the risk of using NRT to the fetus is considered lower than the risk of tobacco smoking.1,6,7,
Category X
This category includes medicines ‘which have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.’1
Isotretinoin is an example of a category X medicine. Exposure in pregnancy has been associated with an increased risk of congenital malformations, including craniofacial, cardiac and central nervous system defects, spontaneous abortion, perinatal mortality and premature birth.1,6
Its use is contraindicated in pregnancy and for those planning to conceive.6
Patient considerations
Case scenario continuedYou discuss identifying and avoiding triggers and using saline nasal spray as a first-line management approach. If this is not possible or not effective, given Elli is having significant daily symptoms, an intranasal corticosteroid could be considered. You review the over-the-counter intranasal corticosteroids and note that budesonide is category A, and beclomethasone and others are category B3. You review the AMH, MotherSafe resources and the Women’s Pregnancy and Breastfeeding Medicines Guide. You note that despite being category B3, beclomethasone is considered safe to use, as when it is used intranasally it enters the bloodstream minimally and it has not been associated with an increased risk of congenital malformations. You explain this and refer Elli to the MotherSafe ‘Hay Fever in Pregnancy and Breastfeeding’ resource for reassurance. |
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[post_content] => An expert weighs in on the legitimacy of adult attention-deficit/hyperactivity disorder (ADHD) diagnoses and where pharmacists fit into the equation.
Diagnosis of ADHD in adults has skyrocketed in recent years. According to a recent briefing conducted by the federal Department of Health and Aged Care, published under freedom of information laws, ADHD diagnoses and prescriptions for ADHD medicines have more than doubled over a 5-year period.
In 2022, 3.2 million prescriptions for ADHD medication were issued to 414,000 patients – a sizable jump from the 1.4 million prescriptions issued to 186,000 Australians in 2018.
Could new diagnostic criteria and guidelines, including the Australian Evidence-Based Clinical Practice Guideline For Attention Deficit Hyperactivity Disorder (ADHD), be helping undiagnosed adults finally receive the care they need?
Or is the condition being overdiagnosed and overmedicated – as some Australian psychiatrists fear – spurred on by social media trends and the COVID-19 pandemic?
And why are women so commonly diagnosed with ADHD in adulthood, when the condition is thought to be more prevalent among males?
Advanced Practice Pharmacist and PSA SA/NT Branch President Dr Manya Angley FPS, an expert in neurodivergence, answers these burning questions in the first of a series of Australian Pharmacist videos – where we speak to thought leaders about a range of hot topics relevant to pharmacy practice.
https://www.youtube.com/watch?v=75zytncYIjU
Dr Angley will be speaking at CPC24 on Neurodiversity/ ADHD in adults on Saturday, 4 May 2024 9:45–10:15 am. Register here to attend.
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[post_content] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
Marketing and prescribing of oxycodone fuelled the opioid epidemic in the United States, still raging almost 30 years after the drug was first introduced.
To understand the previously unmapped associations between Australia’s oxycodone use and sociodemographic factors, UNSW researchers from the Medicines Intelligence Centre of Research Excellence and the National Drug and Alcohol Research Centre (NDARC) analysed linked data from 800,000 patients on PBS medicines dispensed, Medicare claims, hospitalisations and emergency department (ED) visits between 2014–2018.
[caption id="attachment_25808" align="aligncenter" width="400"] Dr Malcolm Gillies[/caption]
While the research centres on oxycodone use in NSW, lead researcher Dr Malcolm Gillies said the findings are representative of the Australian population.
‘There's not much difference between NSW and Victoria in prescribing, which accounts for most of the population.’
Older Australians are more likely to be new users of oxycodone
Initiation rates of oxycodone follow an age gradient, with the average age of new users being 54.7 years of age.
‘Among our oldest age category, which is 85 years and older, patients were started on opioids on average three times more often than those in the youngest age group (18–24),’ said Dr Gillies.
Higher prescribing rates of oxycodone in older patients relate to the higher disease burden in this demographic.
‘For example, there's a higher prevalence of falls and cancer, which are precursors to opioid use,’ he said. ‘But the higher risk of adverse events with opioid use in older patients is something to bear in mind.’
Women are more likely to be initiated on oxycodone than men
An unexpected finding was the ‘definite blip’ of oxycodone use among women of childbearing age (18–44), who have ‘significantly higher’ initiation rates than their male counterparts.
Oxycodone is commonly used after hospital discharge in Australia. But because younger age groups use the opioid less frequently, there’s a distinct reason why prescribing rates are higher among females.
‘Looking at the list of diagnoses in the hospital episodes that precede the start of oxycodone, caesarean sections are quite high on the list.’
Regional and remote use is higher, but socioeconomic status doesn’t factor in
Echoing other research about patterns of opioid prescribing, oxycodone was initiated more frequently in areas outside major cities than in urban areas.
Injury rates are typically higher in rural areas as opposed to urban locations, which is a key differentiator in opioid prescribing, said Dr Gilles.
‘Those injuries tend to be more severe, with longer-term consequences,’ he said. ‘Specialist services are also harder to access outside cities, including chronic pain services – which are important down the line.’
However, there was one distinct variation. ‘Unlike other studies, we didn't see that oxycodone use varied according to socioeconomic status, once we accounted for where people were living, their gender and age,’ he said.
A proportion of the population will become long-term oxycodone users
Patients were typically prescribed oxycodone post-hospital discharge, after a therapeutic procedure, or ED visit, together accounting for half of all initiations.
‘On the other hand, hospital admission for injury or a past-year history of cancer were less common reasons for oxycodone initiation than surgery,’ said Dr Gillies.
Most of the time (two thirds), patients were only dispensed a single pack of PBS oxycodone. But 4.6% of people had a recent dispensing of oxycodone a year after initiation.
‘Even after a serious operation we would expect the need for oxycodone to relieve pain would be over by 90 days,’ said Dr Gillies.
‘The fact that a proportion of people were taking oxycodone 12 months later underlines the need for early, careful assessment of ongoing pain to maximise appropriate use of non-opioid and non-pharmacological pain control.’
While there was no data available on the reason for dispensing at the 12-month mark, Dr Gillies said it was presumably due to an ongoing need for analgesia.
‘Among trauma patients, persistent use is much more common, which is well known in the literature,’ he said. ‘If you have a serious injury and difficult recovery, that might lead to some form of chronic pain.’
While the research didn’t delve into the appropriateness of use, oxycodone prescribing was more often than not for ‘plausible reasons’, including tonsillectomy, or hip and knee replacements. But this wasn’t always the case.
‘There was more room for variation in some cases, including presentations to ED for backache or acute abdominal pain,’ said Dr Gillies.
Recent research revealed that opioids don’t help acute non-specific lower back or neck pain. Other studies have found that physiotherapy is an effective non-pharmacological alternative for ED backache presentations.
‘That can sometimes mean patients don’t need to receive an opioid,’ he added.
The research doesn't tell the full picture
One shortcoming of the research is that other prescribed opioids, available via private prescription, were not recorded. Codeine was also accessible over-the-counter during part of the study period, said Dr Gillies.
‘That means we couldn't see if people were switching between oxycodone and codeine, for example,’ he said. ‘So we may have underestimated the long-term use.’
Better access to data, including GP data linked to the other data sources such as specialist prescribing, would provide a broader idea of oxycodone use, and improve development of healthcare policy and initiatives.
‘Australia has a fragmented healthcare landscape, so getting data about what happens in every corner is a bit of a jigsaw puzzle,’ he said.
Dr Gillies thinks the difference between city and rural oxycodone prescribing should also be further explored to ensure use is appropriate outside metropolitan areas.
‘We've got a follow-up study coming soon which specifically looks at use after hospital discharge’ he said. ‘So watch this space.’
Oxycodone use is trending downwards
While there was a slight increase in oxycodone prescribing from 2014–2017, use tapered off again from 2017–2018, said Dr Gillies.
