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AUSTRALIAN PHARMACIST
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    • Bridget Totterman
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                  [post_content] => Pharmacist scope of practice is expanding at a rapid rate. With more services, training courses and learning opportunities on offer – it can be difficult to know which direction to choose.
      
      Australian Pharmacist spoke with Bridget Totterman MPS – multi-pharmacy owner and PSA Board Director – about how she’s paving her own path to become a pharmacist prescriber.
      

      Tell us about your journey to becoming a prescribing pharmacist.

      It’s still ongoing! I’m currently enrolled in PSA’s Pharmacist Prescribing Scope of Practice Training Program – which is in-depth, and certainly challenging, but in a good way.  I chose the PSA course because it’s self-paced and the team is so supportive. I know PSA will continue to support me through the implementation of new services, and beyond. The training has two arms – a prescribing and clinical practice training program. The prescribing component involves theory-based learning focused on the prescribing cycle, including information gathering, clinical decision making, communicating decisions to patients and other healthcare professionals and reviewing those decisions.  Meanwhile, the clinical component focuses on differential diagnosis. While we learn about that at uni, the clinical training takes a more rigorous approach. It reminds us of the step-by-step process, practical implications and alternative explanations for each symptom.  Even if you’re 99% confident in a patient’s diagnosis, it’s great to challenge yourself and think about what else it could be. This helps to build confidence in the diagnosis and offer the appropriate treatment plan. It also highlights red flags for certain conditions and reiterates the need for referral in these cases – ensuring we are always working as part of a broader healthcare team in the best interests of the patient.

      Are you offering expanded services in your pharmacies?

      Some of our pharmacists have completed the training and are already practicing as prescribing pharmacists.  As of 1 July 2025, the Queensland pharmacy prescribing pilots became permanent for listed acute conditions and medication management services, such as therapeutic substitution and adaptation, and PBS Continued Dispensing Arrangements. So appropriately trained pharmacists can prescribe hormonal contraception and medicines for a raft of acute conditions, such as ear infections and skin conditions. They can also prescribe and administer travel vaccines and provide smoking cessation and weight management services.  If someone comes into the pharmacy with shingles, our trained pharmacists can now prescribe the right treatment for the patient. We all know time is of the essence when it comes to antivirals, and if patients have to wait to see their GP, they may miss the window where treatment is effective.

      What impact has this had on patients and staff?

      Patients have always found pharmacy convenient. Every day of the week, patients can walk in and speak to a trained healthcare professional – no appointment needed. With expanded scope and the ability to prescribe more medicines, we now have more tools in our belt to provide quality healthcare solutions to our patients in a timely manner. It's also great for pharmacists’ professional satisfaction. We had a team meeting at one of my pharmacies last week, and the whole team was so excited to get behind the prescribing pharmacists so we can all help patients access the healthcare they need in a timely way. Our amazing pharmacy assistants have also jumped on board and are of vital assistance in triaging patients and letting them know care is available. It lifts everyone's confidence and reminds us why we love this profession and why we chose pharmacy in the first place – to help patients.

      What would you say to pharmacists apprehensive about prescribing?

      Come to PSA25! Listen to the speakers on the scope of practice panels and talk to people offering these services from different states and territories.  Back in 2014, I was lucky enough to be one of the first pharmacists to participate in the Queensland Pharmacist Immunisation Pilot, allowing us to administer flu vaccines to patients. At the time, I had pharmacists working for me who said, ‘I’ll never be able to vaccinate. I couldn't imagine putting a needle in someone’s arm’. But now they are smashing out vaccinations. While it’s normal to be hesitant, remember that PSA has a long history of supporting pharmacists every step of the way, wherever your scope of practice takes you.  You don't have to see the whole staircase, just take the first step. And if you’re comfortable, the next step. Who knows where it'll take you. 

      Which aspect of scope of practice expansion excites you the most?

      Helping more people, more quickly. It’s disheartening when red tape gets in the way – like when a mum walks into the pharmacy at 10:00 pm on a Friday with a sick child, no access to a GP, and you’re limited in your ability to help. Hopefully, scope of practice expansion will help to expand the workforce by attracting more pharmacists to our profession. And if we're all doing more, that should help to improve the healthcare access crisis we're experiencing at the moment. 

      What services are you keen to see pharmacists branch into?

      Preventative care. I think we can have a huge impact on patients’ lives through weight management and smoking cessation. We chat to people all day, every day. While they may feel uncomfortable discussing their weight in other healthcare settings, speaking with the friendly pharmacist they've seen every week for the past 20 years might put them more at ease.

      Where do you see scope of practice going nationally?

      I'm hoping it will be a domino effect. I don't want to see resources wasted with people trying to reinvent the wheel. Other states and other jurisdictions should adopt guidelines and protocols that have been proven to work. We need consistency across the country, and while that may take time, we should aim to make the process as seamless as possible. Let's just take what works and roll it out.

      What scope of practice sessions or panels are you excited to see at PSA25?

