Jennifer Cooke
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[post_content] => Formal negotiations have begun on a new Pharmacy Programs Agreement (PPA), which sits outside the 8th Community Pharmacy Agreement, the federal Minister for Health, Disability and Ageing Mark Butler announced at PSA25 today.
‘The PSA is the natural home for this agreement because you’ve helped drive the development of new and emerging roles for pharmacists,’ Minister Butler said in his plenary address, which opened PSA25 this morning at Sydney’s International Convention Centre.
First announced in January this year, the proposed agreement between the Australian Government and PSA is expected to strengthen 17 pharmacy programs delivered by pharmacists across the health system.
These include medication management programs such as Home Medicines Reviews and Residential Medication Management Reviews, Aboriginal and Torres Strait Islander-specific programs and rural support programs that encompass pharmacists in a range of practice areas.
PSA National President Associate Professor Fei Sim FPS told delegates: ‘We know these programs work, but for too long pharmacy programs have been scattered across a range of mechanisms without comprehensive evaluation of their impact. That’s part of what this agreement will do.’
Minister Butler also acknowledged PSA’s key role as a signatory to the new agreement ‘as the Albanese Government's health reform agenda continues to unfold, a role that we are committed to enhancing further in enabling you to work at your full scope of practise in delivering more services’, he told the more than 1,200 delegates attending PSA25.
PSA’s agreement approach
The Agreements Lead is National Board Member Associate Professor Shane Jackson FPS. He will head a team of senior pharmacists, including Consultation Lead Debbie Rigby FPS, National Board Member Bridget Totterman MPS, PSA’s General Manager for Policy and Program Delivery Chris Campbell FPS and PSA’s Canberra-based Senior Pharmacist – Strategic Agreements Rhyan Stanley MPS. Input is also expected from the Consultant Pharmacists Community of Specialty Interest led by Deborah Hawthorne FPS.
PSA’s approach from now is expected to be guided by findings from the formal consultation process that began several months ago, according to A/Prof Sim.
There will also be ongoing feedback from stakeholder groups and members and outcomes from a sector-wide roundtable. All responses will continue to shape PSA’s position on key elements of the agreement.
A/Prof Sim also announced that PSA, as a federated organisation, had reached a historic 20,000 members for the first time.
‘This growth reflects the value pharmacists see in what PSA offers,’ she said. ‘Pharmacists are looking for more than just representation, they’re looking for support, connection, and leadership.
‘We’re investing in expert-led, flexible education to support every stage of pharmacy careers and across areas of practice. We’re building a connected, passionate community that understands the goals and challenges our members face.’ She said PSA was also collaborating with other organisations and partners in giving pharmacists the confidence to expand their scope of practice.
Working to full scope
In his address, Minister Butler also canvassed government measures including recent enabling legislation for cheaper medicines for consumers earlier this month with the general co-payment for PBS medicines to be reduced from $31.60 to $25 from 1 January 2026.
‘We want to remove the barriers to working at full scope, reconciling varying state and territory approaches, removing red tape, changing cultures so that we can get, frankly, the absolute best out of you,’ he told hundreds of pharmacist delegates.
His colleague, pharmacist and Assistant Minister for Mental Health and Suicide Prevention and Assistant Minister for Rural and Regional Health Emma McBride told the conference that the government was now considering the 18 recommendations of Professor Mark Cormack’s Unleashing the Potential of our Health Workforce – Scope of Practice Review, with A/Prof Sim part of the review committee.
Working towards a common goal
As PSA moves through the negotiation phase of this new agreement, A/Prof Sim said it was important to ‘pause and recognise the significance of what we are working toward’.
‘Whilst we need to remain pragmatic in our approach, this agreement will lay the foundation for a new, long-overdue infrastructure that has the potential to reshape the future for generations to come. This new agreement belongs to our profession, and PSA will do everything we can, within our ability, to do this for our profession.’
By negotiating a new agreement to govern these 17 specific programs, PSA is seeking to ensure they maximise the positive impact the pharmacy profession can have on patients across multiple areas of practice, she said.
Meanwhile, consultation on pharmacy programs remains open. PSA members are encouraged to provide any additional information, feedback and case studies.
Learn more about membership benefits at www.psa.org.au
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[post_content] => Over the past few years, the words ‘scope of practice’ have been on the lips of pharmacists and government officials, with the hope of addressing some of the major challenges of our health system.
The Unleashing the Potential of our Health Workforce – Scope of Practice Review final review, delivered last year, made sweeping recommendations to how we deliver healthcare in Australia.
However, the 18 recommendations require several hurdles to be overcome before implementation – including changes to how healthcare professionals are trained, and how services are funded and regulated.
But there is movement happening. In July, Queensland pharmacy prescribing pilots became permanent, with 17 individual prescribing services now delivered across the state by pharmacists qualified to prescribe independently and autonomously.
The Queensland Government has also provided additional prescribing initiatives, including partnered pharmacist medication charting as well as therapeutic adaptation and substitution – providing pharmacists with more autonomy and options to help their patients.
Other jurisdictions around the country have also made announcements around prescribing pilots and permanent schemes.
But how far do we have to go to unleash the real potential of the healthcare workforce?
This was the burning question – among others – asked at the Scope of practice panel at PSA25 today.
When will there be harmonisation?
The federal Department of Health, Disability and Ageing has looked at the recommendation about harmonisation of the national legislative framework, said Deputy Secretary for Health Resourcing Penny Shakespeare.
‘We've already had a crack at trying to harmonise drugs and poisons legislation,’ she said. ‘We did a plan about 10 years ago, but we really need to take that forward now – and we're trying to get all of our governments to sign up to that.’
The department also needs to map out what the response will look like in the longer term, including how the health system’s funding and training arrangements are reformed.
‘We need to have a common approach, and if we do not reform in a coordinated way, we will actually hold back implementation of arrangements of practice,’ Ms Shakespeare said. ‘We've really got to try and lock down why we have differences at a state-by-state level, work through if they are evidence-based. And if not, we've got to try and make full changes to implement consistency.’
What’s the value for patients?
ACT-based Shivana Chandra, who works for the Health Care Consumers Association as a research officer, said she can often wait 3–4 weeks to get a GP appointment.
‘And if you've got a UTI, that is not a nice time to wait,’ she said.
Having the UTI prescribing pilots and programs around the country means patients can access the care they need much faster – preventing further deterioration of health.
‘But it's also a cost issue,’ Ms Chandra said. ‘It takes away that cost pressure of having to pay for the GP, then go back to the pharmacist to get treatment.’
But there is not much community awareness of these various pilots and programs, Ms Chandra thinks.
‘You never see any promotions for these programs about what’s happening in pharmacy,’ she said. ‘So you miss a lot of opportunities that way.’
Consumers also rely on healthcare professionals to get their information.
‘There needs to be better promotion from the pharmacists themselves about what they offer, how you can access it and where you can find out more information about it.’
What does it take to embed independent prescribing?
The United Kingdom has had it easy in terms of implementing pharmacist prescribing nationwide, according to Honorary Professor of Pharmacy Policy and Practice
University of Nottingham Bruce Warner.
But there are definitely some lessons Australia can take from the UK, which introduced independent prescribing in 2006.
‘While it’s not a quick process, it’s really important to get the foundations in place, and you have to bring people along with you,’ he said.
‘We spent a lot of time putting infrastructure in place, [including] things such as making sure our community pharmacies had a secure email address, which was one of the objections towards [pharmacist prescribing].'
Pharmacists should also expect a fair amount of scrutiny, but there is a way forward.
‘I was working with our National Patient Safety Agency when independent prescribing came in, and we were getting daily requests from the medical press asking, “How many errors are pharmacists making? How many patients are being harmed?”’ Prof Warner said.
‘Of course the reality was far fewer than they thought, but the scrutiny was intense. And you have to be able to live with that, anticipate that, and be able to work with that and work through it.’
But in 2026, the UK’s first pharmacy graduates will automatically become pharmacist prescribers.
‘That will change things dramatically,’ he said.
Could pharmacists prescribe on the PBS in the future?
Access to subsidised medicines for pharmacists is essential, Ms Shakespeare said.
‘We need [subsidised] supply of medicines to actually deliver change for consumers, and that's not what we've got,’ she said.
But there are some issues that need to be addressed first.
‘We've got a single professional body deciding whether a patient needs a medicine and financially benefiting from the supply of that medicine,’ Ms Shakespeare said. ‘[But] we have the technology [to develop] protocol-based, electronic clinical decision support systems.’
Supporting effective multi-disciplinary team-based care, allowing for information about changes in a patient's medicine regimen to be shared with all members of the care team, is also a top priority.
‘That's the building block we're really focused on at the moment, and have been developing work on that in the department.’
What about substitutions?
While Queensland-based pharmacists are now able to make adaptations and substitutions to prescriptions, the altered scripts will not be PBS subsidised, which multi-pharmacy owner and PSA Board Director Bridget Totterman MPS finds ‘extremely frustrating’.
‘It makes no sense that a patient can't access the PBS for a script that is either adapted, substituted or prescribed,’ she said. ‘Let the pharmacist help the first time.’
However, it is a step forward. After all, there would be no NIPVIP without QPIP.
‘We're absolutely going to fight and advocate for common-sense reform, but we will celebrate the wins along the way,’ she added.
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[post_content] => Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between justified care and risky overreach.
Australia’s adolescent mental health crisis is escalating at a troubling pace. A landmark longitudinal study by Murdoch Children’s Research Institute revealed that by age 18, nearly three quarters (74 %) of Australian teenagers experienced clinically significant symptoms of anxiety or depression at least once – with many enduring chronic episodes spanning multiple school transitions and exam periods.
The Australian Bureau of Statistics confirms that in 2020–22, 38.8 % of 16–24 year‑olds reported a mental disorder in the past 12 months, dominated by anxiety (17.2 %). Contributing factors are complex: academic pressure, early puberty, growing social isolation, socioeconomic stress, and particularly, the impact of social media.
The increase in prescribing
Similarly, antidepressant prescribing among Australian adolescents is on the rise, raising concerns about off-label use and high-dose regimens – with the pharmacist’s role in ensuring safe and appropriate therapy more important than ever. A 2024 ABC report noted that psychotropic use in under‑18s more than doubled from 2013 to 2023.3
Between 2013 and 2019, Selective Serotonin Reuptake Inhibitor (SSRI) prescribing in adolescents steadily climbed, with GPs accounting for 55 % of prescriptions in 12–14 year‑olds and 78 % in 15–17 year‑olds.
According to consultant pharmacist Amanda Fuller, Clinical Lead at Medcast, the increase in antidepressant prescribing reflects a complex mix of demand, access issues, and public perception.
[caption id="attachment_29976" align="alignright" width="300"]
Amanda Fuller[/caption]
‘We’re seeing a growing awareness of mental health in young people, which is a positive shift,’ Ms Fuller said. ‘But when that’s combined with long waitlists for psychologists and psychiatrists, GPs often feel pressure to act quickly – particularly if there are concerns about deterioration or safety.’
This urgency is sometimes reinforced by family expectations. ‘Parents and carers may see antidepressants as a fast-acting solution while they wait for psychological support,’ she added.
Off-label use in high doses
Most prescribing for under-18s is off-label, which complicates matters, Ms Fuller said.
‘This places the responsibility on prescribers to weigh clinical judgment and available evidence against regulatory guidance.’
In Australia, only fluvoxamine and sertraline are approved by the Therapeutic Goods Administration (TGA) to treat obsessive-compulsive disorder (OCD) – in children aged 6 and 8 years and older, respectively. Others are used beyond their approved indications.
Fluoxetine remains the most commonly prescribed antidepressant in this cohort. ‘It’s the recommended first-line SSRI for adolescents and is the only one with consistent trial evidence showing efficacy over placebo in depression,’ Ms Fuller said. ‘But even then, the benefit was modest, placebo response rates were high, and study quality was poor, making interpretation difficult.’
In anxiety, the data is even less robust. ‘There’s limited evidence, though fluoxetine, fluvoxamine, and sertraline have shown some benefit in trials. But again, quality is a concern,’ she said.
Public understanding of antidepressants is also often shaped by outdated ideas, Ms Fuller said. ‘The “chemical imbalance” theory has been largely debunked, but it still drives the belief that medication is essential for treatment.’
More concerning is the increasing use of high-dose antidepressant regimens, sometimes exceeding standard adult doses.
‘We know higher doses are sometimes used in OCD, and prescribers may consider the adolescent’s physical maturity. But there’s no strong evidence to support routine high-dose use in this age group,’ she said.
Psychiatrists are more likely than GPs to prescribe these higher doses, often in complex or treatment-resistant cases. However, efficacy data for higher doses is lacking – even in adult populations.
‘In fluoxetine studies, response rates were actually highest between 20–40 mg daily,’ Ms Fuller said. ‘Going beyond that was linked to more [adverse] effects and increased dropout rates.’
The role of pharmacists
Pharmacists should take a proactive yet respectful approach when faced with uncertainty around an antidepressant prescription, Ms Fuller advised.
‘If something doesn’t add up – if you can’t confirm the indication, or there’s limited information about the treatment plan – it’s absolutely appropriate to contact the prescriber,’ she said.
Before doing so, she recommends checking key factors: ‘Clarify the diagnosis, assess for any psychosocial supports in place, confirm adherence and tolerance, and look at what the follow-up plan involves.’
When contacting prescribers, Ms Fuller urges pharmacists to approach conversations with collaboration, not correction. ‘Assume clinical reasoning is there – your role is to clarify, not challenge,’ she said ‘Focus on shared care, not prescription policing.”’
Australia’s adolescent mental health situation demands attention and pharmacists have a pivotal role in it. Soaring rates of depression, anxiety and antidepressant prescribing underscore the need for thoughtful, patient-centred care.