‘That includes the level of people starting oxycodone for the first time, the level of people who were ongoing users and the proportion of oxycodone among all opioids.’
This downward trend suggests some of the policy levers which have already been pulled – including PBS-listing changes, prescribing restrictions, and real-time prescription monitoring – are working.
‘We don't know whether they're increasing appropriateness, but they are certainly decreasing use,’ he said.
[post_title] => Landmark Australian study on oxycodone prescribing
[post_excerpt] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
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[post_content] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
The Excellence Awards recognise local pharmacists involved in innovative practice, those who are striving to raise practice standards, and those who, through their professionalism, provide a model of practice which others seek to emulate.
PSA SA/NT President Dr Manya Angley FPS congratulated the award recipients.
‘The passion and dedication of pharmacists across South Australia and the Northern Territory is clear. It’s our pleasure to recognise some of them tonight on behalf of the PSA,’ she said.
‘[They] exemplify the highest level of pharmacy practice, from embracing every early career opportunity to driving positive rural health outcomes through to a lifetime of professional excellence.’
Here are the outstanding SA/NT pharmacists who were recognised in this year’s awards.
[caption id="attachment_25798" align="aligncenter" width="600"] PSA SA/NT Pharmacist of the Year Natasha Downing MPS[/caption]
Natasha Downing MPS, SA/NT Pharmacist of the Year
Natasha Downing is a proud South Australian rural woman. She was born and spent her childhood in Jamestown, SA. After a high school education in Adelaide and completing her university studies, she returned to the area where she has been a community pharmacist since 2007. She has a deep commitment to ensuring all those who call the mid-North of South Australia their home can achieve best possible health outcomes.
Since her credentialing in 2015, Ms Downing has seized every opportunity to advance the integration of pharmacists across service delivery in the wider region. As a local, she has a deep understanding of her patients’ journeys and needs. She came to the attention of the Goyder's Line Medical Practice through her high-quality medication reviews (HMRs and RMMRs), and community pharmacist roles. She was then welcomed to the general practice team through a PHN-funded Pharmacist in GP practice opportunity.
Across all her roles, Ms Downing connects well with patients from all walks of life and delivers the same respectful, caring, flexible and high-quality service to all. She goes above and beyond to meet the needs of patients and ensure they use their medicines optimally while considering the broader context of their healthcare. These skills are best applied in her palliative care role, an extremely challenging time for both the patient and their loved ones, where she ensures her patients can express choice and maintain dignity and comfort.
Ms Downing is both a trail blazer and a quiet achiever within the profession. She is an exceptional role model, especially for rural women, and exemplifies PSA’s mission to embed, equip and enable pharmacists to be at the forefront of healthcare in Australia.
[caption id="attachment_25797" align="aligncenter" width="600"] PSA SA/NT ECP of the Year Raymond Truong MPS[/caption]
Raymond Truong MPS, SA/NT Early Career Pharmacist of the Year
ECP Raymond Truong is a fierce advocate and true leader, with a particular focus on supporting and elevating the voices of young pharmacists.
Mr Truong is deeply committed to promoting opportunities for ECPs across all practice settings.
He has been an active PSA member since 2016 and has taken full advantage of the leadership and mentoring opportunities on offer, including membership of the SA/NT PSA ECP working group committee in 2021.
Mr Truong joined the ECP Communities of Special Interest Leadership Committee in 2023. In the same year, he became the ECP representative on the SA/NT Branch Committee. He enthusiastically volunteers to represent the SA/NT Branch to showcase its strengths and build interdisciplinary relationships with other professional groups – including presenting at interprofessional collaboration events between pharmacists and dentists (2021, 2023) and podiatric prescribers (2023).
In his community pharmacy roles, Mr Truong has driven vaccination services, administration of other medicines by injection and a broad range of other advanced professional services. He is a COVID-19 vaccination provider, influenza and whooping cough, a Medication Assisted Treatment for Opioid Dependence service provider, and has played a key role in integration of professional services including B12 administration, Take-Home Naloxone, MS-2 dispensing, and expansion of vaccination services in his practice.
He has also held the position of Pharmacist Manager at Terry White Chemmart Paragon (Modbury), and is currently Professional Services Community Pharmacist at Terry White Chemmart Findon and a community pharmacist at Chemist King, Klemzig.
Mr Truong was elected Chair of SA General Practice Pharmacist Peer Network – a Community of Practice of primary care pharmacists.
In October 2023, he became credentialed to conduct medication management reviews and established a private consultancy, Pill Box Education Services. Mr Truong has commenced conducting HMRs and regularly conducts RMMRs at Pennwood Village Aged Care Home, as well as actively participating in Medicines Advisory Committee meetings in preparation to take on a role as an on-site aged care pharmacist when this program rolls out.
[caption id="attachment_25796" align="aligncenter" width="600"] PSA SA/NT Intern of the YearChloe Hall MPS[/caption]
Chloe Hall MPS, SA/NT Intern Pharmacist of the Year
Chloe Hall’s intern year has been a case study in the power of self-belief. She started her intern year with plenty of fundamental skills and a desire to achieve, but maybe a little self-doubt. As the weeks went by, she continued to extend herself beyond her comfort zone, leading training, embracing opportunities for complex conversations with patients, collaborating with doctors and conducting new pharmacy services.
The more she did these activities, the more evident were her abilities. As she came to quietly recognise this herself, Ms Hall’s practice leapt to an exceptional level. By the end of her internship, the quality of her work, initiative, knowledge and skills made Ms Hall the pharmacist that patients were asking for and to whom more experienced pharmacists would consult and confer with.
[caption id="attachment_25800" align="aligncenter" width="600"] PSA SA/NT Lifetime Achievment Award recipient Peter Halstead FPS[/caption]
Peter Halstead FPS, SA/NT Lifetime Achievement Award
Over his 40-year long career, Peter Halstead has made a sustained contribution to the pharmacy profession and associated organisations, dedicating himself to developing and advancing Australian pharmacy practice. Through these activities, Peter has made a significant contribution to patient care. He has been an advisor, mentor and friend to many members of our profession and epitomises the values of PSA.
After graduating in 1980, Mr Halstead worked as a community pharmacist and was instrumental in developing new areas of practice, becoming a pharmacist adviser to the Department of Veterans Affairs, the Drug and Alcohol Services and The Family Planning Unit at SHINE SA.
In 1996, Peter joined the School of Pharmacy as a research fellow involved with Professor Andy Gilbert and others in the development of new pharmacist roles, particularly in the area of aged care services.
Between 2000–2001, Mr Halstead was the Education Officer of the Pharmacy Board of South Australia. From 2001–2010, he was the Registrar of the Board, a position he held with distinction until the formation of the National Pharmacy Board. During his tenure, Mr Halstead developed and implemented systems and procedures that allowed the formal assessment of the competency of recent graduates and others seeking registration as pharmacists in SA.
Mr Halstead was a Director of the Australian Pharmacy Council from 1996–2010, and since 2010 has been the Senior Pharmacist for the APC involved in the development of assessment processes for intern pharmacists as well as pharmacists from overseas seeking registration with the National Pharmacy Board. He actively supported many overseas pharmacists who were going through the formal process of seeking registration and became a mentor to many.
Mr Halstead was appointed as the General Manager of the Pharmacy Regulation Authority, South Australia (PRASA) in 2010, a position he held for 12 years until his recent retirement. During this period, he continued to engage with the Pharmacy Board of Australia on many issues affecting Australian pharmacy practice.
[caption id="attachment_25795" align="aligncenter" width="600"] Pharmaceutical Society Gold Medal recipient Amelia Thompson[/caption]
Exceptional student recognised
The PSA also awarded the Pharmaceutical Society Gold Medal, recognising the University of South Australia student with the highest grade point average in the Bachelor of Pharmacy (Honours) above 6.25.