      There's so many. I always look forward to hearing from Penny Shakespeare, Deputy Secretary for Health Resourcing at the Department of Health, Disability and Ageing – who's participating in the first Policy Panel on Friday morning (1 August).  Professor Bruce Warner, Honorary Professor of Pharmacy Policy and Practice at theUniversity of Nottingham in the UK, will also be sharing his experiences from an international perspective. I love hearing from people who are actually practicing at full scope.  Pharmacists enhancing Palliative Care across the Health Neighbourhood is another session I hope pharmacists will go along to. Now that PSA’s ASPIRE Palliative Care Foundation Training Program is freely available, pharmacists interested in that field make such a difference in people's lives. 

      Why is it important to connect with other pharmacists at industry events like PSA25?

      To connect with others in our profession. Who knows, you might meet your next employer or someone you want to go into business with. You might even end up with a lifelong mentor or a mentee. It's all about connection, positivity and uplifting each other. Learn more about expanding your scope of practice from Bridget Totterman and others at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => Taking the first steps into pharmacist prescribing [post_excerpt] => Any pharmacist can become a pharmacist prescriber, according to this expert. Here’s how to forge your own path. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => taking-the-first-steps-into-pharmacist-prescribing [to_ping] => [pinged] => [post_modified] => 2025-07-16 15:07:12 [post_modified_gmt] => 2025-07-16 05:07:12 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29898 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Taking the first steps into pharmacist prescribing [title] => Taking the first steps into pharmacist prescribing [href] => https://www.australianpharmacist.com.au/taking-the-first-steps-into-pharmacist-prescribing/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 13579 [authorType] => )

      Taking the first steps into pharmacist prescribing

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                  [post_content] => A practical workflow for cancelling tokens, updating profiles and preventing repeat-token errors at every dispense.
      
      Electronic prescriptions are safe, secure and generally convenient for patients and
      health practitioners.1 This convenience largely stems from the rapid transfer of
      prescriptions and their digital tokens without the need for a physical paper
      prescription.
      
      This transfer is so fast there’s often no lag between a dispensing label being printed
      and the patient receiving a new repeat token on their phone via SMS. So what
      happens if that repeat is sent to the wrong number?
      

      What happens if a pharmacy sends a token to the wrong phone number?

      The wrong person will receive the token. While the design of tokens (no name, limited information) limits the likelihood of a privacy breach, it provides the recipient with unauthorised access to the prescription (and therefore unauthorised access to the prescribed medicine).

      What can cause the token to be associated with the wrong phone number?

      A person’s phone numbers in dispensing software may be incorrect when:
      • imported from details associated with the electronic prescription (e.g. another pharmacy or medical centre)
      • patient has a new phone number
      • pharmacist has transcribed number incorrectly
      • a temporary contact number (e.g. another pharmacy/medical centre) was previously added to the profile and not removed from this field
      • number has been entered on incorrect record
      • patient or legal guardian no longer wishes person associated with the phone number to access the prescription (e.g. divorce, phone shared between multiple adults, child becomes an adult, child custody, intimate partner violence etc.)
      Apart from the last dot point, each example above is a very simple and easy-to-make error. And an error type which pharmacy workflows need to effectively eliminate through routine checks during the dispensing process.

      Will correcting the number and reissuing the token ‘fix everything’?

      No. Once a token has been issued, it cannot be retrieved. Simply changing the phone number in the patient profile and reissuing the token will send the token to the patient’s preferred mobile number, but will not cancel the incorrectly issued token, which will still be sitting in the SMS inbox of the person who received it.

      Then what should I do?

      While a token can’t be retrieved, it can be cancelled. In dispensing software cancelling the dispensing event which caused the token to be generated will cancel the repeat token which was issued because of it. The patient contact details in their profile in the dispensing software should then be updated, including verifying their electronic prescription preferences. The prescription should then be re-dispensed through the dispensing system.2

      Do I need to report this to my indemnity insurer?

      Yes, especially if the issue is not identified at the time of dispensing. A note should be added to the patient profile documenting the incident. Documentation may also be required in the pharmacy’s incident log.

      How can this be avoided?

      Check patient mobile phone numbers at every dispense event prior to authorising dispensing and generating the dispensing label. There are multiple different approaches to workflow for achieving this, including at prescription intake or in forward dispensing – for example, including mobile phone number in information check at scripts-in. As one of the approved identifiers, mobile phone number is a good choice of identifier to use as one of the three identifiers at scripts-in, patient selection and/or scripts-out.3,4