PSA25's session on ‘Dosing dilemmas’, presented by Ms Fuller, offers essential guidance on navigating adolescent antidepressant use – from informed dosing choices to structured monitoring and collaborative decision-making.
Haven’t registered for PSA25 yet? Don’t miss your chance – registrations are still open.
[post_title] => Why are so many teens prescribed high-dose antidepressants?
[post_excerpt] => Youth mental health needs are rising, but so too are questionable prescribing patterns of antidepressants.
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[post_content] => A look at Turlington’s 27‑ingredient balsam, its broad therapeutic claims and how it contrasts with today’s evidence‑based approaches.
Robert Turlington was a 21st Century pharmacist living in the 18th Century. But the Londoner wasn’t always the successful entrepreneur he later became. Instead, Turlington (1697–1766) began his working life as a weaver – and a bankrupt one at that – courtesy of his demanding specialty: silk.1
According to archaeologists Olive Jones and Allen Vegotsky, the ‘multidimensional’ challenges of the silk trade, along with the fallout from bankruptcy, had an unexpected upside. They pushed Turlington to develop skills in marketing, labour organisation and even fashion. This expertise helped him change careers and, in 1740, grow a one-man pharmaceutical operation into an early multinational success story.1
Let sales begin
By 1742, Turlington was selling his Balsam of Life into a market packed with competitors like Friar’s Balsam.2 Both elixirs were sold as treatments for several illnesses and injuries. But in no time, Turlington went beyond ‘several’, pitching his product as a veritable ‘cure-all’.1–5,10
‘The aforesaid Balsam is a certain relief for the gravel, cholic, rheumatism, gout, and sciatic pains, and all colds, coughs, consumptive, pectoral, asthmatical, and nervous disorders, &c. and for any cut, bruise, or the like, as thousands can testify who have been relieved thereby, in the above and other complaints, after every other resource has failed,’ claimed Turlington in a 46-page testimonial pamphlet, accompanying each sale.1
In line with the era’s one-product, multi-ailment ‘polypharmacy’ approach, Turlington’s ‘perfect friend to Nature’ initially contained 27 ingredients in an alcohol solution. Over time, that was reduced to just eight. The key ingredients remained plant-based balsams: gum benzoin, storax and Tolu and Peruvian balsam. Aromatic spices like cinnamon, saffron and nutmeg masked the balsams’ unpleasant taste.1,2,5,6,10
Originally sold in round vials, Turlington’s nostrum became so popular that in 1746 he introduced the first of several distinctively shaped bottles to deter imitators.
In 1754, he followed-up with a unique pear-shaped bottle, which continued to be used in different sizes for over 150 years.1,3,7
They remain collectors’ items to this very day.1,4,5,7,8
Promote, protect, expand
Turlington’s distinctively shaped bottles were more than eye-catching – they reflected a shrewd business strategy.
At a time when English medicines were unregulated, Turlington promptly acquired one of the country’s first medical patents.1,3 Granted by King George in 1744 and lasting until 1758, the patent gave Turlington the legal right to prosecute imitators and widely promote his ‘miracle cure’ – a task he embraced with gusto.1,3,8
‘He had the cachet of having the king’s approval of his medicine, a fake coat of arms, a memorable name, a booklet given free with every purchase, a fixed price, and testimonials from satisfied customers who provided information on ailments that could be treated successfully with Balsam of Life,’ note Jones and Vegotsky.1
In 1748, Turlington extended his patent to include Britain’s North American colonies. Geographic expansion soon followed with sales to the emerging United States, Canada, the West Indies and, yes, Australia. Of course, he also pushed into Scotland, Ireland and Europe.1,3,8–10
Did Turlington’s balsam work?
With so many ingredients in varying amounts, used to treat a wide range of conditions, it’s difficult to say how effective the balsam truly was. At best, balsams exhibit anti-inflammatory, antioxidant and antimicrobial effects.11
Whether it worked or not, Turlington’s balsam left an enduring legacy – in pharmacy history, and also on collectors’ shelves.
References
- Jones O, Vegotsky A. Turlington’s Balsam of Life. Northeast Historical Archaeology. 2016;45:1.
- Dayton L. Friar’s Balsam has a place in modern life. Australian Pharmacist 2024;43(7):66.
- Abbott A. Turlington’s Balsam of Life: Colonial American snake oil? University of Central Florida, Center for Humanities and Digital Research.
- Pope A. Turlington's Balsam, the 18th-century cure-all. Canadian Geographic 2016 7 July.
- Griffenhagen GB, Young JH. Old English patent medicines in America. Contributions from The Museum of History and Technology: Paper 10. Project Gutenberg EBook 30162.
- Dilworth LL, Riley CK, Stennett DK. Chapter 5 - Plant Constituents: Carbohydrates, oils, resins, balsams, and plant hormones. Pharmacognosy, Academic Press 61–80 2017.
- Jones OR. Essence of Peppermint, A history of the medicine and its bottle. Hist.Archaeol. 15(2):3, 28, 33.
- Kemp J. Bottles 1. Turlington's Balsam of Life: the 1754 design. Cures All Diseases.com. 2020.
- Young JH. The Toadstool Millionaires: Chapter 1. Quackwatch. 2002 29 Apr.
- Keys R. Turlington’s Balsam of Life. The Adverts 250 Project. 2022 17 Feb.
[post_title] => Lessons from one of the first medicinal patents
[post_excerpt] => Turlington's Balsam was pitched as a veritable ‘cure-all’ in the 18th century – and remains on collectors’ shelves today.
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[post_content] => Case scenario
[caption id="attachment_27199" align="alignright" width="225"]
This activity is sponsored by PDL. This information is general in nature and designed only to highlight issues for your consideration. Before acting on this information, you should consider your individual circumstances and needs, and obtain advice as appropriate.[/caption]
Joyce, 76, lives independently and takes seven regular medicines with various dosing frequencies. She struggles to manage her medicines, especially with frequent brand changes due to supply issues. To help herself remember, Joyce recently began placing her daily tablets in a dish on the kitchen bench. During a visit, her 6-year-old grandson mistook the tablets for lollies and was about to swallow them when he was stopped just in time. Joyce is shaken by the incident and distressed by what could have happened.
After reading this article, pharmacists should be able to:
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Medicine safety is critical to improving health outcomes for children.1 However, ensuring safe and effective medicine use in paediatric populations presents unique challenges, due to differences in physiology, dosing requirements, and patterns of medicine use compared to adults.
Safety concerns arise because many medicines are prescribed off-label for children.2–5 Clinical trial data involving child populations is limited, with many trials not conducted in children. As a result, the safety and efficacy of medicines prescribed to children are often based on extrapolation from adult data.2,3,6
Medicine-related poisoning is also a key concern for medicine safety in children. In 2021–22 in Australia, 8,288 children were hospitalised due to poisoning-related injuries.7 Many of these hospitalisations were the result of accidental poisonings.1 An Australian review of emergency department data from 1 January 2015 to 31 December 2016 found that accidental exposure was the cause of 82% of poisoning cases involving preschool-aged children.8 Research shows that medicines, ‘including adult and paediatric over-the-counter and prescription medicines, are the leading cause of hospitalised unintentional poisonings’ in children in Australia.9,10
Unintentional exposures occur due to a variety of reasons. Data from the NSW Poisons Information Centre show that poisonings involving paracetamol–opioid combinations, ibuprofen–codeine combinations and oxycodone are common in children under 5 years of age.11 This is largely due to the inquisitive nature of children.5,11 Other reasons include therapeutic errors, such as incorrect dosing, incorrect dosing interval, incorrect patient or incorrect drug.11 This may be due to a dosing error by a parent or carer or unintended exposure to a medicine that was not intended for them.12
Risk factors for child poisoningSocioeconomic disadvantage has been found to increase the risk of unintentional poisoning in Australia.9 People who experience socioeconomic disadvantage often have ‘more comorbidities, use more medication, have less access to childcare and storage equipment and are more likely to experience overcrowding’.9 Living in rented premises has also been identified as a potential risk factor, possibly due to practical constraints on modifying living spaces for safe medicine storage.⁹ However, it’s important to note that evidence is limited and evolving, and challenges with secure storage may be experienced across a range of housing situations.
Changes in prescribing patterns and medicine use can also increase the risk of poisoning exposure to children. One example is the increase in the use of psychotropic medicines in children. ADHD is a common neurodevelopmental disorder among children and adolescents.15 Research shows there has been a twofold increase in the annual prevalence of ADHD medicine use – from 4.9 per 1,000 persons in 2013 to 9.7 per 1,000 persons in 2020 – in Australia.16 There has also been a trend towards increased diagnosis and pharmacological treatment of ADHD.6,17 Methylphenidate is the most commonly used medicine for ADHD in children, followed by lisdexamfetamine.16 The growing use of ADHD medicines may increase the risk of unintentional poisoning in children.17
Non-stimulant medicines such as clonidine, guanfacine and atomoxetine may also be used concurrently with stimulant medications, particularly in young children and adolescents.16 The off-label use of clonidine for children with ADHD remains problematic due to cases of poisonings and overdose from incorrect dosing.16,18 Clonidine has a narrow therapeutic index, meaning toxicity can occur even with even small dosing errors. The Therapeutic Goods Administration (TGA) has issued a safety alert warning to pharmacists and other health professionals about the risks associated with off-label clonidine use in children.19 Pharmacists should thoroughly counsel patients, parents and carers on the importance of correct dosing and proper storage of clonidine, given the high risk of toxicity from accidental overdose and unintentional poisoning. Compounding pharmacists may be asked to prepare clonidine suspensions, as they are not commercially available. Accuracy is essential when compounding medicines, particularly those such as clonidine, where the dose is prescribed in micrograms. Dosing errors can occur when the strength is incorrectly transcribed from micrograms to milligrams, significantly increasing the risk of poisoning exposure.
Another area of concern is medicine dosing in the school setting. The use of psychotropic medicines in children is increasing, and school-aged children may need to be dosed several times per day.20 This increases the risk of medication error and poisoning exposure. Data from the NSW Poisons Information Centre from January 2014 to June 2018 show that incidents involving methylphenidate were the fourth most common poisoning exposure in schools.20 The majority of methylphenidate incidents occurred due to medication errors, such as double dosing or medicine given to the wrong child.20 In this study, medication errors accounted for 11.6% of poisoning exposures.20 Clonidine and paracetamol were also involved in medication errors in schools.20 This highlights the need for school staff to be trained in medicine safety.20
Communication: Effective communication between pharmacists and patients, parents and carers is vital to ensure the safe use of medicines and an awareness of the potential risks that may come with a medicine. Communication should be tailored to account for the socioeconomic, cultural, or educational background of the patient or carer. Counselling should include not only the dose, frequency and duration of therapy for medicines prescribed to children, but also information about safe storage, accessibility and disposal of that medicine. Accessibility and disposal are relevant in any situation where a child might be present.12 Pharmacists should promote the return of unused or unwanted medicines to the pharmacy for safe disposal, helping to reduce the risk of poisoning exposure.
Clinical judgment: Pharmacists and dispensary technicians should implement procedures to flag medicines prescribed for children, ensuring dispensed products are checked for safety and appropriateness. This requires pharmacists to access resources relevant to medicines for children, including dosing guidelines and instructions for the preparation of compounded products. This can be particularly challenging when medicines are prescribed off-label, as information may be more difficult to locate; however, pharmacists are expected to undertake a risk assessment irrespective of the medicine being proprietary, compounded or off-label.
Third party supply: Administration of medicines to children by carers or school staff may involve an increased risk of error and adverse consequences. Consistently asking parents or carers whether a child’s medicine will be administered by a third party may enable the pharmacist to provide additional counselling or support via a dose administration aid (DAA) where appropriate.
Packaging: pharmacists should ensure that all medicines, including compounded preparations, are appropriately packaged using child-resistant closures.
Access to Poisons Information: In the event of a dosing error or suspected poisoning, pharmacists should act immediately by contacting the Poisons Information Centre on 13 11 26 (available Australia-wide), or call 000 if the situation appears life-threatening.9
Pharmacists who wish to enquire about dosing or other medicine-related information prior to dispensing can contact a medicines information centre in their state, as listed in Appendix E of the Australian Medicines Handbook (AMH).
Medicine safety in children requires vigilance, clear communication and proactive intervention by pharmacists. With limited clinical trial data and increasing use of off-label and high-risk medicines, pharmacists must assess individual risks, educate carers, and advocate for secure storage and appropriate administration.
By implementing tailored strategies and promoting awareness, pharmacists can play a pivotal role in preventing accidental poisonings and enhancing the safe use of medicines in children.
Case scenario continuedAt her next pharmacy visit, Joyce mentions the incident to the pharmacist. The pharmacist discusses the risks of leaving medicines unsecured, especially around children, and offers practical solutions. These include a weekly dose administration aid (DAA) to help with organisation, a medication reminder app for her phone, and advice on safe storage, such as using a lockable drawer or placing medicines on a high shelf in a cupboard out of children’s reach. Joyce is reassured by the support and feels more confident in managing her medicines safely moving forward. |
Dr Simone Henriksen (she/her) BPharm, LLB (Hons I), PhD (Law) is a community pharmacist with over 30 years’ experience. She is also a legal academic at the University of the Sunshine Coast. Her research areas include the regulation and clinical governance of health services in Australia.
Morna Falkland BPharm
Dr Simone Henriksen is a former employee of Pharmaceutical Defence Limited (PDL) and a member of the Pharmaceutical Society of Australia (PSA). This article was developed while in the role of PDL Professional Officer.
PDL is a sponsor of the Medicine safety: children and adolescent care report, which is cited in this article.
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[post_content] => Formal negotiations have begun on a new Pharmacy Programs Agreement (PPA), which sits outside the 8th Community Pharmacy Agreement, the federal Minister for Health, Disability and Ageing Mark Butler announced at PSA25 today.