Given the stringent criteria, PSA’s most prestigious student award is not awarded every year. Recipient Amelia Thompson joins a very impressive and select group of pharmacists.
[post_title] => Pharmacists recognised for excellence
[post_excerpt] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
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[post_content] => Measles cases are skyrocketing worldwide. Despite being declared ‘measles free’ since 2014, more than 28 cases of measles have been recorded in Australia this year, including recent alerts in Sydney and South Australia.
This is more than the number of cases recorded in 2023 all together. Is this just a reality of more overseas-acquired cases following increases in overseas travel, or is Australia’s measles-free status at risk?
Professor Margie Danchin, group leader of the Murdoch Children’s Research Institute’s Vaccine Uptake Group, shares seven things pharmacists need to know about measles.
About our expert
|
‘To prevent outbreaks of measles, we need coverage of about 95% for two doses.' Professor margie danchinWith the borders now open, international travel resumed, and a dramatic increase in measles cases globally – the biggest outbreak risk is the importation of measles cases from travellers into Australia. ‘Outbreaks are coming, we will see them this year,’ she said. ‘We know coverage is low in many regions, so it's only a matter of time.’ Along with being highly infectious, measles also has a significant morbidity rate in children under 5 years and older adults. About 1 in a 1000 people or 0.1% will die from measles. ‘It can cause inflammation of the brain, seizures, and respiratory complications such as pneumonia,’ said Prof Danchin. If pregnant women contract measles, babies can be born prematurely or have low birth weight. However, because MMR is a live vaccine, it cannot be administered in pregnancy. ‘Women contemplating pregnancy, travel, or both need to think about their MMR status before they get pregnant,’ she said.
‘Outbreaks are coming, we will see them this year.We know coverage is low in many regions, so it's only a matter of time.' Professor margie danchin‘If pharmacists are aware an adult is travelling, they should ask about polio, measles, and whooping cough vaccination,’ she said. ‘Parents might also come in for some travel medicine or talk about travel, and pharmacists can say “please make sure your children have their measles vaccine if you're going overseas”.’ Children under 12 months (but over 6 months) of age travelling to an area where measles is circulating can receive one dose of the MMR vaccine to ensure some protection against the virus. However, the child will still require two doses of the MMR vaccine at 12 and 18 months of age for a sufficient immune response.
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[post_content] => Case scenario
Elli, 25 years old and 18 weeks pregnant, presents to your pharmacy asking if there is anything she can safely use in pregnancy for hay fever. Elli’s main symptom is significant daily nasal congestion, and she used beclomethasone nasal spray prior to pregnancy with good effect. Elli would prefer to use the beclomethasone again, if possible, as she knows it works well for her. She has not been using anything since finding out she is pregnant, due to safety concerns, but is now desperate for some relief.
Introduction
The Therapeutic Goods Administration (TGA) uses a categorisation system for prescribing medicines in pregnancy that was developed based on the available evidence of the risks associated with taking prescription and over-the-counter medicines during pregnancy.1
This system is used by healthcare professionals, in addition to other evidence-based references, to aid decision-making and to support the safe use of medicines in pregnancy.1
While the current categories present as a simplistic grading system, they do not always accurately communicate clinical risk, or always consider all important factors, such as dose, gestation at the time of exposure, or route of administration. There may also be more current safety and risk information that has become available since the categorisation was issued.2-4
This article discusses the current system, potential issues relating to its use, and the key considerations when determining if a medicine is safe to use by a pregnant person.
Learning objectivesAfter reading this article, pharmacists should be able to:
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Overview of the categories
Category B3
These medicines ‘have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.’1
A specific example of how navigating category B can be difficult is aciclovir (both oral and topical), which remains a category B3 medicine despite extensive human clinical experience having demonstrated no associated increased risk of congenital malformations and it being considered safe to use by specialised references.1,6
Category C
This category includes medicines that ‘owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details’.1
Metformin is an example of a category C medicine. Evidence-based resources indicate that metformin has not been found to be associated with an increased risk of malformations or adverse pregnancy outcomes; however, some studies have suggested it may contribute to increased subcutaneous fat or body mass index and adverse metabolic profiles in the child. Monitoring of both the pregnant person and fetus is recommended when it is used.1,6
Category D
This category includes medicines ‘which have caused, are suspected to have caused, or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details’.1
Medicines in category D are not absolutely contraindicated during pregnancy.1 The use of a category D medicine in pregnancy may be justifiable in some cases where the benefits of treating the maternal condition outweigh the relative risks associated with the medicine for the developing fetus. The category D grading of a medicine may also not be relevant at all stages of a pregnancy or at all doses/dose forms.
An example of this is nicotine replacement therapy (NRT). Despite being category D, it can be considered for use in pregnancy when non-pharmacological management is unsuccessful, as the risk of using NRT to the fetus is considered lower than the risk of tobacco smoking.1,6,7,
Category X
This category includes medicines ‘which have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.’1
Isotretinoin is an example of a category X medicine. Exposure in pregnancy has been associated with an increased risk of congenital malformations, including craniofacial, cardiac and central nervous system defects, spontaneous abortion, perinatal mortality and premature birth.1,6
Its use is contraindicated in pregnancy and for those planning to conceive.6
Patient considerations
Case scenario continuedYou discuss identifying and avoiding triggers and using saline nasal spray as a first-line management approach. If this is not possible or not effective, given Elli is having significant daily symptoms, an intranasal corticosteroid could be considered. You review the over-the-counter intranasal corticosteroids and note that budesonide is category A, and beclomethasone and others are category B3. You review the AMH, MotherSafe resources and the Women’s Pregnancy and Breastfeeding Medicines Guide. You note that despite being category B3, beclomethasone is considered safe to use, as when it is used intranasally it enters the bloodstream minimally and it has not been associated with an increased risk of congenital malformations. You explain this and refer Elli to the MotherSafe ‘Hay Fever in Pregnancy and Breastfeeding’ resource for reassurance. |
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[post_content] => An expert weighs in on the legitimacy of adult attention-deficit/hyperactivity disorder (ADHD) diagnoses and where pharmacists fit into the equation.
Diagnosis of ADHD in adults has skyrocketed in recent years. According to a recent briefing conducted by the federal Department of Health and Aged Care, published under freedom of information laws, ADHD diagnoses and prescriptions for ADHD medicines have more than doubled over a 5-year period.
In 2022, 3.2 million prescriptions for ADHD medication were issued to 414,000 patients – a sizable jump from the 1.4 million prescriptions issued to 186,000 Australians in 2018.
Could new diagnostic criteria and guidelines, including the Australian Evidence-Based Clinical Practice Guideline For Attention Deficit Hyperactivity Disorder (ADHD), be helping undiagnosed adults finally receive the care they need?
Or is the condition being overdiagnosed and overmedicated – as some Australian psychiatrists fear – spurred on by social media trends and the COVID-19 pandemic?
And why are women so commonly diagnosed with ADHD in adulthood, when the condition is thought to be more prevalent among males?
Advanced Practice Pharmacist and PSA SA/NT Branch President Dr Manya Angley FPS, an expert in neurodivergence, answers these burning questions in the first of a series of Australian Pharmacist videos – where we speak to thought leaders about a range of hot topics relevant to pharmacy practice.
https://www.youtube.com/watch?v=75zytncYIjU
Dr Angley will be speaking at CPC24 on Neurodiversity/ ADHD in adults on Saturday, 4 May 2024 9:45–10:15 am. Register here to attend.
[post_title] => Why are so many adults diagnosed with ADHD these days?
[post_excerpt] => An expert weighs in on the legitimacy of ADHD diagnoses and where pharmacists fit into the equation.
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[post_content] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
Marketing and prescribing of oxycodone fuelled the opioid epidemic in the United States, still raging almost 30 years after the drug was first introduced.