      References

      1. digitalhealth.gov.au. Electronic prescribing: for dispensers. 2025. At: www.digitalhealth.gov.au/ealthcare-providers/initiatives-and-programs/electronic-prescribing/for-dispensers/
      2. Pharmaceutical Defence Limited. Electronic prescriptions: National Practice Alerts. 22 December 2023. At: www.pdl.org.au/electronicprescriptions-2/
      3. Pharmaceutical Society of Australia. Professional practice standards 2023 Version 6. 2025. At: www.psa.org.au/practice-support-industry/pps
      4. Australian Commission on Safety and Quality in Health Care. Correct identification and procedure matching. 2025. At: www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safetystandard/correct-identification-and-procedurematching
      [post_title] => Managing eScripts sent to the wrong phone [post_excerpt] => From cancelling the dispensing event to reissuing the prescription, these key steps ensure no token is left active in unauthorised hands. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => managing-escripts-sent-to-the-wrong-phone [to_ping] => [pinged] => [post_modified] => 2025-07-16 15:16:46 [post_modified_gmt] => 2025-07-16 05:16:46 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29876 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Managing eScripts sent to the wrong phone [title] => Managing eScripts sent to the wrong phone [href] => https://www.australianpharmacist.com.au/managing-escripts-sent-to-the-wrong-phone/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29881 [authorType] => )

      Managing eScripts sent to the wrong phone

      medicinal cannabis
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                  [post_date_gmt] => 2025-07-13 23:04:41
                  [post_content] => The Australian Health Practitioner Regulation Agency (AHPRA) has cracked down on medicinal cannabis, with new guidance to tighten up the rules and put practitioners ‘on notice’.
      
      Poor prescribing practices have placed patients at significant harm, with AHPRA stepping in to remind prescribers and dispensers that medicinal cannabis should be treated as any other Controlled Drug (Schedule 8 medicine).
      
      ‘We don’t prescribe opioids to every patient who asks for them, and medicinal cannabis is no different,’ said Medical Board of Australia Chair, Dr Susan O’Dwyer. ‘Patient demand is no indicator of clinical need.’
      
      AHPRA has already taken action against 57 medical practitioners, pharmacists and nurses over medicinal cannabis prescribing practices, with AHPRA CEO Justin Untersteiner confirming that the regulator is currently investigating 60 more.
      
      Australian Pharmacist investigates the issue and pharmacists' obligations going forward.
      

      Booming business, bad practice

      Demand for medicinal cannabis has grown significantly in recent years. Australians spent approximately $402 million on medicinal cannabis in the first half of 2024, nearly matching the $448 million spent in all of 2023. This surge in demand has led to a significant upswing in prescribing, with APHRA identifying eight practitioners who issued more than 10,000 scripts over a 6-month, and one who appears to have issued more than 17,000 scripts. Nearly all medicinal cannabis products are unapproved Schedule 8 medicines, meaning prescribers must use the Special Access Scheme or Authorised Prescriber pathway to prescribe them. But the development of closed loop arrangements, where medicinal cannabis is prescribed via telehealth appointments, has meant that the required level of scrutiny and investigation by prescribing doctors has perhaps not been conducted, said PSA National Vice President and Pharmacy Council of New South Wales Board Member Caroline Diamantis FPS. [caption id="attachment_24130" align="alignright" width="267"]Caroline Diamantis FPS Caroline Diamantis FPS[/caption] ‘Prescribers need to assess if there is a therapeutic need for the prescription and ensure they've developed appropriate management plans.’ AHPRA has said that poor professional standards have been applied, particularly around the volume of medicinal cannabis being prescribed and dispensed. ‘They are looking for stronger safeguards around prescribing, real-time prescription monitoring (RTPM) and S8 controls – prioritising therapeutic need over commercial convenience,’ Ms Diamantis said. The other concern is around various business models that have been ‘conveniently’ created around the demand for medicinal cannabis.  ‘AHPRA’s concern is that the prescriber and dispenser obligations for therapeutic suitability have been overlooked,’ she added. Part and parcel of this new business model is the delivery service for medicinal cannabis adopted by some pharmacists. ‘The very real concern is there's minimal human contact,’ she said. ‘The patient does not have an opportunity to speak with the dispensing pharmacist about any concerns or questions.’

      A real danger for patients

      Medicinal cannabis comes in various dosage formulations with various levels of activity including gummies, tinctures or vaporisers. Patients can sometimes walk away with several different dose forms without prescribers investigating their:
      • mental health
      • medical history
      • underlying illnesses.
      ‘Prescribers have to do their due diligence when they are selecting medicinal cannabis [products],’ Ms Diamantis said. And because these medicines are often prescribed and dispensed via a standalone service, the patient’s regular GP and pharmacist may never know.  ‘I’ve looked after vulnerable young patients, who are 16 and 18 years old and are being carefully monitored by their psychiatrists, GPs and pharmacists – yet without our knowledge, they have been accessing medicinal cannabis for a couple of years through third party online programs,’ she said. ‘The medicinal cannabis was prescribed online and sent through to partner pharmacies, who simply prepared the prescription and forwarded the medication – perhaps with minimal communication and not understanding the full [history] of that patient's health. It's fragmented healthcare at its worst.’  An investigation by the ABC revealed that some patients with a history of psychosis had been hospitalised after being prescribed medicinal cannabis – with one patient dying following inappropriate prescribing.