‘The PSA is the natural home for this agreement because you’ve helped drive the development of new and emerging roles for pharmacists,’ Minister Butler said in his plenary address, which opened PSA25 this morning at Sydney’s International Convention Centre.
First announced in January this year, the proposed agreement between the Australian Government and PSA is expected to strengthen 17 pharmacy programs delivered by pharmacists across the health system.
These include medication management programs such as Home Medicines Reviews and Residential Medication Management Reviews, Aboriginal and Torres Strait Islander-specific programs and rural support programs that encompass pharmacists in a range of practice areas.
PSA National President Associate Professor Fei Sim FPS told delegates: ‘We know these programs work, but for too long pharmacy programs have been scattered across a range of mechanisms without comprehensive evaluation of their impact. That’s part of what this agreement will do.’
Minister Butler also acknowledged PSA’s key role as a signatory to the new agreement ‘as the Albanese Government's health reform agenda continues to unfold, a role that we are committed to enhancing further in enabling you to work at your full scope of practise in delivering more services’, he told the more than 1,200 delegates attending PSA25.
PSA’s agreement approach
The Agreements Lead is National Board Member Associate Professor Shane Jackson FPS. He will head a team of senior pharmacists, including Consultation Lead Debbie Rigby FPS, National Board Member Bridget Totterman MPS, PSA’s General Manager for Policy and Program Delivery Chris Campbell FPS and PSA’s Canberra-based Senior Pharmacist – Strategic Agreements Rhyan Stanley MPS. Input is also expected from the Consultant Pharmacists Community of Specialty Interest led by Deborah Hawthorne FPS.
PSA’s approach from now is expected to be guided by findings from the formal consultation process that began several months ago, according to A/Prof Sim.
There will also be ongoing feedback from stakeholder groups and members and outcomes from a sector-wide roundtable. All responses will continue to shape PSA’s position on key elements of the agreement.
A/Prof Sim also announced that PSA, as a federated organisation, had reached a historic 20,000 members for the first time.
‘This growth reflects the value pharmacists see in what PSA offers,’ she said. ‘Pharmacists are looking for more than just representation, they’re looking for support, connection, and leadership.
‘We’re investing in expert-led, flexible education to support every stage of pharmacy careers and across areas of practice. We’re building a connected, passionate community that understands the goals and challenges our members face.’ She said PSA was also collaborating with other organisations and partners in giving pharmacists the confidence to expand their scope of practice.
Working to full scope
In his address, Minister Butler also canvassed government measures including recent enabling legislation for cheaper medicines for consumers earlier this month with the general co-payment for PBS medicines to be reduced from $31.60 to $25 from 1 January 2026.
‘We want to remove the barriers to working at full scope, reconciling varying state and territory approaches, removing red tape, changing cultures so that we can get, frankly, the absolute best out of you,’ he told hundreds of pharmacist delegates.
His colleague, pharmacist and Assistant Minister for Mental Health and Suicide Prevention and Assistant Minister for Rural and Regional Health Emma McBride told the conference that the government was now considering the 18 recommendations of Professor Mark Cormack’s Unleashing the Potential of our Health Workforce – Scope of Practice Review, with A/Prof Sim part of the review committee.
Working towards a common goal
As PSA moves through the negotiation phase of this new agreement, A/Prof Sim said it was important to ‘pause and recognise the significance of what we are working toward’.
‘Whilst we need to remain pragmatic in our approach, this agreement will lay the foundation for a new, long-overdue infrastructure that has the potential to reshape the future for generations to come. This new agreement belongs to our profession, and PSA will do everything we can, within our ability, to do this for our profession.’
By negotiating a new agreement to govern these 17 specific programs, PSA is seeking to ensure they maximise the positive impact the pharmacy profession can have on patients across multiple areas of practice, she said.
Meanwhile, consultation on pharmacy programs remains open. PSA members are encouraged to provide any additional information, feedback and case studies.
Learn more about membership benefits at www.psa.org.au
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[post_content] => Over the past few years, the words ‘scope of practice’ have been on the lips of pharmacists and government officials, with the hope of addressing some of the major challenges of our health system.
The Unleashing the Potential of our Health Workforce – Scope of Practice Review final review, delivered last year, made sweeping recommendations to how we deliver healthcare in Australia.
However, the 18 recommendations require several hurdles to be overcome before implementation – including changes to how healthcare professionals are trained, and how services are funded and regulated.
But there is movement happening. In July, Queensland pharmacy prescribing pilots became permanent, with 17 individual prescribing services now delivered across the state by pharmacists qualified to prescribe independently and autonomously.
The Queensland Government has also provided additional prescribing initiatives, including partnered pharmacist medication charting as well as therapeutic adaptation and substitution – providing pharmacists with more autonomy and options to help their patients.
Other jurisdictions around the country have also made announcements around prescribing pilots and permanent schemes.
But how far do we have to go to unleash the real potential of the healthcare workforce?
This was the burning question – among others – asked at the Scope of practice panel at PSA25 today.
When will there be harmonisation?
The federal Department of Health, Disability and Ageing has looked at the recommendation about harmonisation of the national legislative framework, said Deputy Secretary for Health Resourcing Penny Shakespeare.
‘We've already had a crack at trying to harmonise drugs and poisons legislation,’ she said. ‘We did a plan about 10 years ago, but we really need to take that forward now – and we're trying to get all of our governments to sign up to that.’
The department also needs to map out what the response will look like in the longer term, including how the health system’s funding and training arrangements are reformed.
‘We need to have a common approach, and if we do not reform in a coordinated way, we will actually hold back implementation of arrangements of practice,’ Ms Shakespeare said. ‘We've really got to try and lock down why we have differences at a state-by-state level, work through if they are evidence-based. And if not, we've got to try and make full changes to implement consistency.’
What’s the value for patients?
ACT-based Shivana Chandra, who works for the Health Care Consumers Association as a research officer, said she can often wait 3–4 weeks to get a GP appointment.
‘And if you've got a UTI, that is not a nice time to wait,’ she said.
Having the UTI prescribing pilots and programs around the country means patients can access the care they need much faster – preventing further deterioration of health.
‘But it's also a cost issue,’ Ms Chandra said. ‘It takes away that cost pressure of having to pay for the GP, then go back to the pharmacist to get treatment.’
But there is not much community awareness of these various pilots and programs, Ms Chandra thinks.
‘You never see any promotions for these programs about what’s happening in pharmacy,’ she said. ‘So you miss a lot of opportunities that way.’
Consumers also rely on healthcare professionals to get their information.
‘There needs to be better promotion from the pharmacists themselves about what they offer, how you can access it and where you can find out more information about it.’
What does it take to embed independent prescribing?
The United Kingdom has had it easy in terms of implementing pharmacist prescribing nationwide, according to Honorary Professor of Pharmacy Policy and Practice
University of Nottingham Bruce Warner.
But there are definitely some lessons Australia can take from the UK, which introduced independent prescribing in 2006.
‘While it’s not a quick process, it’s really important to get the foundations in place, and you have to bring people along with you,’ he said.
‘We spent a lot of time putting infrastructure in place, [including] things such as making sure our community pharmacies had a secure email address, which was one of the objections towards [pharmacist prescribing].'
Pharmacists should also expect a fair amount of scrutiny, but there is a way forward.
‘I was working with our National Patient Safety Agency when independent prescribing came in, and we were getting daily requests from the medical press asking, “How many errors are pharmacists making? How many patients are being harmed?”’ Prof Warner said.
‘Of course the reality was far fewer than they thought, but the scrutiny was intense. And you have to be able to live with that, anticipate that, and be able to work with that and work through it.’
But in 2026, the UK’s first pharmacy graduates will automatically become pharmacist prescribers.
‘That will change things dramatically,’ he said.
Could pharmacists prescribe on the PBS in the future?
Access to subsidised medicines for pharmacists is essential, Ms Shakespeare said.
‘We need [subsidised] supply of medicines to actually deliver change for consumers, and that's not what we've got,’ she said.
But there are some issues that need to be addressed first.
‘We've got a single professional body deciding whether a patient needs a medicine and financially benefiting from the supply of that medicine,’ Ms Shakespeare said. ‘[But] we have the technology [to develop] protocol-based, electronic clinical decision support systems.’
Supporting effective multi-disciplinary team-based care, allowing for information about changes in a patient's medicine regimen to be shared with all members of the care team, is also a top priority.
‘That's the building block we're really focused on at the moment, and have been developing work on that in the department.’
What about substitutions?
While Queensland-based pharmacists are now able to make adaptations and substitutions to prescriptions, the altered scripts will not be PBS subsidised, which multi-pharmacy owner and PSA Board Director Bridget Totterman MPS finds ‘extremely frustrating’.
‘It makes no sense that a patient can't access the PBS for a script that is either adapted, substituted or prescribed,’ she said. ‘Let the pharmacist help the first time.’
However, it is a step forward. After all, there would be no NIPVIP without QPIP.
‘We're absolutely going to fight and advocate for common-sense reform, but we will celebrate the wins along the way,’ she added.
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[post_content] => Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between justified care and risky overreach.
Australia’s adolescent mental health crisis is escalating at a troubling pace. A landmark longitudinal study by Murdoch Children’s Research Institute revealed that by age 18, nearly three quarters (74 %) of Australian teenagers experienced clinically significant symptoms of anxiety or depression at least once – with many enduring chronic episodes spanning multiple school transitions and exam periods.
The Australian Bureau of Statistics confirms that in 2020–22, 38.8 % of 16–24 year‑olds reported a mental disorder in the past 12 months, dominated by anxiety (17.2 %). Contributing factors are complex: academic pressure, early puberty, growing social isolation, socioeconomic stress, and particularly, the impact of social media.
The increase in prescribing
Similarly, antidepressant prescribing among Australian adolescents is on the rise, raising concerns about off-label use and high-dose regimens – with the pharmacist’s role in ensuring safe and appropriate therapy more important than ever. A 2024 ABC report noted that psychotropic use in under‑18s more than doubled from 2013 to 2023.3
Between 2013 and 2019, Selective Serotonin Reuptake Inhibitor (SSRI) prescribing in adolescents steadily climbed, with GPs accounting for 55 % of prescriptions in 12–14 year‑olds and 78 % in 15–17 year‑olds.
According to consultant pharmacist Amanda Fuller, Clinical Lead at Medcast, the increase in antidepressant prescribing reflects a complex mix of demand, access issues, and public perception.
[caption id="attachment_29976" align="alignright" width="300"] Amanda Fuller[/caption]
‘We’re seeing a growing awareness of mental health in young people, which is a positive shift,’ Ms Fuller said. ‘But when that’s combined with long waitlists for psychologists and psychiatrists, GPs often feel pressure to act quickly – particularly if there are concerns about deterioration or safety.’
This urgency is sometimes reinforced by family expectations. ‘Parents and carers may see antidepressants as a fast-acting solution while they wait for psychological support,’ she added.
Off-label use in high doses
Most prescribing for under-18s is off-label, which complicates matters, Ms Fuller said.
‘This places the responsibility on prescribers to weigh clinical judgment and available evidence against regulatory guidance.’
In Australia, only fluvoxamine and sertraline are approved by the Therapeutic Goods Administration (TGA) to treat obsessive-compulsive disorder (OCD) – in children aged 6 and 8 years and older, respectively. Others are used beyond their approved indications.
Fluoxetine remains the most commonly prescribed antidepressant in this cohort. ‘It’s the recommended first-line SSRI for adolescents and is the only one with consistent trial evidence showing efficacy over placebo in depression,’ Ms Fuller said. ‘But even then, the benefit was modest, placebo response rates were high, and study quality was poor, making interpretation difficult.’
In anxiety, the data is even less robust. ‘There’s limited evidence, though fluoxetine, fluvoxamine, and sertraline have shown some benefit in trials. But again, quality is a concern,’ she said.
Public understanding of antidepressants is also often shaped by outdated ideas, Ms Fuller said. ‘The “chemical imbalance” theory has been largely debunked, but it still drives the belief that medication is essential for treatment.’
More concerning is the increasing use of high-dose antidepressant regimens, sometimes exceeding standard adult doses.
‘We know higher doses are sometimes used in OCD, and prescribers may consider the adolescent’s physical maturity. But there’s no strong evidence to support routine high-dose use in this age group,’ she said.
Psychiatrists are more likely than GPs to prescribe these higher doses, often in complex or treatment-resistant cases. However, efficacy data for higher doses is lacking – even in adult populations.
‘In fluoxetine studies, response rates were actually highest between 20–40 mg daily,’ Ms Fuller said. ‘Going beyond that was linked to more [adverse] effects and increased dropout rates.’
The role of pharmacists
Pharmacists should take a proactive yet respectful approach when faced with uncertainty around an antidepressant prescription, Ms Fuller advised.
‘If something doesn’t add up – if you can’t confirm the indication, or there’s limited information about the treatment plan – it’s absolutely appropriate to contact the prescriber,’ she said.
Before doing so, she recommends checking key factors: ‘Clarify the diagnosis, assess for any psychosocial supports in place, confirm adherence and tolerance, and look at what the follow-up plan involves.’
When contacting prescribers, Ms Fuller urges pharmacists to approach conversations with collaboration, not correction. ‘Assume clinical reasoning is there – your role is to clarify, not challenge,’ she said ‘Focus on shared care, not prescription policing.”’
Australia’s adolescent mental health situation demands attention and pharmacists have a pivotal role in it. Soaring rates of depression, anxiety and antidepressant prescribing underscore the need for thoughtful, patient-centred care.
PSA25's session on ‘Dosing dilemmas’, presented by Ms Fuller, offers essential guidance on navigating adolescent antidepressant use – from informed dosing choices to structured monitoring and collaborative decision-making.