To understand the previously unmapped associations between Australia’s oxycodone use and sociodemographic factors, UNSW researchers from the Medicines Intelligence Centre of Research Excellence and the National Drug and Alcohol Research Centre (NDARC) analysed linked data from 800,000 patients on PBS medicines dispensed, Medicare claims, hospitalisations and emergency department (ED) visits between 2014–2018.
[caption id="attachment_25808" align="aligncenter" width="400"] Dr Malcolm Gillies[/caption]
While the research centres on oxycodone use in NSW, lead researcher Dr Malcolm Gillies said the findings are representative of the Australian population.
‘There's not much difference between NSW and Victoria in prescribing, which accounts for most of the population.’
Older Australians are more likely to be new users of oxycodone
Initiation rates of oxycodone follow an age gradient, with the average age of new users being 54.7 years of age.
‘Among our oldest age category, which is 85 years and older, patients were started on opioids on average three times more often than those in the youngest age group (18–24),’ said Dr Gillies.
Higher prescribing rates of oxycodone in older patients relate to the higher disease burden in this demographic.
‘For example, there's a higher prevalence of falls and cancer, which are precursors to opioid use,’ he said. ‘But the higher risk of adverse events with opioid use in older patients is something to bear in mind.’
Women are more likely to be initiated on oxycodone than men
An unexpected finding was the ‘definite blip’ of oxycodone use among women of childbearing age (18–44), who have ‘significantly higher’ initiation rates than their male counterparts.
Oxycodone is commonly used after hospital discharge in Australia. But because younger age groups use the opioid less frequently, there’s a distinct reason why prescribing rates are higher among females.
‘Looking at the list of diagnoses in the hospital episodes that precede the start of oxycodone, caesarean sections are quite high on the list.’
Regional and remote use is higher, but socioeconomic status doesn’t factor in
Echoing other research about patterns of opioid prescribing, oxycodone was initiated more frequently in areas outside major cities than in urban areas.
Injury rates are typically higher in rural areas as opposed to urban locations, which is a key differentiator in opioid prescribing, said Dr Gilles.
‘Those injuries tend to be more severe, with longer-term consequences,’ he said. ‘Specialist services are also harder to access outside cities, including chronic pain services – which are important down the line.’
However, there was one distinct variation. ‘Unlike other studies, we didn't see that oxycodone use varied according to socioeconomic status, once we accounted for where people were living, their gender and age,’ he said.
A proportion of the population will become long-term oxycodone users
Patients were typically prescribed oxycodone post-hospital discharge, after a therapeutic procedure, or ED visit, together accounting for half of all initiations.
‘On the other hand, hospital admission for injury or a past-year history of cancer were less common reasons for oxycodone initiation than surgery,’ said Dr Gillies.
Most of the time (two thirds), patients were only dispensed a single pack of PBS oxycodone. But 4.6% of people had a recent dispensing of oxycodone a year after initiation.
‘Even after a serious operation we would expect the need for oxycodone to relieve pain would be over by 90 days,’ said Dr Gillies.
‘The fact that a proportion of people were taking oxycodone 12 months later underlines the need for early, careful assessment of ongoing pain to maximise appropriate use of non-opioid and non-pharmacological pain control.’
While there was no data available on the reason for dispensing at the 12-month mark, Dr Gillies said it was presumably due to an ongoing need for analgesia.
‘Among trauma patients, persistent use is much more common, which is well known in the literature,’ he said. ‘If you have a serious injury and difficult recovery, that might lead to some form of chronic pain.’
While the research didn’t delve into the appropriateness of use, oxycodone prescribing was more often than not for ‘plausible reasons’, including tonsillectomy, or hip and knee replacements. But this wasn’t always the case.
‘There was more room for variation in some cases, including presentations to ED for backache or acute abdominal pain,’ said Dr Gillies.
Recent research revealed that opioids don’t help acute non-specific lower back or neck pain. Other studies have found that physiotherapy is an effective non-pharmacological alternative for ED backache presentations.
‘That can sometimes mean patients don’t need to receive an opioid,’ he added.
The research doesn't tell the full picture
One shortcoming of the research is that other prescribed opioids, available via private prescription, were not recorded. Codeine was also accessible over-the-counter during part of the study period, said Dr Gillies.
‘That means we couldn't see if people were switching between oxycodone and codeine, for example,’ he said. ‘So we may have underestimated the long-term use.’
Better access to data, including GP data linked to the other data sources such as specialist prescribing, would provide a broader idea of oxycodone use, and improve development of healthcare policy and initiatives.
‘Australia has a fragmented healthcare landscape, so getting data about what happens in every corner is a bit of a jigsaw puzzle,’ he said.
Dr Gillies thinks the difference between city and rural oxycodone prescribing should also be further explored to ensure use is appropriate outside metropolitan areas.
‘We've got a follow-up study coming soon which specifically looks at use after hospital discharge’ he said. ‘So watch this space.’
Oxycodone use is trending downwards
While there was a slight increase in oxycodone prescribing from 2014–2017, use tapered off again from 2017–2018, said Dr Gillies.
‘That includes the level of people starting oxycodone for the first time, the level of people who were ongoing users and the proportion of oxycodone among all opioids.’
This downward trend suggests some of the policy levers which have already been pulled – including PBS-listing changes, prescribing restrictions, and real-time prescription monitoring – are working.
‘We don't know whether they're increasing appropriateness, but they are certainly decreasing use,’ he said.
[post_title] => Landmark Australian study on oxycodone prescribing
[post_excerpt] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
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[post_content] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
The Excellence Awards recognise local pharmacists involved in innovative practice, those who are striving to raise practice standards, and those who, through their professionalism, provide a model of practice which others seek to emulate.
PSA SA/NT President Dr Manya Angley FPS congratulated the award recipients.
‘The passion and dedication of pharmacists across South Australia and the Northern Territory is clear. It’s our pleasure to recognise some of them tonight on behalf of the PSA,’ she said.
‘[They] exemplify the highest level of pharmacy practice, from embracing every early career opportunity to driving positive rural health outcomes through to a lifetime of professional excellence.’
Here are the outstanding SA/NT pharmacists who were recognised in this year’s awards.
[caption id="attachment_25798" align="aligncenter" width="600"] PSA SA/NT Pharmacist of the Year Natasha Downing MPS[/caption]
Natasha Downing MPS, SA/NT Pharmacist of the Year
Natasha Downing is a proud South Australian rural woman. She was born and spent her childhood in Jamestown, SA. After a high school education in Adelaide and completing her university studies, she returned to the area where she has been a community pharmacist since 2007. She has a deep commitment to ensuring all those who call the mid-North of South Australia their home can achieve best possible health outcomes.
Since her credentialing in 2015, Ms Downing has seized every opportunity to advance the integration of pharmacists across service delivery in the wider region. As a local, she has a deep understanding of her patients’ journeys and needs. She came to the attention of the Goyder's Line Medical Practice through her high-quality medication reviews (HMRs and RMMRs), and community pharmacist roles. She was then welcomed to the general practice team through a PHN-funded Pharmacist in GP practice opportunity.
Across all her roles, Ms Downing connects well with patients from all walks of life and delivers the same respectful, caring, flexible and high-quality service to all. She goes above and beyond to meet the needs of patients and ensure they use their medicines optimally while considering the broader context of their healthcare. These skills are best applied in her palliative care role, an extremely challenging time for both the patient and their loved ones, where she ensures her patients can express choice and maintain dignity and comfort.
Ms Downing is both a trail blazer and a quiet achiever within the profession. She is an exceptional role model, especially for rural women, and exemplifies PSA’s mission to embed, equip and enable pharmacists to be at the forefront of healthcare in Australia.
[caption id="attachment_25797" align="aligncenter" width="600"] PSA SA/NT ECP of the Year Raymond Truong MPS[/caption]
Raymond Truong MPS, SA/NT Early Career Pharmacist of the Year
ECP Raymond Truong is a fierce advocate and true leader, with a particular focus on supporting and elevating the voices of young pharmacists.