      Your professional obligations

      Pharmacists have a right to question prescribers, and an obligation to communicate with prescriber if they have concerns, Ms Diamantis said. ‘I have seen cases at the Pharmacy Council where volumes of medicinal cannabis have been provided to a single patient, with pharmacists not recognising that they have the final autonomy as the gatekeeper of the medication,’ she said. Pharmacists should be accessing RTPM systems for every dispense event for medicinal cannabis, whether or not there is a legal compulsion upon them to do so. RTPM allows pharmacists to identify that a person has been prescribed medicinal cannabis or that may not have been disclosed or on a pharmacy’s dispensing system. It also highlights medicinal cannabis supply patterns which indicate overuse or potential drug-drug interactions with other high-risk medicines such as opioids.
      ‘It’s illegal in NSW to dispense an S8 unregistered item on a fax or email. YOu either need a token or a real paper script.' CAROLINE DIAMANTIS FPS 
      However, pharmacists should also be aware there may be gaps in these records. While all electronic prescriptions and computer-generated paper scripts with an eScript barcode will automatically be recorded in RTPM as unapproved therapeutic goods, human coding errors mean sometimes medicinal cannabis prescription or dispense events are not visible. Other reasons the script may not be visible include:
      • forgery
      • system glitch
      • the script being from a state that does not allow the person's history to be seen in the state where the script is presented.
      Pharmacists should also be aware of the regulations in their state or territory around dispensing an unapproved Controlled Drug (S8). ‘[For example], it’s illegal in NSW to dispense an S8 unregistered item on a fax or email,’ Ms Diamantis said. ‘You either need a token or a real paper script.’ This is not something that many pharmacists know. ‘We have seen it time and time again at the Pharmacy Council where people have found themselves in trouble because they don't know that,’ she said.

      Time for a change

      The use of loopholes and prioritising commercial interests over patient health and safety has created a ballooning public health challenge. The challenge for regulators will be maintaining access to medicinal cannabis to people with a therapeutic need, while cracking down on problematic prescribing practices. ‘We do need to keep the standard quite high,’ she said. ‘And if [individual patients] do have valid therapeutic reasons for it, there shouldn't be a problem in the end – we just need everyone on the same page.’ Overall, it has been a learning process, Ms Diamantis believes. ‘As time has passed, I think AHPRA has realised that the regulation needs to be reviewed and that there has to be an increased awareness of the harm that could be inflicted on the public,’ she said. ‘There's nothing wrong with reviewing the legislation, rules and guidelines to make sure that we are in alignment as prescribers and dispensers in keeping the public safe, because that is the ultimate goal for everyone.’ [post_title] => What pharmacists need to know about the medicinal cannabis shake up [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => what-pharmacists-need-to-know-about-the-medicinal-cannabis-shake-up [to_ping] => [pinged] => [post_modified] => 2025-07-14 14:29:16 [post_modified_gmt] => 2025-07-14 04:29:16 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29885 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => What pharmacists need to know about the medicinal cannabis shake up [title] => What pharmacists need to know about the medicinal cannabis shake up [href] => https://www.australianpharmacist.com.au/what-pharmacists-need-to-know-about-the-medicinal-cannabis-shake-up/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29890 [authorType] => )

      What pharmacists need to know about the medicinal cannabis shake up

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                  [post_date] => 2025-07-09 10:22:04
                  [post_date_gmt] => 2025-07-09 00:22:04
                  [post_content] => Endometriosis, affecting approximately one in seven Australian women, remains under-recognised, under-funded and misunderstood. 
      
      Despite the profound impact endometriosis has on health and wellbeing, its diagnosis and management is complex –  with an average of 6–8 years between the onset of symptoms and diagnosis.
      
      ‘This delay is where pharmacists have a crucial role in recognising the symptoms of endometriosis and referring women promptly for diagnosis and treatment,’ said Grace Wong, Medication Safety Pharmacist at The Royal Women's Hospital – who will be leading a session on Championing change for endometriosis care at PSA25 next month.
      

      Why does endometriosis take so long to diagnose?

      There are several interrelated factors at play. Historically, a definitive diagnosis of endometriosis required laparoscopic surgery with histopathological confirmation.  But the limited availability of trained gynaecologists to perform these procedures has created a bottleneck in timely diagnosis. Additionally, the variable and often non-specific nature of endometriosis symptoms – such as chronic pelvic pain, fatigue, dysmenorrhea, cyclical hematuria, dysuria and gastrointestinal disturbances – can lead to misdiagnosis of other conditions such as irritable bowel syndrome. Patients experiencing chronic pelvic or abdominal pain may present repeatedly for symptom relief, with opioids or high-dose non-steroidal anti-inflammatory drugs (NSAIDs) often supplied without further investigation into the underlying cause. This pattern not only delays appropriate diagnosis but also increases the risk of adverse effects and medicine overuse. Societal stigmas surrounding menstruation can lead many to normalise menstrual pain, delaying medical attention. ‘Removing stigma and making women feel confident and comfortable to speak to their pharmacist for advice is something pharmacists and pharmacy support staff can continue to improve,’ Wong said.