Haven’t registered for PSA25 yet? Don’t miss your chance – registrations are still open.
[post_title] => Why are so many teens prescribed high-dose antidepressants?
[post_excerpt] => Youth mental health needs are rising, but so too are questionable prescribing patterns of antidepressants.
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[post_content] => A look at Turlington’s 27‑ingredient balsam, its broad therapeutic claims and how it contrasts with today’s evidence‑based approaches.
Robert Turlington was a 21st Century pharmacist living in the 18th Century. But the Londoner wasn’t always the successful entrepreneur he later became. Instead, Turlington (1697–1766) began his working life as a weaver – and a bankrupt one at that – courtesy of his demanding specialty: silk.1
According to archaeologists Olive Jones and Allen Vegotsky, the ‘multidimensional’ challenges of the silk trade, along with the fallout from bankruptcy, had an unexpected upside. They pushed Turlington to develop skills in marketing, labour organisation and even fashion. This expertise helped him change careers and, in 1740, grow a one-man pharmaceutical operation into an early multinational success story.1
Let sales begin
By 1742, Turlington was selling his Balsam of Life into a market packed with competitors like Friar’s Balsam.2 Both elixirs were sold as treatments for several illnesses and injuries. But in no time, Turlington went beyond ‘several’, pitching his product as a veritable ‘cure-all’.1–5,10
‘The aforesaid Balsam is a certain relief for the gravel, cholic, rheumatism, gout, and sciatic pains, and all colds, coughs, consumptive, pectoral, asthmatical, and nervous disorders, &c. and for any cut, bruise, or the like, as thousands can testify who have been relieved thereby, in the above and other complaints, after every other resource has failed,’ claimed Turlington in a 46-page testimonial pamphlet, accompanying each sale.1
In line with the era’s one-product, multi-ailment ‘polypharmacy’ approach, Turlington’s ‘perfect friend to Nature’ initially contained 27 ingredients in an alcohol solution. Over time, that was reduced to just eight. The key ingredients remained plant-based balsams: gum benzoin, storax and Tolu and Peruvian balsam. Aromatic spices like cinnamon, saffron and nutmeg masked the balsams’ unpleasant taste.1,2,5,6,10
Originally sold in round vials, Turlington’s nostrum became so popular that in 1746 he introduced the first of several distinctively shaped bottles to deter imitators.
In 1754, he followed-up with a unique pear-shaped bottle, which continued to be used in different sizes for over 150 years.1,3,7
They remain collectors’ items to this very day.1,4,5,7,8
Promote, protect, expand
Turlington’s distinctively shaped bottles were more than eye-catching – they reflected a shrewd business strategy.
At a time when English medicines were unregulated, Turlington promptly acquired one of the country’s first medical patents.1,3 Granted by King George in 1744 and lasting until 1758, the patent gave Turlington the legal right to prosecute imitators and widely promote his ‘miracle cure’ – a task he embraced with gusto.1,3,8
‘He had the cachet of having the king’s approval of his medicine, a fake coat of arms, a memorable name, a booklet given free with every purchase, a fixed price, and testimonials from satisfied customers who provided information on ailments that could be treated successfully with Balsam of Life,’ note Jones and Vegotsky.1
In 1748, Turlington extended his patent to include Britain’s North American colonies. Geographic expansion soon followed with sales to the emerging United States, Canada, the West Indies and, yes, Australia. Of course, he also pushed into Scotland, Ireland and Europe.1,3,8–10
Did Turlington’s balsam work?
With so many ingredients in varying amounts, used to treat a wide range of conditions, it’s difficult to say how effective the balsam truly was. At best, balsams exhibit anti-inflammatory, antioxidant and antimicrobial effects.11
Whether it worked or not, Turlington’s balsam left an enduring legacy – in pharmacy history, and also on collectors’ shelves.
References
- Jones O, Vegotsky A. Turlington’s Balsam of Life. Northeast Historical Archaeology. 2016;45:1.
- Dayton L. Friar’s Balsam has a place in modern life. Australian Pharmacist 2024;43(7):66.
- Abbott A. Turlington’s Balsam of Life: Colonial American snake oil? University of Central Florida, Center for Humanities and Digital Research.
- Pope A. Turlington's Balsam, the 18th-century cure-all. Canadian Geographic 2016 7 July.
- Griffenhagen GB, Young JH. Old English patent medicines in America. Contributions from The Museum of History and Technology: Paper 10. Project Gutenberg EBook 30162.
- Dilworth LL, Riley CK, Stennett DK. Chapter 5 - Plant Constituents: Carbohydrates, oils, resins, balsams, and plant hormones. Pharmacognosy, Academic Press 61–80 2017.
- Jones OR. Essence of Peppermint, A history of the medicine and its bottle. Hist.Archaeol. 15(2):3, 28, 33.
- Kemp J. Bottles 1. Turlington's Balsam of Life: the 1754 design. Cures All Diseases.com. 2020.
- Young JH. The Toadstool Millionaires: Chapter 1. Quackwatch. 2002 29 Apr.
- Keys R. Turlington’s Balsam of Life. The Adverts 250 Project. 2022 17 Feb.
[post_title] => Lessons from one of the first medicinal patents
[post_excerpt] => Turlington's Balsam was pitched as a veritable ‘cure-all’ in the 18th century – and remains on collectors’ shelves today.
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[title_attribute] => Lessons from one of the first medicinal patents
[title] => Lessons from one of the first medicinal patents
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[post_content] => Case scenario
[caption id="attachment_27199" align="alignright" width="225"] This activity is sponsored by PDL. This information is general in nature and designed only to highlight issues for your consideration. Before acting on this information, you should consider your individual circumstances and needs, and obtain advice as appropriate.[/caption]
Joyce, 76, lives independently and takes seven regular medicines with various dosing frequencies. She struggles to manage her medicines, especially with frequent brand changes due to supply issues. To help herself remember, Joyce recently began placing her daily tablets in a dish on the kitchen bench. During a visit, her 6-year-old grandson mistook the tablets for lollies and was about to swallow them when he was stopped just in time. Joyce is shaken by the incident and distressed by what could have happened.
After reading this article, pharmacists should be able to:
|
Medicine safety is critical to improving health outcomes for children.1 However, ensuring safe and effective medicine use in paediatric populations presents unique challenges, due to differences in physiology, dosing requirements, and patterns of medicine use compared to adults.
Safety concerns arise because many medicines are prescribed off-label for children.2–5 Clinical trial data involving child populations is limited, with many trials not conducted in children. As a result, the safety and efficacy of medicines prescribed to children are often based on extrapolation from adult data.2,3,6
Medicine-related poisoning is also a key concern for medicine safety in children. In 2021–22 in Australia, 8,288 children were hospitalised due to poisoning-related injuries.7 Many of these hospitalisations were the result of accidental poisonings.1 An Australian review of emergency department data from 1 January 2015 to 31 December 2016 found that accidental exposure was the cause of 82% of poisoning cases involving preschool-aged children.8 Research shows that medicines, ‘including adult and paediatric over-the-counter and prescription medicines, are the leading cause of hospitalised unintentional poisonings’ in children in Australia.9,10
Unintentional exposures occur due to a variety of reasons. Data from the NSW Poisons Information Centre show that poisonings involving paracetamol–opioid combinations, ibuprofen–codeine combinations and oxycodone are common in children under 5 years of age.11 This is largely due to the inquisitive nature of children.5,11 Other reasons include therapeutic errors, such as incorrect dosing, incorrect dosing interval, incorrect patient or incorrect drug.11 This may be due to a dosing error by a parent or carer or unintended exposure to a medicine that was not intended for them.12
Risk factors for child poisoningSocioeconomic disadvantage has been found to increase the risk of unintentional poisoning in Australia.9 People who experience socioeconomic disadvantage often have ‘more comorbidities, use more medication, have less access to childcare and storage equipment and are more likely to experience overcrowding’.9 Living in rented premises has also been identified as a potential risk factor, possibly due to practical constraints on modifying living spaces for safe medicine storage.⁹ However, it’s important to note that evidence is limited and evolving, and challenges with secure storage may be experienced across a range of housing situations.
Changes in prescribing patterns and medicine use can also increase the risk of poisoning exposure to children. One example is the increase in the use of psychotropic medicines in children. ADHD is a common neurodevelopmental disorder among children and adolescents.15 Research shows there has been a twofold increase in the annual prevalence of ADHD medicine use – from 4.9 per 1,000 persons in 2013 to 9.7 per 1,000 persons in 2020 – in Australia.16 There has also been a trend towards increased diagnosis and pharmacological treatment of ADHD.6,17 Methylphenidate is the most commonly used medicine for ADHD in children, followed by lisdexamfetamine.16 The growing use of ADHD medicines may increase the risk of unintentional poisoning in children.17
Non-stimulant medicines such as clonidine, guanfacine and atomoxetine may also be used concurrently with stimulant medications, particularly in young children and adolescents.16 The off-label use of clonidine for children with ADHD remains problematic due to cases of poisonings and overdose from incorrect dosing.16,18 Clonidine has a narrow therapeutic index, meaning toxicity can occur even with even small dosing errors. The Therapeutic Goods Administration (TGA) has issued a safety alert warning to pharmacists and other health professionals about the risks associated with off-label clonidine use in children.19 Pharmacists should thoroughly counsel patients, parents and carers on the importance of correct dosing and proper storage of clonidine, given the high risk of toxicity from accidental overdose and unintentional poisoning. Compounding pharmacists may be asked to prepare clonidine suspensions, as they are not commercially available. Accuracy is essential when compounding medicines, particularly those such as clonidine, where the dose is prescribed in micrograms. Dosing errors can occur when the strength is incorrectly transcribed from micrograms to milligrams, significantly increasing the risk of poisoning exposure.
Another area of concern is medicine dosing in the school setting. The use of psychotropic medicines in children is increasing, and school-aged children may need to be dosed several times per day.20 This increases the risk of medication error and poisoning exposure. Data from the NSW Poisons Information Centre from January 2014 to June 2018 show that incidents involving methylphenidate were the fourth most common poisoning exposure in schools.20 The majority of methylphenidate incidents occurred due to medication errors, such as double dosing or medicine given to the wrong child.20 In this study, medication errors accounted for 11.6% of poisoning exposures.20 Clonidine and paracetamol were also involved in medication errors in schools.20 This highlights the need for school staff to be trained in medicine safety.20
Communication: Effective communication between pharmacists and patients, parents and carers is vital to ensure the safe use of medicines and an awareness of the potential risks that may come with a medicine. Communication should be tailored to account for the socioeconomic, cultural, or educational background of the patient or carer. Counselling should include not only the dose, frequency and duration of therapy for medicines prescribed to children, but also information about safe storage, accessibility and disposal of that medicine. Accessibility and disposal are relevant in any situation where a child might be present.12 Pharmacists should promote the return of unused or unwanted medicines to the pharmacy for safe disposal, helping to reduce the risk of poisoning exposure.
Clinical judgment: Pharmacists and dispensary technicians should implement procedures to flag medicines prescribed for children, ensuring dispensed products are checked for safety and appropriateness. This requires pharmacists to access resources relevant to medicines for children, including dosing guidelines and instructions for the preparation of compounded products. This can be particularly challenging when medicines are prescribed off-label, as information may be more difficult to locate; however, pharmacists are expected to undertake a risk assessment irrespective of the medicine being proprietary, compounded or off-label.
Third party supply: Administration of medicines to children by carers or school staff may involve an increased risk of error and adverse consequences. Consistently asking parents or carers whether a child’s medicine will be administered by a third party may enable the pharmacist to provide additional counselling or support via a dose administration aid (DAA) where appropriate.
Packaging: pharmacists should ensure that all medicines, including compounded preparations, are appropriately packaged using child-resistant closures.
Access to Poisons Information: In the event of a dosing error or suspected poisoning, pharmacists should act immediately by contacting the Poisons Information Centre on 13 11 26 (available Australia-wide), or call 000 if the situation appears life-threatening.9
Pharmacists who wish to enquire about dosing or other medicine-related information prior to dispensing can contact a medicines information centre in their state, as listed in Appendix E of the Australian Medicines Handbook (AMH).
Medicine safety in children requires vigilance, clear communication and proactive intervention by pharmacists. With limited clinical trial data and increasing use of off-label and high-risk medicines, pharmacists must assess individual risks, educate carers, and advocate for secure storage and appropriate administration.
By implementing tailored strategies and promoting awareness, pharmacists can play a pivotal role in preventing accidental poisonings and enhancing the safe use of medicines in children.
Case scenario continuedAt her next pharmacy visit, Joyce mentions the incident to the pharmacist. The pharmacist discusses the risks of leaving medicines unsecured, especially around children, and offers practical solutions. These include a weekly dose administration aid (DAA) to help with organisation, a medication reminder app for her phone, and advice on safe storage, such as using a lockable drawer or placing medicines on a high shelf in a cupboard out of children’s reach. Joyce is reassured by the support and feels more confident in managing her medicines safely moving forward. |
Dr Simone Henriksen (she/her) BPharm, LLB (Hons I), PhD (Law) is a community pharmacist with over 30 years’ experience. She is also a legal academic at the University of the Sunshine Coast. Her research areas include the regulation and clinical governance of health services in Australia.
Morna Falkland BPharm
Dr Simone Henriksen is a former employee of Pharmaceutical Defence Limited (PDL) and a member of the Pharmaceutical Society of Australia (PSA). This article was developed while in the role of PDL Professional Officer.
PDL is a sponsor of the Medicine safety: children and adolescent care report, which is cited in this article.
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[post_content] => Formal negotiations have begun on a new Pharmacy Programs Agreement (PPA), which sits outside the 8th Community Pharmacy Agreement, the federal Minister for Health, Disability and Ageing Mark Butler announced at PSA25 today.