Mr Truong is deeply committed to promoting opportunities for ECPs across all practice settings.
He has been an active PSA member since 2016 and has taken full advantage of the leadership and mentoring opportunities on offer, including membership of the SA/NT PSA ECP working group committee in 2021.
Mr Truong joined the ECP Communities of Special Interest Leadership Committee in 2023. In the same year, he became the ECP representative on the SA/NT Branch Committee. He enthusiastically volunteers to represent the SA/NT Branch to showcase its strengths and build interdisciplinary relationships with other professional groups – including presenting at interprofessional collaboration events between pharmacists and dentists (2021, 2023) and podiatric prescribers (2023).
In his community pharmacy roles, Mr Truong has driven vaccination services, administration of other medicines by injection and a broad range of other advanced professional services. He is a COVID-19 vaccination provider, influenza and whooping cough, a Medication Assisted Treatment for Opioid Dependence service provider, and has played a key role in integration of professional services including B12 administration, Take-Home Naloxone, MS-2 dispensing, and expansion of vaccination services in his practice.
He has also held the position of Pharmacist Manager at Terry White Chemmart Paragon (Modbury), and is currently Professional Services Community Pharmacist at Terry White Chemmart Findon and a community pharmacist at Chemist King, Klemzig.
Mr Truong was elected Chair of SA General Practice Pharmacist Peer Network – a Community of Practice of primary care pharmacists.
In October 2023, he became credentialed to conduct medication management reviews and established a private consultancy, Pill Box Education Services. Mr Truong has commenced conducting HMRs and regularly conducts RMMRs at Pennwood Village Aged Care Home, as well as actively participating in Medicines Advisory Committee meetings in preparation to take on a role as an on-site aged care pharmacist when this program rolls out.
[caption id="attachment_25796" align="aligncenter" width="600"] PSA SA/NT Intern of the YearChloe Hall MPS[/caption]
Chloe Hall MPS, SA/NT Intern Pharmacist of the Year
Chloe Hall’s intern year has been a case study in the power of self-belief. She started her intern year with plenty of fundamental skills and a desire to achieve, but maybe a little self-doubt. As the weeks went by, she continued to extend herself beyond her comfort zone, leading training, embracing opportunities for complex conversations with patients, collaborating with doctors and conducting new pharmacy services.
The more she did these activities, the more evident were her abilities. As she came to quietly recognise this herself, Ms Hall’s practice leapt to an exceptional level. By the end of her internship, the quality of her work, initiative, knowledge and skills made Ms Hall the pharmacist that patients were asking for and to whom more experienced pharmacists would consult and confer with.
[caption id="attachment_25800" align="aligncenter" width="600"] PSA SA/NT Lifetime Achievment Award recipient Peter Halstead FPS[/caption]
Peter Halstead FPS, SA/NT Lifetime Achievement Award
Over his 40-year long career, Peter Halstead has made a sustained contribution to the pharmacy profession and associated organisations, dedicating himself to developing and advancing Australian pharmacy practice. Through these activities, Peter has made a significant contribution to patient care. He has been an advisor, mentor and friend to many members of our profession and epitomises the values of PSA.
After graduating in 1980, Mr Halstead worked as a community pharmacist and was instrumental in developing new areas of practice, becoming a pharmacist adviser to the Department of Veterans Affairs, the Drug and Alcohol Services and The Family Planning Unit at SHINE SA.
In 1996, Peter joined the School of Pharmacy as a research fellow involved with Professor Andy Gilbert and others in the development of new pharmacist roles, particularly in the area of aged care services.
Between 2000–2001, Mr Halstead was the Education Officer of the Pharmacy Board of South Australia. From 2001–2010, he was the Registrar of the Board, a position he held with distinction until the formation of the National Pharmacy Board. During his tenure, Mr Halstead developed and implemented systems and procedures that allowed the formal assessment of the competency of recent graduates and others seeking registration as pharmacists in SA.
Mr Halstead was a Director of the Australian Pharmacy Council from 1996–2010, and since 2010 has been the Senior Pharmacist for the APC involved in the development of assessment processes for intern pharmacists as well as pharmacists from overseas seeking registration with the National Pharmacy Board. He actively supported many overseas pharmacists who were going through the formal process of seeking registration and became a mentor to many.
Mr Halstead was appointed as the General Manager of the Pharmacy Regulation Authority, South Australia (PRASA) in 2010, a position he held for 12 years until his recent retirement. During this period, he continued to engage with the Pharmacy Board of Australia on many issues affecting Australian pharmacy practice.
[caption id="attachment_25795" align="aligncenter" width="600"] Pharmaceutical Society Gold Medal recipient Amelia Thompson[/caption]
Exceptional student recognised
The PSA also awarded the Pharmaceutical Society Gold Medal, recognising the University of South Australia student with the highest grade point average in the Bachelor of Pharmacy (Honours) above 6.25.
Given the stringent criteria, PSA’s most prestigious student award is not awarded every year. Recipient Amelia Thompson joins a very impressive and select group of pharmacists.
[post_title] => Pharmacists recognised for excellence
[post_excerpt] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
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[post_content] => Measles cases are skyrocketing worldwide. Despite being declared ‘measles free’ since 2014, more than 28 cases of measles have been recorded in Australia this year, including recent alerts in Sydney and South Australia.
This is more than the number of cases recorded in 2023 all together. Is this just a reality of more overseas-acquired cases following increases in overseas travel, or is Australia’s measles-free status at risk?
Professor Margie Danchin, group leader of the Murdoch Children’s Research Institute’s Vaccine Uptake Group, shares seven things pharmacists need to know about measles.
About our expert
|
‘To prevent outbreaks of measles, we need coverage of about 95% for two doses.' Professor margie danchinWith the borders now open, international travel resumed, and a dramatic increase in measles cases globally – the biggest outbreak risk is the importation of measles cases from travellers into Australia. ‘Outbreaks are coming, we will see them this year,’ she said. ‘We know coverage is low in many regions, so it's only a matter of time.’ Along with being highly infectious, measles also has a significant morbidity rate in children under 5 years and older adults. About 1 in a 1000 people or 0.1% will die from measles. ‘It can cause inflammation of the brain, seizures, and respiratory complications such as pneumonia,’ said Prof Danchin. If pregnant women contract measles, babies can be born prematurely or have low birth weight. However, because MMR is a live vaccine, it cannot be administered in pregnancy. ‘Women contemplating pregnancy, travel, or both need to think about their MMR status before they get pregnant,’ she said.
‘Outbreaks are coming, we will see them this year.We know coverage is low in many regions, so it's only a matter of time.' Professor margie danchin‘If pharmacists are aware an adult is travelling, they should ask about polio, measles, and whooping cough vaccination,’ she said. ‘Parents might also come in for some travel medicine or talk about travel, and pharmacists can say “please make sure your children have their measles vaccine if you're going overseas”.’ Children under 12 months (but over 6 months) of age travelling to an area where measles is circulating can receive one dose of the MMR vaccine to ensure some protection against the virus. However, the child will still require two doses of the MMR vaccine at 12 and 18 months of age for a sufficient immune response.
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[post_content] => Case scenario
Elli, 25 years old and 18 weeks pregnant, presents to your pharmacy asking if there is anything she can safely use in pregnancy for hay fever. Elli’s main symptom is significant daily nasal congestion, and she used beclomethasone nasal spray prior to pregnancy with good effect. Elli would prefer to use the beclomethasone again, if possible, as she knows it works well for her. She has not been using anything since finding out she is pregnant, due to safety concerns, but is now desperate for some relief.