      When should endometriosis be suspected?

      Endometriosis should be considered in anyone of reproductive age presenting with persistent pelvic pain – especially when it’s acyclical, unresponsive to first-line treatments, or associated with other gynaecological symptoms such as dyspareunia (painful intercourse) or dysmenorrhoea. Atypical symptoms of endometriosis include:
      • cyclical gastrointestinal symptoms (such as painful bowel movements)
      • dyschesia (difficult defecation)
      • chronic fatigue
      • urinary urgency
      • pain in the lower back, legs, upper abdomen or chest.
      ‘Once diagnosed, pharmacists can help women manage their symptoms through providing evidence-based advice, appropriate counselling for any prescribed medicines, and support women in their journey to managing their condition and leading high quality and productive lives,’ Wong said.

      What’s the role of pharmacists?

      Pharmacists are often the first health professionals that people with endometriosis speak to about menstrual pain or gastrointestinal discomfort. So understanding the pathophysiology, risk factors, and wide-ranging symptoms of endometriosis is essential.  Pharmacists can play a critical role by recognising these red flags, challenging the stigma of normalising menstrual pain and shifting symptomatic management with: 
      • over-the-counter pain relief
      • investigating the presentation and symptoms
      • seeking appropriate medical assessment aids in the timely diagnosis of endometriosis
      • inquiring about patients who present prescriptions for menstrual-related analgesia, who may have underlying red flags that went unrecognised by prescribers.
      Validating patient experiences means avoiding the following terminology:
      • ‘It's just period pain’ or ‘That's normal for women’: these phrases are dismissive and contribute to delayed diagnosis and stigma
      • ‘Everyone goes through this’: minimises the patient's pain and experience
      • ‘Are you sure it's not just stress?’: while stress can exacerbate symptoms, it should not be suggested as the sole cause
      • ‘You don't look sick’: many chronic illnesses, including endometriosis, are invisible.
      Instead, pharmacists could ask:
      • ‘Could you describe if you’ve experienced painful intercourse or pain during bowel movements, particularly around your menstrual cycle?’
      • ‘Do you have any urinary symptoms, such as pain or blood in your urine, and do these seem to relate to your period?’
      • ‘Would you be willing to track your symptoms daily to help us identify any patterns?’
      Pharmacists should also inquire about the impact of symptoms on quality of life and well-being to help break through the ‘suck it up’ mentality that’s often dismissed as normal menstrual pain or hormonal fluctuations. ‘As trusted health professionals, pharmacists have an important role in raising awareness about this condition and supporting efforts to improve services for women with endometriosis,’ Wong said.

      What are the treatment options?

      Treatment of endometriosis is often medical, with a patient-centred approach based on symptoms and reproductive goals. When pharmacological treatment is appropriate, pharmacists hold a critical role in supporting medicine adherence and counselling.  Common pharmacological treatments include:
      • hormonal therapies such as combined oral contraceptive pill (COCP), progestogen-only pills, or levonorgestrel-releasing intrauterine devices (IUDs)
      • non-hormonal options including NSAIDs for pain control
      • emerging therapies including GnRH antagonists (e.g. elagolix, relugolix) and selective progesterone receptor modulators, particularly for refractory cases.
      As medicines experts, pharmacists play a critical role in counselling patients on endometriosis treatments, and managing adverse effects such as reduced bone density associated with GnRH therapy.

      What does the future hold?

      Until recently, endometriosis had been largely overlooked in national funding and research priorities. However, there has been a recent welcome shift in public health policy towards acknowledging endometriosis as a serious chronic condition requiring coordinated care.  The federal government’s National Action Plan for Endometriosis, launched in 2018, marked the first significant step toward national recognition. Since then, investment in awareness campaigns have helped improve visibility and care pathways. Building on this, the 2025–26 federal budget introduced pivotal investments in women’s health, including the establishment of 11 specialist endometriosis and pelvic pain clinics and the addition of a new Medicare Benefits Schedule item for advanced diagnostic ultrasound techniques. ‘Pharmacists are an integral part of the healthcare system, and I envisage there is potential for pharmacists to be more involved directly and indirectly in care of women with endometriosis, to help support the National Action Plan's vision,’ Wong said. ‘To prepare for further involvement, I would encourage pharmacists to find ways to upskill now to be ready and confident to step up when the time comes.’ Hear more from Grace Wong about the role of pharmacists in endometriosis by attending the ‘Championing change for endometriosis care’ session at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => Empowering pharmacists to spot endometriosis early [post_excerpt] => Endometriosis, affecting approximately one in seven Australian women, remains under-recognised, under-funded and misunderstood. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => empowering-pharmacists-to-spot-endometriosis-early [to_ping] => [pinged] => [post_modified] => 2025-07-09 17:51:13 [post_modified_gmt] => 2025-07-09 07:51:13 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29844 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Empowering pharmacists to spot endometriosis early [title] => Empowering pharmacists to spot endometriosis early [href] => https://www.australianpharmacist.com.au/empowering-pharmacists-to-spot-endometriosis-early/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29846 [authorType] => )

      Empowering pharmacists to spot endometriosis early

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                  [post_date] => 2025-07-07 12:34:12
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                  [post_content] => On  1 July 2025, new vaping standards came into force for all therapeutic vaping products for smoking cessation and nicotine dependence.
      