‘The PSA is the natural home for this agreement because you’ve helped drive the development of new and emerging roles for pharmacists,’ Minister Butler said in his plenary address, which opened PSA25 this morning at Sydney’s International Convention Centre.
First announced in January this year, the proposed agreement between the Australian Government and PSA is expected to strengthen 17 pharmacy programs delivered by pharmacists across the health system.
These include medication management programs such as Home Medicines Reviews and Residential Medication Management Reviews, Aboriginal and Torres Strait Islander-specific programs and rural support programs that encompass pharmacists in a range of practice areas.
PSA National President Associate Professor Fei Sim FPS told delegates: ‘We know these programs work, but for too long pharmacy programs have been scattered across a range of mechanisms without comprehensive evaluation of their impact. That’s part of what this agreement will do.’
Minister Butler also acknowledged PSA’s key role as a signatory to the new agreement ‘as the Albanese Government's health reform agenda continues to unfold, a role that we are committed to enhancing further in enabling you to work at your full scope of practise in delivering more services’, he told the more than 1,200 delegates attending PSA25.
PSA’s agreement approach
The Agreements Lead is National Board Member Associate Professor Shane Jackson FPS. He will head a team of senior pharmacists, including Consultation Lead Debbie Rigby FPS, National Board Member Bridget Totterman MPS, PSA’s General Manager for Policy and Program Delivery Chris Campbell FPS and PSA’s Canberra-based Senior Pharmacist – Strategic Agreements Rhyan Stanley MPS. Input is also expected from the Consultant Pharmacists Community of Specialty Interest led by Deborah Hawthorne FPS.
PSA’s approach from now is expected to be guided by findings from the formal consultation process that began several months ago, according to A/Prof Sim.
There will also be ongoing feedback from stakeholder groups and members and outcomes from a sector-wide roundtable. All responses will continue to shape PSA’s position on key elements of the agreement.
A/Prof Sim also announced that PSA, as a federated organisation, had reached a historic 20,000 members for the first time.
‘This growth reflects the value pharmacists see in what PSA offers,’ she said. ‘Pharmacists are looking for more than just representation, they’re looking for support, connection, and leadership.
‘We’re investing in expert-led, flexible education to support every stage of pharmacy careers and across areas of practice. We’re building a connected, passionate community that understands the goals and challenges our members face.’ She said PSA was also collaborating with other organisations and partners in giving pharmacists the confidence to expand their scope of practice.
Working to full scope
In his address, Minister Butler also canvassed government measures including recent enabling legislation for cheaper medicines for consumers earlier this month with the general co-payment for PBS medicines to be reduced from $31.60 to $25 from 1 January 2026.
‘We want to remove the barriers to working at full scope, reconciling varying state and territory approaches, removing red tape, changing cultures so that we can get, frankly, the absolute best out of you,’ he told hundreds of pharmacist delegates.
His colleague, pharmacist and Assistant Minister for Mental Health and Suicide Prevention and Assistant Minister for Rural and Regional Health Emma McBride told the conference that the government was now considering the 18 recommendations of Professor Mark Cormack’s Unleashing the Potential of our Health Workforce – Scope of Practice Review, with A/Prof Sim part of the review committee.
Working towards a common goal
As PSA moves through the negotiation phase of this new agreement, A/Prof Sim said it was important to ‘pause and recognise the significance of what we are working toward’.
‘Whilst we need to remain pragmatic in our approach, this agreement will lay the foundation for a new, long-overdue infrastructure that has the potential to reshape the future for generations to come. This new agreement belongs to our profession, and PSA will do everything we can, within our ability, to do this for our profession.’
By negotiating a new agreement to govern these 17 specific programs, PSA is seeking to ensure they maximise the positive impact the pharmacy profession can have on patients across multiple areas of practice, she said.
Meanwhile, consultation on pharmacy programs remains open. PSA members are encouraged to provide any additional information, feedback and case studies.
Learn more about membership benefits at www.psa.org.au
[post_title] => New Pharmacy Programs Agreement negotiations have begun
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[post_content] => Over the past few years, the words ‘scope of practice’ have been on the lips of pharmacists and government officials, with the hope of addressing some of the major challenges of our health system.
The Unleashing the Potential of our Health Workforce – Scope of Practice Review final review, delivered last year, made sweeping recommendations to how we deliver healthcare in Australia.
However, the 18 recommendations require several hurdles to be overcome before implementation – including changes to how healthcare professionals are trained, and how services are funded and regulated.
But there is movement happening. In July, Queensland pharmacy prescribing pilots became permanent, with 17 individual prescribing services now delivered across the state by pharmacists qualified to prescribe independently and autonomously.
The Queensland Government has also provided additional prescribing initiatives, including partnered pharmacist medication charting as well as therapeutic adaptation and substitution – providing pharmacists with more autonomy and options to help their patients.
Other jurisdictions around the country have also made announcements around prescribing pilots and permanent schemes.
But how far do we have to go to unleash the real potential of the healthcare workforce?
This was the burning question – among others – asked at the Scope of practice panel at PSA25 today.
When will there be harmonisation?
The federal Department of Health, Disability and Ageing has looked at the recommendation about harmonisation of the national legislative framework, said Deputy Secretary for Health Resourcing Penny Shakespeare.
‘We've already had a crack at trying to harmonise drugs and poisons legislation,’ she said. ‘We did a plan about 10 years ago, but we really need to take that forward now – and we're trying to get all of our governments to sign up to that.’
The department also needs to map out what the response will look like in the longer term, including how the health system’s funding and training arrangements are reformed.
‘We need to have a common approach, and if we do not reform in a coordinated way, we will actually hold back implementation of arrangements of practice,’ Ms Shakespeare said. ‘We've really got to try and lock down why we have differences at a state-by-state level, work through if they are evidence-based. And if not, we've got to try and make full changes to implement consistency.’
What’s the value for patients?
ACT-based Shivana Chandra, who works for the Health Care Consumers Association as a research officer, said she can often wait 3–4 weeks to get a GP appointment.
‘And if you've got a UTI, that is not a nice time to wait,’ she said.
Having the UTI prescribing pilots and programs around the country means patients can access the care they need much faster – preventing further deterioration of health.
‘But it's also a cost issue,’ Ms Chandra said. ‘It takes away that cost pressure of having to pay for the GP, then go back to the pharmacist to get treatment.’
But there is not much community awareness of these various pilots and programs, Ms Chandra thinks.
‘You never see any promotions for these programs about what’s happening in pharmacy,’ she said. ‘So you miss a lot of opportunities that way.’
Consumers also rely on healthcare professionals to get their information.
‘There needs to be better promotion from the pharmacists themselves about what they offer, how you can access it and where you can find out more information about it.’
What does it take to embed independent prescribing?
The United Kingdom has had it easy in terms of implementing pharmacist prescribing nationwide, according to Honorary Professor of Pharmacy Policy and Practice
University of Nottingham Bruce Warner.
But there are definitely some lessons Australia can take from the UK, which introduced independent prescribing in 2006.
‘While it’s not a quick process, it’s really important to get the foundations in place, and you have to bring people along with you,’ he said.
‘We spent a lot of time putting infrastructure in place, [including] things such as making sure our community pharmacies had a secure email address, which was one of the objections towards [pharmacist prescribing].'
Pharmacists should also expect a fair amount of scrutiny, but there is a way forward.
‘I was working with our National Patient Safety Agency when independent prescribing came in, and we were getting daily requests from the medical press asking, “How many errors are pharmacists making? How many patients are being harmed?”’ Prof Warner said.
‘Of course the reality was far fewer than they thought, but the scrutiny was intense. And you have to be able to live with that, anticipate that, and be able to work with that and work through it.’
But in 2026, the UK’s first pharmacy graduates will automatically become pharmacist prescribers.
‘That will change things dramatically,’ he said.
Could pharmacists prescribe on the PBS in the future?
Access to subsidised medicines for pharmacists is essential, Ms Shakespeare said.
‘We need [subsidised] supply of medicines to actually deliver change for consumers, and that's not what we've got,’ she said.
But there are some issues that need to be addressed first.
‘We've got a single professional body deciding whether a patient needs a medicine and financially benefiting from the supply of that medicine,’ Ms Shakespeare said. ‘[But] we have the technology [to develop] protocol-based, electronic clinical decision support systems.’
Supporting effective multi-disciplinary team-based care, allowing for information about changes in a patient's medicine regimen to be shared with all members of the care team, is also a top priority.
‘That's the building block we're really focused on at the moment, and have been developing work on that in the department.’
What about substitutions?
While Queensland-based pharmacists are now able to make adaptations and substitutions to prescriptions, the altered scripts will not be PBS subsidised, which multi-pharmacy owner and PSA Board Director Bridget Totterman MPS finds ‘extremely frustrating’.
‘It makes no sense that a patient can't access the PBS for a script that is either adapted, substituted or prescribed,’ she said. ‘Let the pharmacist help the first time.’
However, it is a step forward. After all, there would be no NIPVIP without QPIP.
‘We're absolutely going to fight and advocate for common-sense reform, but we will celebrate the wins along the way,’ she added.
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[post_content] => Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between justified care and risky overreach.
Australia’s adolescent mental health crisis is escalating at a troubling pace. A landmark longitudinal study by Murdoch Children’s Research Institute revealed that by age 18, nearly three quarters (74 %) of Australian teenagers experienced clinically significant symptoms of anxiety or depression at least once – with many enduring chronic episodes spanning multiple school transitions and exam periods.
The Australian Bureau of Statistics confirms that in 2020–22, 38.8 % of 16–24 year‑olds reported a mental disorder in the past 12 months, dominated by anxiety (17.2 %). Contributing factors are complex: academic pressure, early puberty, growing social isolation, socioeconomic stress, and particularly, the impact of social media.
The increase in prescribing
Similarly, antidepressant prescribing among Australian adolescents is on the rise, raising concerns about off-label use and high-dose regimens – with the pharmacist’s role in ensuring safe and appropriate therapy more important than ever. A 2024 ABC report noted that psychotropic use in under‑18s more than doubled from 2013 to 2023.3
Between 2013 and 2019, Selective Serotonin Reuptake Inhibitor (SSRI) prescribing in adolescents steadily climbed, with GPs accounting for 55 % of prescriptions in 12–14 year‑olds and 78 % in 15–17 year‑olds.
According to consultant pharmacist Amanda Fuller, Clinical Lead at Medcast, the increase in antidepressant prescribing reflects a complex mix of demand, access issues, and public perception.
[caption id="attachment_29976" align="alignright" width="300"] Amanda Fuller[/caption]
‘We’re seeing a growing awareness of mental health in young people, which is a positive shift,’ Ms Fuller said. ‘But when that’s combined with long waitlists for psychologists and psychiatrists, GPs often feel pressure to act quickly – particularly if there are concerns about deterioration or safety.’
This urgency is sometimes reinforced by family expectations. ‘Parents and carers may see antidepressants as a fast-acting solution while they wait for psychological support,’ she added.
Off-label use in high doses
Most prescribing for under-18s is off-label, which complicates matters, Ms Fuller said.
‘This places the responsibility on prescribers to weigh clinical judgment and available evidence against regulatory guidance.’
In Australia, only fluvoxamine and sertraline are approved by the Therapeutic Goods Administration (TGA) to treat obsessive-compulsive disorder (OCD) – in children aged 6 and 8 years and older, respectively. Others are used beyond their approved indications.
Fluoxetine remains the most commonly prescribed antidepressant in this cohort. ‘It’s the recommended first-line SSRI for adolescents and is the only one with consistent trial evidence showing efficacy over placebo in depression,’ Ms Fuller said. ‘But even then, the benefit was modest, placebo response rates were high, and study quality was poor, making interpretation difficult.’
In anxiety, the data is even less robust. ‘There’s limited evidence, though fluoxetine, fluvoxamine, and sertraline have shown some benefit in trials. But again, quality is a concern,’ she said.
Public understanding of antidepressants is also often shaped by outdated ideas, Ms Fuller said. ‘The “chemical imbalance” theory has been largely debunked, but it still drives the belief that medication is essential for treatment.’
More concerning is the increasing use of high-dose antidepressant regimens, sometimes exceeding standard adult doses.
‘We know higher doses are sometimes used in OCD, and prescribers may consider the adolescent’s physical maturity. But there’s no strong evidence to support routine high-dose use in this age group,’ she said.
Psychiatrists are more likely than GPs to prescribe these higher doses, often in complex or treatment-resistant cases. However, efficacy data for higher doses is lacking – even in adult populations.
‘In fluoxetine studies, response rates were actually highest between 20–40 mg daily,’ Ms Fuller said. ‘Going beyond that was linked to more [adverse] effects and increased dropout rates.’
The role of pharmacists
Pharmacists should take a proactive yet respectful approach when faced with uncertainty around an antidepressant prescription, Ms Fuller advised.
‘If something doesn’t add up – if you can’t confirm the indication, or there’s limited information about the treatment plan – it’s absolutely appropriate to contact the prescriber,’ she said.
Before doing so, she recommends checking key factors: ‘Clarify the diagnosis, assess for any psychosocial supports in place, confirm adherence and tolerance, and look at what the follow-up plan involves.’
When contacting prescribers, Ms Fuller urges pharmacists to approach conversations with collaboration, not correction. ‘Assume clinical reasoning is there – your role is to clarify, not challenge,’ she said ‘Focus on shared care, not prescription policing.”’
Australia’s adolescent mental health situation demands attention and pharmacists have a pivotal role in it. Soaring rates of depression, anxiety and antidepressant prescribing underscore the need for thoughtful, patient-centred care.
PSA25's session on ‘Dosing dilemmas’, presented by Ms Fuller, offers essential guidance on navigating adolescent antidepressant use – from informed dosing choices to structured monitoring and collaborative decision-making.