Introduction
The Therapeutic Goods Administration (TGA) uses a categorisation system for prescribing medicines in pregnancy that was developed based on the available evidence of the risks associated with taking prescription and over-the-counter medicines during pregnancy.1
This system is used by healthcare professionals, in addition to other evidence-based references, to aid decision-making and to support the safe use of medicines in pregnancy.1
While the current categories present as a simplistic grading system, they do not always accurately communicate clinical risk, or always consider all important factors, such as dose, gestation at the time of exposure, or route of administration. There may also be more current safety and risk information that has become available since the categorisation was issued.2-4
This article discusses the current system, potential issues relating to its use, and the key considerations when determining if a medicine is safe to use by a pregnant person.
Learning objectivesAfter reading this article, pharmacists should be able to:
|
Overview of the categories
Category B3
These medicines ‘have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.’1
A specific example of how navigating category B can be difficult is aciclovir (both oral and topical), which remains a category B3 medicine despite extensive human clinical experience having demonstrated no associated increased risk of congenital malformations and it being considered safe to use by specialised references.1,6
Category C
This category includes medicines that ‘owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details’.1
Metformin is an example of a category C medicine. Evidence-based resources indicate that metformin has not been found to be associated with an increased risk of malformations or adverse pregnancy outcomes; however, some studies have suggested it may contribute to increased subcutaneous fat or body mass index and adverse metabolic profiles in the child. Monitoring of both the pregnant person and fetus is recommended when it is used.1,6
Category D
This category includes medicines ‘which have caused, are suspected to have caused, or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details’.1
Medicines in category D are not absolutely contraindicated during pregnancy.1 The use of a category D medicine in pregnancy may be justifiable in some cases where the benefits of treating the maternal condition outweigh the relative risks associated with the medicine for the developing fetus. The category D grading of a medicine may also not be relevant at all stages of a pregnancy or at all doses/dose forms.
An example of this is nicotine replacement therapy (NRT). Despite being category D, it can be considered for use in pregnancy when non-pharmacological management is unsuccessful, as the risk of using NRT to the fetus is considered lower than the risk of tobacco smoking.1,6,7,
Category X
This category includes medicines ‘which have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.’1
Isotretinoin is an example of a category X medicine. Exposure in pregnancy has been associated with an increased risk of congenital malformations, including craniofacial, cardiac and central nervous system defects, spontaneous abortion, perinatal mortality and premature birth.1,6
Its use is contraindicated in pregnancy and for those planning to conceive.6
Patient considerations
Case scenario continuedYou discuss identifying and avoiding triggers and using saline nasal spray as a first-line management approach. If this is not possible or not effective, given Elli is having significant daily symptoms, an intranasal corticosteroid could be considered. You review the over-the-counter intranasal corticosteroids and note that budesonide is category A, and beclomethasone and others are category B3. You review the AMH, MotherSafe resources and the Women’s Pregnancy and Breastfeeding Medicines Guide. You note that despite being category B3, beclomethasone is considered safe to use, as when it is used intranasally it enters the bloodstream minimally and it has not been associated with an increased risk of congenital malformations. You explain this and refer Elli to the MotherSafe ‘Hay Fever in Pregnancy and Breastfeeding’ resource for reassurance. |
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[post_content] => An expert weighs in on the legitimacy of adult attention-deficit/hyperactivity disorder (ADHD) diagnoses and where pharmacists fit into the equation.
Diagnosis of ADHD in adults has skyrocketed in recent years. According to a recent briefing conducted by the federal Department of Health and Aged Care, published under freedom of information laws, ADHD diagnoses and prescriptions for ADHD medicines have more than doubled over a 5-year period.
In 2022, 3.2 million prescriptions for ADHD medication were issued to 414,000 patients – a sizable jump from the 1.4 million prescriptions issued to 186,000 Australians in 2018.
Could new diagnostic criteria and guidelines, including the Australian Evidence-Based Clinical Practice Guideline For Attention Deficit Hyperactivity Disorder (ADHD), be helping undiagnosed adults finally receive the care they need?
Or is the condition being overdiagnosed and overmedicated – as some Australian psychiatrists fear – spurred on by social media trends and the COVID-19 pandemic?
And why are women so commonly diagnosed with ADHD in adulthood, when the condition is thought to be more prevalent among males?
Advanced Practice Pharmacist and PSA SA/NT Branch President Dr Manya Angley FPS, an expert in neurodivergence, answers these burning questions in the first of a series of Australian Pharmacist videos – where we speak to thought leaders about a range of hot topics relevant to pharmacy practice.
https://www.youtube.com/watch?v=75zytncYIjU
Dr Angley will be speaking at CPC24 on Neurodiversity/ ADHD in adults on Saturday, 4 May 2024 9:45–10:15 am. Register here to attend.
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[post_excerpt] => An expert weighs in on the legitimacy of ADHD diagnoses and where pharmacists fit into the equation.
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[post_content] => Oxycodone is the most prescribed strong opioid in Australia. Yet little was known about its use and prescribing patterns – until now.
Marketing and prescribing of oxycodone fuelled the opioid epidemic in the United States, still raging almost 30 years after the drug was first introduced.
To understand the previously unmapped associations between Australia’s oxycodone use and sociodemographic factors, UNSW researchers from the Medicines Intelligence Centre of Research Excellence and the National Drug and Alcohol Research Centre (NDARC) analysed linked data from 800,000 patients on PBS medicines dispensed, Medicare claims, hospitalisations and emergency department (ED) visits between 2014–2018.
[caption id="attachment_25808" align="aligncenter" width="400"] Dr Malcolm Gillies[/caption]
While the research centres on oxycodone use in NSW, lead researcher Dr Malcolm Gillies said the findings are representative of the Australian population.
‘There's not much difference between NSW and Victoria in prescribing, which accounts for most of the population.’
Older Australians are more likely to be new users of oxycodone
Initiation rates of oxycodone follow an age gradient, with the average age of new users being 54.7 years of age.
‘Among our oldest age category, which is 85 years and older, patients were started on opioids on average three times more often than those in the youngest age group (18–24),’ said Dr Gillies.
Higher prescribing rates of oxycodone in older patients relate to the higher disease burden in this demographic.
‘For example, there's a higher prevalence of falls and cancer, which are precursors to opioid use,’ he said. ‘But the higher risk of adverse events with opioid use in older patients is something to bear in mind.’
Women are more likely to be initiated on oxycodone than men
An unexpected finding was the ‘definite blip’ of oxycodone use among women of childbearing age (18–44), who have ‘significantly higher’ initiation rates than their male counterparts.
Oxycodone is commonly used after hospital discharge in Australia. But because younger age groups use the opioid less frequently, there’s a distinct reason why prescribing rates are higher among females.
‘Looking at the list of diagnoses in the hospital episodes that precede the start of oxycodone, caesarean sections are quite high on the list.’
Regional and remote use is higher, but socioeconomic status doesn’t factor in
Echoing other research about patterns of opioid prescribing, oxycodone was initiated more frequently in areas outside major cities than in urban areas.
Injury rates are typically higher in rural areas as opposed to urban locations, which is a key differentiator in opioid prescribing, said Dr Gilles.
‘Those injuries tend to be more severe, with longer-term consequences,’ he said. ‘Specialist services are also harder to access outside cities, including chronic pain services – which are important down the line.’
However, there was one distinct variation. ‘Unlike other studies, we didn't see that oxycodone use varied according to socioeconomic status, once we accounted for where people were living, their gender and age,’ he said.
A proportion of the population will become long-term oxycodone users
Patients were typically prescribed oxycodone post-hospital discharge, after a therapeutic procedure, or ED visit, together accounting for half of all initiations.
‘On the other hand, hospital admission for injury or a past-year history of cancer were less common reasons for oxycodone initiation than surgery,’ said Dr Gillies.
Most of the time (two thirds), patients were only dispensed a single pack of PBS oxycodone. But 4.6% of people had a recent dispensing of oxycodone a year after initiation.
‘Even after a serious operation we would expect the need for oxycodone to relieve pain would be over by 90 days,’ said Dr Gillies.