      The Therapeutic Goods Administration's (TGA’s) strengthened standards, designed to reduce harm from vape use, are the culmination of the national vaping reforms, said PSA Project Manager Nikita Dalla Venezia, who worked closely on the PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
      
      ‘Because the changes were fairly substantial, my understanding is that they were staggered,’ she said. ‘This is just the next step of that comprehensive approach to mitigating risk for people who use therapeutic vapes.’
      
      The principal purpose of the reforms is to minimise youth uptake of vaping – an objective that, according to the Cancer Council’s iterative Generation Vape study, appears to be succeeding.
      
      ‘In Wave 7 of the study, which came out after the reforms were introduced, over 50% of youths said they would decline a vape if offered one from a friend, which is a substantial increase from Wave 2 data (less than 40%) that was collected prior to the reforms,’ Ms Dalla Venezia said.
      

      What key changes are introduced in the updated standards?

      Changes to the packaging, labelling and design of vaping products have been introduced. Vaping devices and accessories now need to appear as therapeutic products to reduce their appeal for recreational use among both adolescents and adults, Ms Dalla Venezia said. ‘The packaging needs to be plain, and the design has to be simple with very limited colours,’ she said. New labelling, usage instructions and information leaflets are also required, along with name restrictions. ‘The permitted ingredients have changed, to now only include nicotine, propylene glycol glycerol, and water,’ she  said. ‘And the only flavours allowed are mint, menthol or tobacco.’ Vaping devices and accessories must also meet stricter standards for:
      • medical device quality
      • risk management
      • battery and electrical safety
      • specific design and construction
      • toxicological risk assessment.

      What previously met the standards but now breaches them?

      Concentrations of nicotine over 50 mg/mL. The permitted concentration of nicotine has now changed to a maximum of 50 mg/mL, so vapes exceeding this level cannot be supplied. While the primary onus is on manufacturers of vaping products to ensure they're adhering to the standards, pharmacists need to check that their stock is compliant.

      How can I comply with the new standards?

      By checking all vaping products in your pharmacy against the TGA’s Notified vape list, which has changed since the reforms were initiated last year, Ms Dalla Venezia said. ‘I understand that the TGA conducts compliance assessments as part of ongoing compliance monitoring for these products,’ she said. ‘And since the reforms, a number of those items have been withdrawn.’ Therapeutic vaping products on the list of notified vapes have not been assessed by the TGA for quality, safety, efficacy or performance. But product sponsors must notify the TGA that their good complies with the minimum requirements for notified vaping goods, adhering to the product standards: 
      • Therapeutic Goods (Standard for Therapeutic Vaping Goods) (TGO 110) Order 2021
      • Therapeutic Goods (Medical Device Standard – Therapeutic Vaping Devices) Order 2023 (MDSO).
      In addition to the notified vape list, there's a separate database on the TGA website that pharmacists can check to see which products have been withdrawn or ceased. ‘If pharmacists suspect a product they have is no longer consistent with these changes, they can  look at that withdrawn database,’ Ms Dalla Venezia said. ‘These lists can also be filtered by date.’ It’s also important to educate all pharmacy staff to ensure they are aware of the strengthened product standards, product compliance and availability – and alternative brands. 

      Do the changes apply to both prescription and Pharmacist Only vapes?

      Yes. All therapeutic vapes, whether prescribed or supplied after a consultation with a pharmacist, must comply with the new standards.  To ensure a smooth transition, pharmacists should communicate with prescribers – and patients – about the changes to vaping product standards, and available products. ‘The federal Department of Health, Disability and Ageing is continuously monitoring the products on the list and making sure that they adhere to the standards for vaping products,’ Ms Dalla Venezia said.  ‘So it’s a good idea to take note of all of your inventory, and if there’s anything you know you’re dispensing on a regular basis, cross reference it with the notified vape list.’  For more information on prescribing and dispensing vapes, refer to these PSA checklists:
      • Pharmacist Workflow for Prescribing and Dispensing Therapeutic Vapes
      • Pharmacist Workflow for Dispensing Nicotine Vaping Products.

      Can I sell my existing products until the stock is exhausted?

      Only if it’s on the notified vape list. Since the standards came into effect last week on 1 July, all supplied vaping products must adhere to the new requirements. Pharmacists should contact the manufacturer of non-compliant stock, Ms Dalla Venezia said. ‘The TGA has directed pharmacists to return non-compliant products to the supplier,’ she said. ‘If they're not able to return the products, they should dispose of them as per their state or territory regulations.’