Haven’t registered for PSA25 yet? Don’t miss your chance – registrations are still open.
[post_title] => Why are so many teens prescribed high-dose antidepressants?
[post_excerpt] => Youth mental health needs are rising, but so too are questionable prescribing patterns of antidepressants.
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[post_content] => A look at Turlington’s 27‑ingredient balsam, its broad therapeutic claims and how it contrasts with today’s evidence‑based approaches.
Robert Turlington was a 21st Century pharmacist living in the 18th Century. But the Londoner wasn’t always the successful entrepreneur he later became. Instead, Turlington (1697–1766) began his working life as a weaver – and a bankrupt one at that – courtesy of his demanding specialty: silk.1
According to archaeologists Olive Jones and Allen Vegotsky, the ‘multidimensional’ challenges of the silk trade, along with the fallout from bankruptcy, had an unexpected upside. They pushed Turlington to develop skills in marketing, labour organisation and even fashion. This expertise helped him change careers and, in 1740, grow a one-man pharmaceutical operation into an early multinational success story.1
Let sales begin
By 1742, Turlington was selling his Balsam of Life into a market packed with competitors like Friar’s Balsam.2 Both elixirs were sold as treatments for several illnesses and injuries. But in no time, Turlington went beyond ‘several’, pitching his product as a veritable ‘cure-all’.1–5,10
‘The aforesaid Balsam is a certain relief for the gravel, cholic, rheumatism, gout, and sciatic pains, and all colds, coughs, consumptive, pectoral, asthmatical, and nervous disorders, &c. and for any cut, bruise, or the like, as thousands can testify who have been relieved thereby, in the above and other complaints, after every other resource has failed,’ claimed Turlington in a 46-page testimonial pamphlet, accompanying each sale.1
In line with the era’s one-product, multi-ailment ‘polypharmacy’ approach, Turlington’s ‘perfect friend to Nature’ initially contained 27 ingredients in an alcohol solution. Over time, that was reduced to just eight. The key ingredients remained plant-based balsams: gum benzoin, storax and Tolu and Peruvian balsam. Aromatic spices like cinnamon, saffron and nutmeg masked the balsams’ unpleasant taste.1,2,5,6,10
Originally sold in round vials, Turlington’s nostrum became so popular that in 1746 he introduced the first of several distinctively shaped bottles to deter imitators.
In 1754, he followed-up with a unique pear-shaped bottle, which continued to be used in different sizes for over 150 years.1,3,7
They remain collectors’ items to this very day.1,4,5,7,8
Promote, protect, expand
Turlington’s distinctively shaped bottles were more than eye-catching – they reflected a shrewd business strategy.
At a time when English medicines were unregulated, Turlington promptly acquired one of the country’s first medical patents.1,3 Granted by King George in 1744 and lasting until 1758, the patent gave Turlington the legal right to prosecute imitators and widely promote his ‘miracle cure’ – a task he embraced with gusto.1,3,8
‘He had the cachet of having the king’s approval of his medicine, a fake coat of arms, a memorable name, a booklet given free with every purchase, a fixed price, and testimonials from satisfied customers who provided information on ailments that could be treated successfully with Balsam of Life,’ note Jones and Vegotsky.1
In 1748, Turlington extended his patent to include Britain’s North American colonies. Geographic expansion soon followed with sales to the emerging United States, Canada, the West Indies and, yes, Australia. Of course, he also pushed into Scotland, Ireland and Europe.1,3,8–10
Did Turlington’s balsam work?
With so many ingredients in varying amounts, used to treat a wide range of conditions, it’s difficult to say how effective the balsam truly was. At best, balsams exhibit anti-inflammatory, antioxidant and antimicrobial effects.11
Whether it worked or not, Turlington’s balsam left an enduring legacy – in pharmacy history, and also on collectors’ shelves.
References
- Jones O, Vegotsky A. Turlington’s Balsam of Life. Northeast Historical Archaeology. 2016;45:1.
- Dayton L. Friar’s Balsam has a place in modern life. Australian Pharmacist 2024;43(7):66.
- Abbott A. Turlington’s Balsam of Life: Colonial American snake oil? University of Central Florida, Center for Humanities and Digital Research.
- Pope A. Turlington's Balsam, the 18th-century cure-all. Canadian Geographic 2016 7 July.
- Griffenhagen GB, Young JH. Old English patent medicines in America. Contributions from The Museum of History and Technology: Paper 10. Project Gutenberg EBook 30162.
- Dilworth LL, Riley CK, Stennett DK. Chapter 5 - Plant Constituents: Carbohydrates, oils, resins, balsams, and plant hormones. Pharmacognosy, Academic Press 61–80 2017.
- Jones OR. Essence of Peppermint, A history of the medicine and its bottle. Hist.Archaeol. 15(2):3, 28, 33.
- Kemp J. Bottles 1. Turlington's Balsam of Life: the 1754 design. Cures All Diseases.com. 2020.
- Young JH. The Toadstool Millionaires: Chapter 1. Quackwatch. 2002 29 Apr.
- Keys R. Turlington’s Balsam of Life. The Adverts 250 Project. 2022 17 Feb.
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[caption id="attachment_27199" align="alignright" width="225"] This activity is sponsored by PDL. This information is general in nature and designed only to highlight issues for your consideration. Before acting on this information, you should consider your individual circumstances and needs, and obtain advice as appropriate.[/caption]
Joyce, 76, lives independently and takes seven regular medicines with various dosing frequencies. She struggles to manage her medicines, especially with frequent brand changes due to supply issues. To help herself remember, Joyce recently began placing her daily tablets in a dish on the kitchen bench. During a visit, her 6-year-old grandson mistook the tablets for lollies and was about to swallow them when he was stopped just in time. Joyce is shaken by the incident and distressed by what could have happened.
After reading this article, pharmacists should be able to:
|
Medicine safety is critical to improving health outcomes for children.1 However, ensuring safe and effective medicine use in paediatric populations presents unique challenges, due to differences in physiology, dosing requirements, and patterns of medicine use compared to adults.
Safety concerns arise because many medicines are prescribed off-label for children.2–5 Clinical trial data involving child populations is limited, with many trials not conducted in children. As a result, the safety and efficacy of medicines prescribed to children are often based on extrapolation from adult data.2,3,6
Medicine-related poisoning is also a key concern for medicine safety in children. In 2021–22 in Australia, 8,288 children were hospitalised due to poisoning-related injuries.7 Many of these hospitalisations were the result of accidental poisonings.1 An Australian review of emergency department data from 1 January 2015 to 31 December 2016 found that accidental exposure was the cause of 82% of poisoning cases involving preschool-aged children.8 Research shows that medicines, ‘including adult and paediatric over-the-counter and prescription medicines, are the leading cause of hospitalised unintentional poisonings’ in children in Australia.9,10
Unintentional exposures occur due to a variety of reasons. Data from the NSW Poisons Information Centre show that poisonings involving paracetamol–opioid combinations, ibuprofen–codeine combinations and oxycodone are common in children under 5 years of age.11 This is largely due to the inquisitive nature of children.5,11 Other reasons include therapeutic errors, such as incorrect dosing, incorrect dosing interval, incorrect patient or incorrect drug.11 This may be due to a dosing error by a parent or carer or unintended exposure to a medicine that was not intended for them.12
Risk factors for child poisoningSocioeconomic disadvantage has been found to increase the risk of unintentional poisoning in Australia.9 People who experience socioeconomic disadvantage often have ‘more comorbidities, use more medication, have less access to childcare and storage equipment and are more likely to experience overcrowding’.9 Living in rented premises has also been identified as a potential risk factor, possibly due to practical constraints on modifying living spaces for safe medicine storage.⁹ However, it’s important to note that evidence is limited and evolving, and challenges with secure storage may be experienced across a range of housing situations.
Changes in prescribing patterns and medicine use can also increase the risk of poisoning exposure to children. One example is the increase in the use of psychotropic medicines in children. ADHD is a common neurodevelopmental disorder among children and adolescents.15 Research shows there has been a twofold increase in the annual prevalence of ADHD medicine use – from 4.9 per 1,000 persons in 2013 to 9.7 per 1,000 persons in 2020 – in Australia.16 There has also been a trend towards increased diagnosis and pharmacological treatment of ADHD.6,17 Methylphenidate is the most commonly used medicine for ADHD in children, followed by lisdexamfetamine.16 The growing use of ADHD medicines may increase the risk of unintentional poisoning in children.17
Non-stimulant medicines such as clonidine, guanfacine and atomoxetine may also be used concurrently with stimulant medications, particularly in young children and adolescents.16 The off-label use of clonidine for children with ADHD remains problematic due to cases of poisonings and overdose from incorrect dosing.16,18 Clonidine has a narrow therapeutic index, meaning toxicity can occur even with even small dosing errors. The Therapeutic Goods Administration (TGA) has issued a safety alert warning to pharmacists and other health professionals about the risks associated with off-label clonidine use in children.19 Pharmacists should thoroughly counsel patients, parents and carers on the importance of correct dosing and proper storage of clonidine, given the high risk of toxicity from accidental overdose and unintentional poisoning. Compounding pharmacists may be asked to prepare clonidine suspensions, as they are not commercially available. Accuracy is essential when compounding medicines, particularly those such as clonidine, where the dose is prescribed in micrograms. Dosing errors can occur when the strength is incorrectly transcribed from micrograms to milligrams, significantly increasing the risk of poisoning exposure.
Another area of concern is medicine dosing in the school setting. The use of psychotropic medicines in children is increasing, and school-aged children may need to be dosed several times per day.20 This increases the risk of medication error and poisoning exposure. Data from the NSW Poisons Information Centre from January 2014 to June 2018 show that incidents involving methylphenidate were the fourth most common poisoning exposure in schools.20 The majority of methylphenidate incidents occurred due to medication errors, such as double dosing or medicine given to the wrong child.20 In this study, medication errors accounted for 11.6% of poisoning exposures.20 Clonidine and paracetamol were also involved in medication errors in schools.20 This highlights the need for school staff to be trained in medicine safety.20
Communication: Effective communication between pharmacists and patients, parents and carers is vital to ensure the safe use of medicines and an awareness of the potential risks that may come with a medicine. Communication should be tailored to account for the socioeconomic, cultural, or educational background of the patient or carer. Counselling should include not only the dose, frequency and duration of therapy for medicines prescribed to children, but also information about safe storage, accessibility and disposal of that medicine. Accessibility and disposal are relevant in any situation where a child might be present.12 Pharmacists should promote the return of unused or unwanted medicines to the pharmacy for safe disposal, helping to reduce the risk of poisoning exposure.
Clinical judgment: Pharmacists and dispensary technicians should implement procedures to flag medicines prescribed for children, ensuring dispensed products are checked for safety and appropriateness. This requires pharmacists to access resources relevant to medicines for children, including dosing guidelines and instructions for the preparation of compounded products. This can be particularly challenging when medicines are prescribed off-label, as information may be more difficult to locate; however, pharmacists are expected to undertake a risk assessment irrespective of the medicine being proprietary, compounded or off-label.
Third party supply: Administration of medicines to children by carers or school staff may involve an increased risk of error and adverse consequences. Consistently asking parents or carers whether a child’s medicine will be administered by a third party may enable the pharmacist to provide additional counselling or support via a dose administration aid (DAA) where appropriate.
Packaging: pharmacists should ensure that all medicines, including compounded preparations, are appropriately packaged using child-resistant closures.
Access to Poisons Information: In the event of a dosing error or suspected poisoning, pharmacists should act immediately by contacting the Poisons Information Centre on 13 11 26 (available Australia-wide), or call 000 if the situation appears life-threatening.9
Pharmacists who wish to enquire about dosing or other medicine-related information prior to dispensing can contact a medicines information centre in their state, as listed in Appendix E of the Australian Medicines Handbook (AMH).
Medicine safety in children requires vigilance, clear communication and proactive intervention by pharmacists. With limited clinical trial data and increasing use of off-label and high-risk medicines, pharmacists must assess individual risks, educate carers, and advocate for secure storage and appropriate administration.
By implementing tailored strategies and promoting awareness, pharmacists can play a pivotal role in preventing accidental poisonings and enhancing the safe use of medicines in children.
Case scenario continuedAt her next pharmacy visit, Joyce mentions the incident to the pharmacist. The pharmacist discusses the risks of leaving medicines unsecured, especially around children, and offers practical solutions. These include a weekly dose administration aid (DAA) to help with organisation, a medication reminder app for her phone, and advice on safe storage, such as using a lockable drawer or placing medicines on a high shelf in a cupboard out of children’s reach. Joyce is reassured by the support and feels more confident in managing her medicines safely moving forward. |
Dr Simone Henriksen (she/her) BPharm, LLB (Hons I), PhD (Law) is a community pharmacist with over 30 years’ experience. She is also a legal academic at the University of the Sunshine Coast. Her research areas include the regulation and clinical governance of health services in Australia.
Morna Falkland BPharm
Dr Simone Henriksen is a former employee of Pharmaceutical Defence Limited (PDL) and a member of the Pharmaceutical Society of Australia (PSA). This article was developed while in the role of PDL Professional Officer.
PDL is a sponsor of the Medicine safety: children and adolescent care report, which is cited in this article.
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[post_content] => Formal negotiations have begun on a new Pharmacy Programs Agreement (PPA), which sits outside the 8th Community Pharmacy Agreement, the federal Minister for Health, Disability and Ageing Mark Butler announced at PSA25 today.
‘The PSA is the natural home for this agreement because you’ve helped drive the development of new and emerging roles for pharmacists,’ Minister Butler said in his plenary address, which opened PSA25 this morning at Sydney’s International Convention Centre.