‘The fact that a proportion of people were taking oxycodone 12 months later underlines the need for early, careful assessment of ongoing pain to maximise appropriate use of non-opioid and non-pharmacological pain control.’
While there was no data available on the reason for dispensing at the 12-month mark, Dr Gillies said it was presumably due to an ongoing need for analgesia.
‘Among trauma patients, persistent use is much more common, which is well known in the literature,’ he said. ‘If you have a serious injury and difficult recovery, that might lead to some form of chronic pain.’
While the research didn’t delve into the appropriateness of use, oxycodone prescribing was more often than not for ‘plausible reasons’, including tonsillectomy, or hip and knee replacements. But this wasn’t always the case.
‘There was more room for variation in some cases, including presentations to ED for backache or acute abdominal pain,’ said Dr Gillies.
Recent research revealed that opioids don’t help acute non-specific lower back or neck pain. Other studies have found that physiotherapy is an effective non-pharmacological alternative for ED backache presentations.
‘That can sometimes mean patients don’t need to receive an opioid,’ he added.
The research doesn't tell the full picture
One shortcoming of the research is that other prescribed opioids, available via private prescription, were not recorded. Codeine was also accessible over-the-counter during part of the study period, said Dr Gillies.
‘That means we couldn't see if people were switching between oxycodone and codeine, for example,’ he said. ‘So we may have underestimated the long-term use.’
Better access to data, including GP data linked to the other data sources such as specialist prescribing, would provide a broader idea of oxycodone use, and improve development of healthcare policy and initiatives.
‘Australia has a fragmented healthcare landscape, so getting data about what happens in every corner is a bit of a jigsaw puzzle,’ he said.
Dr Gillies thinks the difference between city and rural oxycodone prescribing should also be further explored to ensure use is appropriate outside metropolitan areas.
‘We've got a follow-up study coming soon which specifically looks at use after hospital discharge’ he said. ‘So watch this space.’
Oxycodone use is trending downwards
While there was a slight increase in oxycodone prescribing from 2014–2017, use tapered off again from 2017–2018, said Dr Gillies.
‘That includes the level of people starting oxycodone for the first time, the level of people who were ongoing users and the proportion of oxycodone among all opioids.’
This downward trend suggests some of the policy levers which have already been pulled – including PBS-listing changes, prescribing restrictions, and real-time prescription monitoring – are working.
‘We don't know whether they're increasing appropriateness, but they are certainly decreasing use,’ he said.
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[post_content] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
The Excellence Awards recognise local pharmacists involved in innovative practice, those who are striving to raise practice standards, and those who, through their professionalism, provide a model of practice which others seek to emulate.
PSA SA/NT President Dr Manya Angley FPS congratulated the award recipients.
‘The passion and dedication of pharmacists across South Australia and the Northern Territory is clear. It’s our pleasure to recognise some of them tonight on behalf of the PSA,’ she said.
‘[They] exemplify the highest level of pharmacy practice, from embracing every early career opportunity to driving positive rural health outcomes through to a lifetime of professional excellence.’
Here are the outstanding SA/NT pharmacists who were recognised in this year’s awards.
[caption id="attachment_25798" align="aligncenter" width="600"] PSA SA/NT Pharmacist of the Year Natasha Downing MPS[/caption]
Natasha Downing MPS, SA/NT Pharmacist of the Year
Natasha Downing is a proud South Australian rural woman. She was born and spent her childhood in Jamestown, SA. After a high school education in Adelaide and completing her university studies, she returned to the area where she has been a community pharmacist since 2007. She has a deep commitment to ensuring all those who call the mid-North of South Australia their home can achieve best possible health outcomes.
Since her credentialing in 2015, Ms Downing has seized every opportunity to advance the integration of pharmacists across service delivery in the wider region. As a local, she has a deep understanding of her patients’ journeys and needs. She came to the attention of the Goyder's Line Medical Practice through her high-quality medication reviews (HMRs and RMMRs), and community pharmacist roles. She was then welcomed to the general practice team through a PHN-funded Pharmacist in GP practice opportunity.
Across all her roles, Ms Downing connects well with patients from all walks of life and delivers the same respectful, caring, flexible and high-quality service to all. She goes above and beyond to meet the needs of patients and ensure they use their medicines optimally while considering the broader context of their healthcare. These skills are best applied in her palliative care role, an extremely challenging time for both the patient and their loved ones, where she ensures her patients can express choice and maintain dignity and comfort.
Ms Downing is both a trail blazer and a quiet achiever within the profession. She is an exceptional role model, especially for rural women, and exemplifies PSA’s mission to embed, equip and enable pharmacists to be at the forefront of healthcare in Australia.
[caption id="attachment_25797" align="aligncenter" width="600"] PSA SA/NT ECP of the Year Raymond Truong MPS[/caption]
Raymond Truong MPS, SA/NT Early Career Pharmacist of the Year
ECP Raymond Truong is a fierce advocate and true leader, with a particular focus on supporting and elevating the voices of young pharmacists.
Mr Truong is deeply committed to promoting opportunities for ECPs across all practice settings.
He has been an active PSA member since 2016 and has taken full advantage of the leadership and mentoring opportunities on offer, including membership of the SA/NT PSA ECP working group committee in 2021.
Mr Truong joined the ECP Communities of Special Interest Leadership Committee in 2023. In the same year, he became the ECP representative on the SA/NT Branch Committee. He enthusiastically volunteers to represent the SA/NT Branch to showcase its strengths and build interdisciplinary relationships with other professional groups – including presenting at interprofessional collaboration events between pharmacists and dentists (2021, 2023) and podiatric prescribers (2023).
In his community pharmacy roles, Mr Truong has driven vaccination services, administration of other medicines by injection and a broad range of other advanced professional services. He is a COVID-19 vaccination provider, influenza and whooping cough, a Medication Assisted Treatment for Opioid Dependence service provider, and has played a key role in integration of professional services including B12 administration, Take-Home Naloxone, MS-2 dispensing, and expansion of vaccination services in his practice.
He has also held the position of Pharmacist Manager at Terry White Chemmart Paragon (Modbury), and is currently Professional Services Community Pharmacist at Terry White Chemmart Findon and a community pharmacist at Chemist King, Klemzig.
Mr Truong was elected Chair of SA General Practice Pharmacist Peer Network – a Community of Practice of primary care pharmacists.
In October 2023, he became credentialed to conduct medication management reviews and established a private consultancy, Pill Box Education Services. Mr Truong has commenced conducting HMRs and regularly conducts RMMRs at Pennwood Village Aged Care Home, as well as actively participating in Medicines Advisory Committee meetings in preparation to take on a role as an on-site aged care pharmacist when this program rolls out.
[caption id="attachment_25796" align="aligncenter" width="600"] PSA SA/NT Intern of the YearChloe Hall MPS[/caption]
Chloe Hall MPS, SA/NT Intern Pharmacist of the Year
Chloe Hall’s intern year has been a case study in the power of self-belief. She started her intern year with plenty of fundamental skills and a desire to achieve, but maybe a little self-doubt. As the weeks went by, she continued to extend herself beyond her comfort zone, leading training, embracing opportunities for complex conversations with patients, collaborating with doctors and conducting new pharmacy services.
The more she did these activities, the more evident were her abilities. As she came to quietly recognise this herself, Ms Hall’s practice leapt to an exceptional level. By the end of her internship, the quality of her work, initiative, knowledge and skills made Ms Hall the pharmacist that patients were asking for and to whom more experienced pharmacists would consult and confer with.
[caption id="attachment_25800" align="aligncenter" width="600"] PSA SA/NT Lifetime Achievment Award recipient Peter Halstead FPS[/caption]
Peter Halstead FPS, SA/NT Lifetime Achievement Award
Over his 40-year long career, Peter Halstead has made a sustained contribution to the pharmacy profession and associated organisations, dedicating himself to developing and advancing Australian pharmacy practice. Through these activities, Peter has made a significant contribution to patient care. He has been an advisor, mentor and friend to many members of our profession and epitomises the values of PSA.