      Do the new standards mean vapes are now first-line therapy?

      Vapes are absolutely not the first-line treatment option for smoking cessation, Ms Dalla Venezia emphasised. ‘PSA’s recommendations and guidelines haven't [needed to] change in response to the standard changes,’ she said. The recommended pathway for smoking cessation includes:
      • Behavioural support: essential for all patients attempting to quit smoking, either alone or in combination with pharmacotherapy
      • First-line pharmacotherapy:
        • Nicotine Replacement Therapy (NRT)  – patches, gum, lozenges, mouth spray
        • Varenicline
        • Bupropion
      Using combination NRT with behavioural support is more effective than NRT monotherapy. Although therapeutic vapes are not first-line therapy for smoking cessation, the use of a therapeutic vape from the list of notified vapes is considered to be less harmful than smoking, Ms Dalla Venezia said. ‘We don’t want people to fear considering therapeutic vapes if they’re therapeutically appropriate,’ she said. ‘They are still an option for people who have gone through all the approved, first-line NRT steps and still are not able to quit smoking.’

      Is there a first-line therapy specifically for vaping cessation?

      Not definitively, Ms Dalla Venezia said. ‘There isn't a substantial body of evidence for vaping cessation at the moment,’ she said. ‘But within the PSA guidelines, we take the same approach to vaping as we take to smoking cessation.’  That means pharmacists should recommend combination NRT for vaping cessation as the most effective first-line treatment option. ‘As evidence evolves, we'll continue to revisit the guidelines. But that's the best approach that we have with the evidence that's available to us at the moment,’ Ms Dalla Venezia said. ‘As recreational vapes are becoming less accessible, a new subset of the population who are nicotine dependent through vapes as the medium are going to need ongoing support from pharmacists.’ Historically, Australia's tobacco control and marketing around the harms of smoking have been successful, however they no longer reach the primary demographic – youth. To engage young people aged 14–17 on a platform they actually use through people who speak their language, the federal Department of Health, Ageing and Disability engaged 10 influencers – one of which alone has 1.7 million followers on Tiktok in that age bracket. ‘It's a really great opportunity to reach young people  because that's the group of people who were beginning to use vapes at such rapidly increasing rates,’ Ms Dalla Venezia said. Pharmacists should refer to the TGA vaping hub for a comprehensive overview of all changes. Keen to learn more about smoking and vaping cessation? Attend the 'Clearing the air on smoking and vaping cessation' workshop at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => The new vaping standards explained [post_excerpt] => On  1 July 2025, new vaping standards came into force for all therapeutic vaping products for smoking cessation and nicotine dependence. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => the-new-vaping-standards-explained [to_ping] => [pinged] => [post_modified] => 2025-07-07 15:10:03 [post_modified_gmt] => 2025-07-07 05:10:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29824 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The new vaping standards explained [title] => The new vaping standards explained [href] => https://www.australianpharmacist.com.au/the-new-vaping-standards-explained/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29826 [authorType] => )

      The new vaping standards explained

  • Clinical
    • Bridget Totterman
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                  [post_content] => Pharmacist scope of practice is expanding at a rapid rate. With more services, training courses and learning opportunities on offer – it can be difficult to know which direction to choose.
      
      Australian Pharmacist spoke with Bridget Totterman MPS – multi-pharmacy owner and PSA Board Director – about how she’s paving her own path to become a pharmacist prescriber.
      

      Tell us about your journey to becoming a prescribing pharmacist.

      It’s still ongoing! I’m currently enrolled in PSA’s Pharmacist Prescribing Scope of Practice Training Program – which is in-depth, and certainly challenging, but in a good way.  I chose the PSA course because it’s self-paced and the team is so supportive. I know PSA will continue to support me through the implementation of new services, and beyond. The training has two arms – a prescribing and clinical practice training program. The prescribing component involves theory-based learning focused on the prescribing cycle, including information gathering, clinical decision making, communicating decisions to patients and other healthcare professionals and reviewing those decisions.  Meanwhile, the clinical component focuses on differential diagnosis. While we learn about that at uni, the clinical training takes a more rigorous approach. It reminds us of the step-by-step process, practical implications and alternative explanations for each symptom.  Even if you’re 99% confident in a patient’s diagnosis, it’s great to challenge yourself and think about what else it could be. This helps to build confidence in the diagnosis and offer the appropriate treatment plan. It also highlights red flags for certain conditions and reiterates the need for referral in these cases – ensuring we are always working as part of a broader healthcare team in the best interests of the patient.

      Are you offering expanded services in your pharmacies?