First announced in January this year, the proposed agreement between the Australian Government and PSA is expected to strengthen 17 pharmacy programs delivered by pharmacists across the health system.
These include medication management programs such as Home Medicines Reviews and Residential Medication Management Reviews, Aboriginal and Torres Strait Islander-specific programs and rural support programs that encompass pharmacists in a range of practice areas.
PSA National President Associate Professor Fei Sim FPS told delegates: ‘We know these programs work, but for too long pharmacy programs have been scattered across a range of mechanisms without comprehensive evaluation of their impact. That’s part of what this agreement will do.’
Minister Butler also acknowledged PSA’s key role as a signatory to the new agreement ‘as the Albanese Government's health reform agenda continues to unfold, a role that we are committed to enhancing further in enabling you to work at your full scope of practise in delivering more services’, he told the more than 1,200 delegates attending PSA25.
PSA’s agreement approach
The Agreements Lead is National Board Member Associate Professor Shane Jackson FPS. He will head a team of senior pharmacists, including Consultation Lead Debbie Rigby FPS, National Board Member Bridget Totterman MPS, PSA’s General Manager for Policy and Program Delivery Chris Campbell FPS and PSA’s Canberra-based Senior Pharmacist – Strategic Agreements Rhyan Stanley MPS. Input is also expected from the Consultant Pharmacists Community of Specialty Interest led by Deborah Hawthorne FPS.
PSA’s approach from now is expected to be guided by findings from the formal consultation process that began several months ago, according to A/Prof Sim.
There will also be ongoing feedback from stakeholder groups and members and outcomes from a sector-wide roundtable. All responses will continue to shape PSA’s position on key elements of the agreement.
A/Prof Sim also announced that PSA, as a federated organisation, had reached a historic 20,000 members for the first time.
‘This growth reflects the value pharmacists see in what PSA offers,’ she said. ‘Pharmacists are looking for more than just representation, they’re looking for support, connection, and leadership.
‘We’re investing in expert-led, flexible education to support every stage of pharmacy careers and across areas of practice. We’re building a connected, passionate community that understands the goals and challenges our members face.’ She said PSA was also collaborating with other organisations and partners in giving pharmacists the confidence to expand their scope of practice.
Working to full scope
In his address, Minister Butler also canvassed government measures including recent enabling legislation for cheaper medicines for consumers earlier this month with the general co-payment for PBS medicines to be reduced from $31.60 to $25 from 1 January 2026.
‘We want to remove the barriers to working at full scope, reconciling varying state and territory approaches, removing red tape, changing cultures so that we can get, frankly, the absolute best out of you,’ he told hundreds of pharmacist delegates.
His colleague, pharmacist and Assistant Minister for Mental Health and Suicide Prevention and Assistant Minister for Rural and Regional Health Emma McBride told the conference that the government was now considering the 18 recommendations of Professor Mark Cormack’s Unleashing the Potential of our Health Workforce – Scope of Practice Review, with A/Prof Sim part of the review committee.
Working towards a common goal
As PSA moves through the negotiation phase of this new agreement, A/Prof Sim said it was important to ‘pause and recognise the significance of what we are working toward’.
‘Whilst we need to remain pragmatic in our approach, this agreement will lay the foundation for a new, long-overdue infrastructure that has the potential to reshape the future for generations to come. This new agreement belongs to our profession, and PSA will do everything we can, within our ability, to do this for our profession.’
By negotiating a new agreement to govern these 17 specific programs, PSA is seeking to ensure they maximise the positive impact the pharmacy profession can have on patients across multiple areas of practice, she said.
Meanwhile, consultation on pharmacy programs remains open. PSA members are encouraged to provide any additional information, feedback and case studies.
Learn more about membership benefits at www.psa.org.au
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[post_content] => Over the past few years, the words ‘scope of practice’ have been on the lips of pharmacists and government officials, with the hope of addressing some of the major challenges of our health system.
The Unleashing the Potential of our Health Workforce – Scope of Practice Review final review, delivered last year, made sweeping recommendations to how we deliver healthcare in Australia.
However, the 18 recommendations require several hurdles to be overcome before implementation – including changes to how healthcare professionals are trained, and how services are funded and regulated.
But there is movement happening. In July, Queensland pharmacy prescribing pilots became permanent, with 17 individual prescribing services now delivered across the state by pharmacists qualified to prescribe independently and autonomously.
The Queensland Government has also provided additional prescribing initiatives, including partnered pharmacist medication charting as well as therapeutic adaptation and substitution – providing pharmacists with more autonomy and options to help their patients.
Other jurisdictions around the country have also made announcements around prescribing pilots and permanent schemes.
But how far do we have to go to unleash the real potential of the healthcare workforce?
This was the burning question – among others – asked at the Scope of practice panel at PSA25 today.
When will there be harmonisation?
The federal Department of Health, Disability and Ageing has looked at the recommendation about harmonisation of the national legislative framework, said Deputy Secretary for Health Resourcing Penny Shakespeare.
‘We've already had a crack at trying to harmonise drugs and poisons legislation,’ she said. ‘We did a plan about 10 years ago, but we really need to take that forward now – and we're trying to get all of our governments to sign up to that.’
The department also needs to map out what the response will look like in the longer term, including how the health system’s funding and training arrangements are reformed.
‘We need to have a common approach, and if we do not reform in a coordinated way, we will actually hold back implementation of arrangements of practice,’ Ms Shakespeare said. ‘We've really got to try and lock down why we have differences at a state-by-state level, work through if they are evidence-based. And if not, we've got to try and make full changes to implement consistency.’
What’s the value for patients?
ACT-based Shivana Chandra, who works for the Health Care Consumers Association as a research officer, said she can often wait 3–4 weeks to get a GP appointment.
‘And if you've got a UTI, that is not a nice time to wait,’ she said.
Having the UTI prescribing pilots and programs around the country means patients can access the care they need much faster – preventing further deterioration of health.
‘But it's also a cost issue,’ Ms Chandra said. ‘It takes away that cost pressure of having to pay for the GP, then go back to the pharmacist to get treatment.’
But there is not much community awareness of these various pilots and programs, Ms Chandra thinks.
‘You never see any promotions for these programs about what’s happening in pharmacy,’ she said. ‘So you miss a lot of opportunities that way.’
Consumers also rely on healthcare professionals to get their information.
‘There needs to be better promotion from the pharmacists themselves about what they offer, how you can access it and where you can find out more information about it.’
What does it take to embed independent prescribing?
The United Kingdom has had it easy in terms of implementing pharmacist prescribing nationwide, according to Honorary Professor of Pharmacy Policy and Practice
University of Nottingham Bruce Warner.
But there are definitely some lessons Australia can take from the UK, which introduced independent prescribing in 2006.
‘While it’s not a quick process, it’s really important to get the foundations in place, and you have to bring people along with you,’ he said.
‘We spent a lot of time putting infrastructure in place, [including] things such as making sure our community pharmacies had a secure email address, which was one of the objections towards [pharmacist prescribing].'
Pharmacists should also expect a fair amount of scrutiny, but there is a way forward.
‘I was working with our National Patient Safety Agency when independent prescribing came in, and we were getting daily requests from the medical press asking, “How many errors are pharmacists making? How many patients are being harmed?”’ Prof Warner said.
‘Of course the reality was far fewer than they thought, but the scrutiny was intense. And you have to be able to live with that, anticipate that, and be able to work with that and work through it.’
But in 2026, the UK’s first pharmacy graduates will automatically become pharmacist prescribers.
‘That will change things dramatically,’ he said.
Could pharmacists prescribe on the PBS in the future?
Access to subsidised medicines for pharmacists is essential, Ms Shakespeare said.
‘We need [subsidised] supply of medicines to actually deliver change for consumers, and that's not what we've got,’ she said.
But there are some issues that need to be addressed first.
‘We've got a single professional body deciding whether a patient needs a medicine and financially benefiting from the supply of that medicine,’ Ms Shakespeare said. ‘[But] we have the technology [to develop] protocol-based, electronic clinical decision support systems.’
Supporting effective multi-disciplinary team-based care, allowing for information about changes in a patient's medicine regimen to be shared with all members of the care team, is also a top priority.
‘That's the building block we're really focused on at the moment, and have been developing work on that in the department.’
What about substitutions?
While Queensland-based pharmacists are now able to make adaptations and substitutions to prescriptions, the altered scripts will not be PBS subsidised, which multi-pharmacy owner and PSA Board Director Bridget Totterman MPS finds ‘extremely frustrating’.
‘It makes no sense that a patient can't access the PBS for a script that is either adapted, substituted or prescribed,’ she said. ‘Let the pharmacist help the first time.’
However, it is a step forward. After all, there would be no NIPVIP without QPIP.
‘We're absolutely going to fight and advocate for common-sense reform, but we will celebrate the wins along the way,’ she added.
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[post_content] => Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between justified care and risky overreach.
Australia’s adolescent mental health crisis is escalating at a troubling pace. A landmark longitudinal study by Murdoch Children’s Research Institute revealed that by age 18, nearly three quarters (74 %) of Australian teenagers experienced clinically significant symptoms of anxiety or depression at least once – with many enduring chronic episodes spanning multiple school transitions and exam periods.
The Australian Bureau of Statistics confirms that in 2020–22, 38.8 % of 16–24 year‑olds reported a mental disorder in the past 12 months, dominated by anxiety (17.2 %). Contributing factors are complex: academic pressure, early puberty, growing social isolation, socioeconomic stress, and particularly, the impact of social media.
The increase in prescribing
Similarly, antidepressant prescribing among Australian adolescents is on the rise, raising concerns about off-label use and high-dose regimens – with the pharmacist’s role in ensuring safe and appropriate therapy more important than ever. A 2024 ABC report noted that psychotropic use in under‑18s more than doubled from 2013 to 2023.3
Between 2013 and 2019, Selective Serotonin Reuptake Inhibitor (SSRI) prescribing in adolescents steadily climbed, with GPs accounting for 55 % of prescriptions in 12–14 year‑olds and 78 % in 15–17 year‑olds.
According to consultant pharmacist Amanda Fuller, Clinical Lead at Medcast, the increase in antidepressant prescribing reflects a complex mix of demand, access issues, and public perception.
[caption id="attachment_29976" align="alignright" width="300"] Amanda Fuller[/caption]
‘We’re seeing a growing awareness of mental health in young people, which is a positive shift,’ Ms Fuller said. ‘But when that’s combined with long waitlists for psychologists and psychiatrists, GPs often feel pressure to act quickly – particularly if there are concerns about deterioration or safety.’
This urgency is sometimes reinforced by family expectations. ‘Parents and carers may see antidepressants as a fast-acting solution while they wait for psychological support,’ she added.
Off-label use in high doses
Most prescribing for under-18s is off-label, which complicates matters, Ms Fuller said.
‘This places the responsibility on prescribers to weigh clinical judgment and available evidence against regulatory guidance.’
In Australia, only fluvoxamine and sertraline are approved by the Therapeutic Goods Administration (TGA) to treat obsessive-compulsive disorder (OCD) – in children aged 6 and 8 years and older, respectively. Others are used beyond their approved indications.
Fluoxetine remains the most commonly prescribed antidepressant in this cohort. ‘It’s the recommended first-line SSRI for adolescents and is the only one with consistent trial evidence showing efficacy over placebo in depression,’ Ms Fuller said. ‘But even then, the benefit was modest, placebo response rates were high, and study quality was poor, making interpretation difficult.’
In anxiety, the data is even less robust. ‘There’s limited evidence, though fluoxetine, fluvoxamine, and sertraline have shown some benefit in trials. But again, quality is a concern,’ she said.
Public understanding of antidepressants is also often shaped by outdated ideas, Ms Fuller said. ‘The “chemical imbalance” theory has been largely debunked, but it still drives the belief that medication is essential for treatment.’
More concerning is the increasing use of high-dose antidepressant regimens, sometimes exceeding standard adult doses.
‘We know higher doses are sometimes used in OCD, and prescribers may consider the adolescent’s physical maturity. But there’s no strong evidence to support routine high-dose use in this age group,’ she said.
Psychiatrists are more likely than GPs to prescribe these higher doses, often in complex or treatment-resistant cases. However, efficacy data for higher doses is lacking – even in adult populations.
‘In fluoxetine studies, response rates were actually highest between 20–40 mg daily,’ Ms Fuller said. ‘Going beyond that was linked to more [adverse] effects and increased dropout rates.’
The role of pharmacists
Pharmacists should take a proactive yet respectful approach when faced with uncertainty around an antidepressant prescription, Ms Fuller advised.
‘If something doesn’t add up – if you can’t confirm the indication, or there’s limited information about the treatment plan – it’s absolutely appropriate to contact the prescriber,’ she said.
Before doing so, she recommends checking key factors: ‘Clarify the diagnosis, assess for any psychosocial supports in place, confirm adherence and tolerance, and look at what the follow-up plan involves.’
When contacting prescribers, Ms Fuller urges pharmacists to approach conversations with collaboration, not correction. ‘Assume clinical reasoning is there – your role is to clarify, not challenge,’ she said ‘Focus on shared care, not prescription policing.”’
Australia’s adolescent mental health situation demands attention and pharmacists have a pivotal role in it. Soaring rates of depression, anxiety and antidepressant prescribing underscore the need for thoughtful, patient-centred care.
PSA25's session on ‘Dosing dilemmas’, presented by Ms Fuller, offers essential guidance on navigating adolescent antidepressant use – from informed dosing choices to structured monitoring and collaborative decision-making.
Haven’t registered for PSA25 yet? Don’t miss your chance – registrations are still open.
[post_title] => Why are so many teens prescribed high-dose antidepressants?
[post_excerpt] => Youth mental health needs are rising, but so too are questionable prescribing patterns of antidepressants.