After graduating in 1980, Mr Halstead worked as a community pharmacist and was instrumental in developing new areas of practice, becoming a pharmacist adviser to the Department of Veterans Affairs, the Drug and Alcohol Services and The Family Planning Unit at SHINE SA.
In 1996, Peter joined the School of Pharmacy as a research fellow involved with Professor Andy Gilbert and others in the development of new pharmacist roles, particularly in the area of aged care services.
Between 2000–2001, Mr Halstead was the Education Officer of the Pharmacy Board of South Australia. From 2001–2010, he was the Registrar of the Board, a position he held with distinction until the formation of the National Pharmacy Board. During his tenure, Mr Halstead developed and implemented systems and procedures that allowed the formal assessment of the competency of recent graduates and others seeking registration as pharmacists in SA.
Mr Halstead was a Director of the Australian Pharmacy Council from 1996–2010, and since 2010 has been the Senior Pharmacist for the APC involved in the development of assessment processes for intern pharmacists as well as pharmacists from overseas seeking registration with the National Pharmacy Board. He actively supported many overseas pharmacists who were going through the formal process of seeking registration and became a mentor to many.
Mr Halstead was appointed as the General Manager of the Pharmacy Regulation Authority, South Australia (PRASA) in 2010, a position he held for 12 years until his recent retirement. During this period, he continued to engage with the Pharmacy Board of Australia on many issues affecting Australian pharmacy practice.
[caption id="attachment_25795" align="aligncenter" width="600"] Pharmaceutical Society Gold Medal recipient Amelia Thompson[/caption]
Exceptional student recognised
The PSA also awarded the Pharmaceutical Society Gold Medal, recognising the University of South Australia student with the highest grade point average in the Bachelor of Pharmacy (Honours) above 6.25.
Given the stringent criteria, PSA’s most prestigious student award is not awarded every year. Recipient Amelia Thompson joins a very impressive and select group of pharmacists.
[post_title] => Pharmacists recognised for excellence
[post_excerpt] => The PSA recognised outstanding pharmacists at its 2024 South Australia and Northern Territory Excellence Awards in Adelaide over the weekend.
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[post_content] => Measles cases are skyrocketing worldwide. Despite being declared ‘measles free’ since 2014, more than 28 cases of measles have been recorded in Australia this year, including recent alerts in Sydney and South Australia.
This is more than the number of cases recorded in 2023 all together. Is this just a reality of more overseas-acquired cases following increases in overseas travel, or is Australia’s measles-free status at risk?
Professor Margie Danchin, group leader of the Murdoch Children’s Research Institute’s Vaccine Uptake Group, shares seven things pharmacists need to know about measles.
About our expert
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‘To prevent outbreaks of measles, we need coverage of about 95% for two doses.' Professor margie danchinWith the borders now open, international travel resumed, and a dramatic increase in measles cases globally – the biggest outbreak risk is the importation of measles cases from travellers into Australia. ‘Outbreaks are coming, we will see them this year,’ she said. ‘We know coverage is low in many regions, so it's only a matter of time.’ Along with being highly infectious, measles also has a significant morbidity rate in children under 5 years and older adults. About 1 in a 1000 people or 0.1% will die from measles. ‘It can cause inflammation of the brain, seizures, and respiratory complications such as pneumonia,’ said Prof Danchin. If pregnant women contract measles, babies can be born prematurely or have low birth weight. However, because MMR is a live vaccine, it cannot be administered in pregnancy. ‘Women contemplating pregnancy, travel, or both need to think about their MMR status before they get pregnant,’ she said.
‘Outbreaks are coming, we will see them this year.We know coverage is low in many regions, so it's only a matter of time.' Professor margie danchin‘If pharmacists are aware an adult is travelling, they should ask about polio, measles, and whooping cough vaccination,’ she said. ‘Parents might also come in for some travel medicine or talk about travel, and pharmacists can say “please make sure your children have their measles vaccine if you're going overseas”.’ Children under 12 months (but over 6 months) of age travelling to an area where measles is circulating can receive one dose of the MMR vaccine to ensure some protection against the virus. However, the child will still require two doses of the MMR vaccine at 12 and 18 months of age for a sufficient immune response.
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[post_content] => Case scenario
Elli, 25 years old and 18 weeks pregnant, presents to your pharmacy asking if there is anything she can safely use in pregnancy for hay fever. Elli’s main symptom is significant daily nasal congestion, and she used beclomethasone nasal spray prior to pregnancy with good effect. Elli would prefer to use the beclomethasone again, if possible, as she knows it works well for her. She has not been using anything since finding out she is pregnant, due to safety concerns, but is now desperate for some relief.
Introduction
The Therapeutic Goods Administration (TGA) uses a categorisation system for prescribing medicines in pregnancy that was developed based on the available evidence of the risks associated with taking prescription and over-the-counter medicines during pregnancy.1
This system is used by healthcare professionals, in addition to other evidence-based references, to aid decision-making and to support the safe use of medicines in pregnancy.1
While the current categories present as a simplistic grading system, they do not always accurately communicate clinical risk, or always consider all important factors, such as dose, gestation at the time of exposure, or route of administration. There may also be more current safety and risk information that has become available since the categorisation was issued.2-4
This article discusses the current system, potential issues relating to its use, and the key considerations when determining if a medicine is safe to use by a pregnant person.
Learning objectivesAfter reading this article, pharmacists should be able to:
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Overview of the categories
Category B3
These medicines ‘have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.’1
A specific example of how navigating category B can be difficult is aciclovir (both oral and topical), which remains a category B3 medicine despite extensive human clinical experience having demonstrated no associated increased risk of congenital malformations and it being considered safe to use by specialised references.1,6
Category C
This category includes medicines that ‘owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details’.1
Metformin is an example of a category C medicine. Evidence-based resources indicate that metformin has not been found to be associated with an increased risk of malformations or adverse pregnancy outcomes; however, some studies have suggested it may contribute to increased subcutaneous fat or body mass index and adverse metabolic profiles in the child. Monitoring of both the pregnant person and fetus is recommended when it is used.1,6
Category D
This category includes medicines ‘which have caused, are suspected to have caused, or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details’.1
Medicines in category D are not absolutely contraindicated during pregnancy.1 The use of a category D medicine in pregnancy may be justifiable in some cases where the benefits of treating the maternal condition outweigh the relative risks associated with the medicine for the developing fetus. The category D grading of a medicine may also not be relevant at all stages of a pregnancy or at all doses/dose forms.
An example of this is nicotine replacement therapy (NRT). Despite being category D, it can be considered for use in pregnancy when non-pharmacological management is unsuccessful, as the risk of using NRT to the fetus is considered lower than the risk of tobacco smoking.1,6,7,
Category X
This category includes medicines ‘which have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.’1
Isotretinoin is an example of a category X medicine. Exposure in pregnancy has been associated with an increased risk of congenital malformations, including craniofacial, cardiac and central nervous system defects, spontaneous abortion, perinatal mortality and premature birth.1,6
Its use is contraindicated in pregnancy and for those planning to conceive.6
Patient considerations
Case scenario continuedYou discuss identifying and avoiding triggers and using saline nasal spray as a first-line management approach. If this is not possible or not effective, given Elli is having significant daily symptoms, an intranasal corticosteroid could be considered. You review the over-the-counter intranasal corticosteroids and note that budesonide is category A, and beclomethasone and others are category B3. You review the AMH, MotherSafe resources and the Women’s Pregnancy and Breastfeeding Medicines Guide. You note that despite being category B3, beclomethasone is considered safe to use, as when it is used intranasally it enters the bloodstream minimally and it has not been associated with an increased risk of congenital malformations. You explain this and refer Elli to the MotherSafe ‘Hay Fever in Pregnancy and Breastfeeding’ resource for reassurance. |
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