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[post_content] => A look at Turlington’s 27‑ingredient balsam, its broad therapeutic claims and how it contrasts with today’s evidence‑based approaches.
Robert Turlington was a 21st Century pharmacist living in the 18th Century. But the Londoner wasn’t always the successful entrepreneur he later became. Instead, Turlington (1697–1766) began his working life as a weaver – and a bankrupt one at that – courtesy of his demanding specialty: silk.1
According to archaeologists Olive Jones and Allen Vegotsky, the ‘multidimensional’ challenges of the silk trade, along with the fallout from bankruptcy, had an unexpected upside. They pushed Turlington to develop skills in marketing, labour organisation and even fashion. This expertise helped him change careers and, in 1740, grow a one-man pharmaceutical operation into an early multinational success story.1
Let sales begin
By 1742, Turlington was selling his Balsam of Life into a market packed with competitors like Friar’s Balsam.2 Both elixirs were sold as treatments for several illnesses and injuries. But in no time, Turlington went beyond ‘several’, pitching his product as a veritable ‘cure-all’.1–5,10
‘The aforesaid Balsam is a certain relief for the gravel, cholic, rheumatism, gout, and sciatic pains, and all colds, coughs, consumptive, pectoral, asthmatical, and nervous disorders, &c. and for any cut, bruise, or the like, as thousands can testify who have been relieved thereby, in the above and other complaints, after every other resource has failed,’ claimed Turlington in a 46-page testimonial pamphlet, accompanying each sale.1
In line with the era’s one-product, multi-ailment ‘polypharmacy’ approach, Turlington’s ‘perfect friend to Nature’ initially contained 27 ingredients in an alcohol solution. Over time, that was reduced to just eight. The key ingredients remained plant-based balsams: gum benzoin, storax and Tolu and Peruvian balsam. Aromatic spices like cinnamon, saffron and nutmeg masked the balsams’ unpleasant taste.1,2,5,6,10
Originally sold in round vials, Turlington’s nostrum became so popular that in 1746 he introduced the first of several distinctively shaped bottles to deter imitators.
In 1754, he followed-up with a unique pear-shaped bottle, which continued to be used in different sizes for over 150 years.1,3,7
They remain collectors’ items to this very day.1,4,5,7,8
Promote, protect, expand
Turlington’s distinctively shaped bottles were more than eye-catching – they reflected a shrewd business strategy.
At a time when English medicines were unregulated, Turlington promptly acquired one of the country’s first medical patents.1,3 Granted by King George in 1744 and lasting until 1758, the patent gave Turlington the legal right to prosecute imitators and widely promote his ‘miracle cure’ – a task he embraced with gusto.1,3,8
‘He had the cachet of having the king’s approval of his medicine, a fake coat of arms, a memorable name, a booklet given free with every purchase, a fixed price, and testimonials from satisfied customers who provided information on ailments that could be treated successfully with Balsam of Life,’ note Jones and Vegotsky.1
In 1748, Turlington extended his patent to include Britain’s North American colonies. Geographic expansion soon followed with sales to the emerging United States, Canada, the West Indies and, yes, Australia. Of course, he also pushed into Scotland, Ireland and Europe.1,3,8–10
Did Turlington’s balsam work?
With so many ingredients in varying amounts, used to treat a wide range of conditions, it’s difficult to say how effective the balsam truly was. At best, balsams exhibit anti-inflammatory, antioxidant and antimicrobial effects.11
Whether it worked or not, Turlington’s balsam left an enduring legacy – in pharmacy history, and also on collectors’ shelves.
References
- Jones O, Vegotsky A. Turlington’s Balsam of Life. Northeast Historical Archaeology. 2016;45:1.
- Dayton L. Friar’s Balsam has a place in modern life. Australian Pharmacist 2024;43(7):66.
- Abbott A. Turlington’s Balsam of Life: Colonial American snake oil? University of Central Florida, Center for Humanities and Digital Research.
- Pope A. Turlington's Balsam, the 18th-century cure-all. Canadian Geographic 2016 7 July.
- Griffenhagen GB, Young JH. Old English patent medicines in America. Contributions from The Museum of History and Technology: Paper 10. Project Gutenberg EBook 30162.
- Dilworth LL, Riley CK, Stennett DK. Chapter 5 - Plant Constituents: Carbohydrates, oils, resins, balsams, and plant hormones. Pharmacognosy, Academic Press 61–80 2017.
- Jones OR. Essence of Peppermint, A history of the medicine and its bottle. Hist.Archaeol. 15(2):3, 28, 33.
- Kemp J. Bottles 1. Turlington's Balsam of Life: the 1754 design. Cures All Diseases.com. 2020.
- Young JH. The Toadstool Millionaires: Chapter 1. Quackwatch. 2002 29 Apr.
- Keys R. Turlington’s Balsam of Life. The Adverts 250 Project. 2022 17 Feb.
[post_title] => Lessons from one of the first medicinal patents
[post_excerpt] => Turlington's Balsam was pitched as a veritable ‘cure-all’ in the 18th century – and remains on collectors’ shelves today.
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[caption id="attachment_27199" align="alignright" width="225"] This activity is sponsored by PDL. This information is general in nature and designed only to highlight issues for your consideration. Before acting on this information, you should consider your individual circumstances and needs, and obtain advice as appropriate.[/caption]
Joyce, 76, lives independently and takes seven regular medicines with various dosing frequencies. She struggles to manage her medicines, especially with frequent brand changes due to supply issues. To help herself remember, Joyce recently began placing her daily tablets in a dish on the kitchen bench. During a visit, her 6-year-old grandson mistook the tablets for lollies and was about to swallow them when he was stopped just in time. Joyce is shaken by the incident and distressed by what could have happened.
After reading this article, pharmacists should be able to:
|
Medicine safety is critical to improving health outcomes for children.1 However, ensuring safe and effective medicine use in paediatric populations presents unique challenges, due to differences in physiology, dosing requirements, and patterns of medicine use compared to adults.
Safety concerns arise because many medicines are prescribed off-label for children.2–5 Clinical trial data involving child populations is limited, with many trials not conducted in children. As a result, the safety and efficacy of medicines prescribed to children are often based on extrapolation from adult data.2,3,6
Medicine-related poisoning is also a key concern for medicine safety in children. In 2021–22 in Australia, 8,288 children were hospitalised due to poisoning-related injuries.7 Many of these hospitalisations were the result of accidental poisonings.1 An Australian review of emergency department data from 1 January 2015 to 31 December 2016 found that accidental exposure was the cause of 82% of poisoning cases involving preschool-aged children.8 Research shows that medicines, ‘including adult and paediatric over-the-counter and prescription medicines, are the leading cause of hospitalised unintentional poisonings’ in children in Australia.9,10
Unintentional exposures occur due to a variety of reasons. Data from the NSW Poisons Information Centre show that poisonings involving paracetamol–opioid combinations, ibuprofen–codeine combinations and oxycodone are common in children under 5 years of age.11 This is largely due to the inquisitive nature of children.5,11 Other reasons include therapeutic errors, such as incorrect dosing, incorrect dosing interval, incorrect patient or incorrect drug.11 This may be due to a dosing error by a parent or carer or unintended exposure to a medicine that was not intended for them.12
Risk factors for child poisoningSocioeconomic disadvantage has been found to increase the risk of unintentional poisoning in Australia.9 People who experience socioeconomic disadvantage often have ‘more comorbidities, use more medication, have less access to childcare and storage equipment and are more likely to experience overcrowding’.9 Living in rented premises has also been identified as a potential risk factor, possibly due to practical constraints on modifying living spaces for safe medicine storage.⁹ However, it’s important to note that evidence is limited and evolving, and challenges with secure storage may be experienced across a range of housing situations.
Changes in prescribing patterns and medicine use can also increase the risk of poisoning exposure to children. One example is the increase in the use of psychotropic medicines in children. ADHD is a common neurodevelopmental disorder among children and adolescents.15 Research shows there has been a twofold increase in the annual prevalence of ADHD medicine use – from 4.9 per 1,000 persons in 2013 to 9.7 per 1,000 persons in 2020 – in Australia.16 There has also been a trend towards increased diagnosis and pharmacological treatment of ADHD.6,17 Methylphenidate is the most commonly used medicine for ADHD in children, followed by lisdexamfetamine.16 The growing use of ADHD medicines may increase the risk of unintentional poisoning in children.17
Non-stimulant medicines such as clonidine, guanfacine and atomoxetine may also be used concurrently with stimulant medications, particularly in young children and adolescents.16 The off-label use of clonidine for children with ADHD remains problematic due to cases of poisonings and overdose from incorrect dosing.16,18 Clonidine has a narrow therapeutic index, meaning toxicity can occur even with even small dosing errors. The Therapeutic Goods Administration (TGA) has issued a safety alert warning to pharmacists and other health professionals about the risks associated with off-label clonidine use in children.19 Pharmacists should thoroughly counsel patients, parents and carers on the importance of correct dosing and proper storage of clonidine, given the high risk of toxicity from accidental overdose and unintentional poisoning. Compounding pharmacists may be asked to prepare clonidine suspensions, as they are not commercially available. Accuracy is essential when compounding medicines, particularly those such as clonidine, where the dose is prescribed in micrograms. Dosing errors can occur when the strength is incorrectly transcribed from micrograms to milligrams, significantly increasing the risk of poisoning exposure.
Another area of concern is medicine dosing in the school setting. The use of psychotropic medicines in children is increasing, and school-aged children may need to be dosed several times per day.20 This increases the risk of medication error and poisoning exposure. Data from the NSW Poisons Information Centre from January 2014 to June 2018 show that incidents involving methylphenidate were the fourth most common poisoning exposure in schools.20 The majority of methylphenidate incidents occurred due to medication errors, such as double dosing or medicine given to the wrong child.20 In this study, medication errors accounted for 11.6% of poisoning exposures.20 Clonidine and paracetamol were also involved in medication errors in schools.20 This highlights the need for school staff to be trained in medicine safety.20
Communication: Effective communication between pharmacists and patients, parents and carers is vital to ensure the safe use of medicines and an awareness of the potential risks that may come with a medicine. Communication should be tailored to account for the socioeconomic, cultural, or educational background of the patient or carer. Counselling should include not only the dose, frequency and duration of therapy for medicines prescribed to children, but also information about safe storage, accessibility and disposal of that medicine. Accessibility and disposal are relevant in any situation where a child might be present.12 Pharmacists should promote the return of unused or unwanted medicines to the pharmacy for safe disposal, helping to reduce the risk of poisoning exposure.
Clinical judgment: Pharmacists and dispensary technicians should implement procedures to flag medicines prescribed for children, ensuring dispensed products are checked for safety and appropriateness. This requires pharmacists to access resources relevant to medicines for children, including dosing guidelines and instructions for the preparation of compounded products. This can be particularly challenging when medicines are prescribed off-label, as information may be more difficult to locate; however, pharmacists are expected to undertake a risk assessment irrespective of the medicine being proprietary, compounded or off-label.
Third party supply: Administration of medicines to children by carers or school staff may involve an increased risk of error and adverse consequences. Consistently asking parents or carers whether a child’s medicine will be administered by a third party may enable the pharmacist to provide additional counselling or support via a dose administration aid (DAA) where appropriate.
Packaging: pharmacists should ensure that all medicines, including compounded preparations, are appropriately packaged using child-resistant closures.
Access to Poisons Information: In the event of a dosing error or suspected poisoning, pharmacists should act immediately by contacting the Poisons Information Centre on 13 11 26 (available Australia-wide), or call 000 if the situation appears life-threatening.9
Pharmacists who wish to enquire about dosing or other medicine-related information prior to dispensing can contact a medicines information centre in their state, as listed in Appendix E of the Australian Medicines Handbook (AMH).
Medicine safety in children requires vigilance, clear communication and proactive intervention by pharmacists. With limited clinical trial data and increasing use of off-label and high-risk medicines, pharmacists must assess individual risks, educate carers, and advocate for secure storage and appropriate administration.
By implementing tailored strategies and promoting awareness, pharmacists can play a pivotal role in preventing accidental poisonings and enhancing the safe use of medicines in children.
Case scenario continuedAt her next pharmacy visit, Joyce mentions the incident to the pharmacist. The pharmacist discusses the risks of leaving medicines unsecured, especially around children, and offers practical solutions. These include a weekly dose administration aid (DAA) to help with organisation, a medication reminder app for her phone, and advice on safe storage, such as using a lockable drawer or placing medicines on a high shelf in a cupboard out of children’s reach. Joyce is reassured by the support and feels more confident in managing her medicines safely moving forward. |
Dr Simone Henriksen (she/her) BPharm, LLB (Hons I), PhD (Law) is a community pharmacist with over 30 years’ experience. She is also a legal academic at the University of the Sunshine Coast. Her research areas include the regulation and clinical governance of health services in Australia.
Morna Falkland BPharm
Dr Simone Henriksen is a former employee of Pharmaceutical Defence Limited (PDL) and a member of the Pharmaceutical Society of Australia (PSA). This article was developed while in the role of PDL Professional Officer.
PDL is a sponsor of the Medicine safety: children and adolescent care report, which is cited in this article.
[post_title] => Preventing harm: medicine safety in children [post_excerpt] => Medicine safety in children requires vigilance, clear communication and proactive intervention by pharmacists to prevent accidental poisonings. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => preventing-harm-medicine-safety-in-children [to_ping] => [pinged] => [post_modified] => 2025-07-25 11:45:11 [post_modified_gmt] => 2025-07-25 01:45:11 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29861 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Preventing harm: medicine safety in children [title] => Preventing harm: medicine safety in children [href] => https://www.australianpharmacist.com.au/preventing-harm-medicine-safety-in-children/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 29952 [authorType] => ) Get your weekly dose of the news and research you need to help advance your practice.
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