      Some of our pharmacists have completed the training and are already practicing as prescribing pharmacists.  As of 1 July 2025, the Queensland pharmacy prescribing pilots became permanent for listed acute conditions and medication management services, such as therapeutic substitution and adaptation, and PBS Continued Dispensing Arrangements. So appropriately trained pharmacists can prescribe hormonal contraception and medicines for a raft of acute conditions, such as ear infections and skin conditions. They can also prescribe and administer travel vaccines and provide smoking cessation and weight management services.  If someone comes into the pharmacy with shingles, our trained pharmacists can now prescribe the right treatment for the patient. We all know time is of the essence when it comes to antivirals, and if patients have to wait to see their GP, they may miss the window where treatment is effective.

      What impact has this had on patients and staff?

      Patients have always found pharmacy convenient. Every day of the week, patients can walk in and speak to a trained healthcare professional – no appointment needed. With expanded scope and the ability to prescribe more medicines, we now have more tools in our belt to provide quality healthcare solutions to our patients in a timely manner. It's also great for pharmacists’ professional satisfaction. We had a team meeting at one of my pharmacies last week, and the whole team was so excited to get behind the prescribing pharmacists so we can all help patients access the healthcare they need in a timely way. Our amazing pharmacy assistants have also jumped on board and are of vital assistance in triaging patients and letting them know care is available. It lifts everyone's confidence and reminds us why we love this profession and why we chose pharmacy in the first place – to help patients.

      What would you say to pharmacists apprehensive about prescribing?

      Come to PSA25! Listen to the speakers on the scope of practice panels and talk to people offering these services from different states and territories.  Back in 2014, I was lucky enough to be one of the first pharmacists to participate in the Queensland Pharmacist Immunisation Pilot, allowing us to administer flu vaccines to patients. At the time, I had pharmacists working for me who said, ‘I’ll never be able to vaccinate. I couldn't imagine putting a needle in someone’s arm’. But now they are smashing out vaccinations. While it’s normal to be hesitant, remember that PSA has a long history of supporting pharmacists every step of the way, wherever your scope of practice takes you.  You don't have to see the whole staircase, just take the first step. And if you’re comfortable, the next step. Who knows where it'll take you. 

      Which aspect of scope of practice expansion excites you the most?

      Helping more people, more quickly. It’s disheartening when red tape gets in the way – like when a mum walks into the pharmacy at 10:00 pm on a Friday with a sick child, no access to a GP, and you’re limited in your ability to help. Hopefully, scope of practice expansion will help to expand the workforce by attracting more pharmacists to our profession. And if we're all doing more, that should help to improve the healthcare access crisis we're experiencing at the moment. 

      What services are you keen to see pharmacists branch into?

      Preventative care. I think we can have a huge impact on patients’ lives through weight management and smoking cessation. We chat to people all day, every day. While they may feel uncomfortable discussing their weight in other healthcare settings, speaking with the friendly pharmacist they've seen every week for the past 20 years might put them more at ease.

      Where do you see scope of practice going nationally?

      I'm hoping it will be a domino effect. I don't want to see resources wasted with people trying to reinvent the wheel. Other states and other jurisdictions should adopt guidelines and protocols that have been proven to work. We need consistency across the country, and while that may take time, we should aim to make the process as seamless as possible. Let's just take what works and roll it out.

      What scope of practice sessions or panels are you excited to see at PSA25?

      There's so many. I always look forward to hearing from Penny Shakespeare, Deputy Secretary for Health Resourcing at the Department of Health, Disability and Ageing – who's participating in the first Policy Panel on Friday morning (1 August).  Professor Bruce Warner, Honorary Professor of Pharmacy Policy and Practice at theUniversity of Nottingham in the UK, will also be sharing his experiences from an international perspective. I love hearing from people who are actually practicing at full scope.  Pharmacists enhancing Palliative Care across the Health Neighbourhood is another session I hope pharmacists will go along to. Now that PSA’s ASPIRE Palliative Care Foundation Training Program is freely available, pharmacists interested in that field make such a difference in people's lives. 

      Why is it important to connect with other pharmacists at industry events like PSA25?

      To connect with others in our profession. Who knows, you might meet your next employer or someone you want to go into business with. You might even end up with a lifelong mentor or a mentee. It's all about connection, positivity and uplifting each other. Learn more about expanding your scope of practice from Bridget Totterman and others at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => Taking the first steps into pharmacist prescribing [post_excerpt] => Any pharmacist can become a pharmacist prescriber, according to this expert. Here’s how to forge your own path. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => taking-the-first-steps-into-pharmacist-prescribing [to_ping] => [pinged] => [post_modified] => 2025-07-16 15:07:12 [post_modified_gmt] => 2025-07-16 05:07:12 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29898 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Taking the first steps into pharmacist prescribing [title] => Taking the first steps into pharmacist prescribing [href] => https://www.australianpharmacist.com.au/taking-the-first-steps-into-pharmacist-prescribing/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 13579 [authorType] => )

      Taking the first steps into pharmacist prescribing

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                  [ID] => 29876
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                  [post_date] => 2025-07-14 10:15:54
                  [post_date_gmt] => 2025-07-14 00:15:54
                  [post_content] => A practical workflow for cancelling tokens, updating profiles and preventing repeat-token errors at every dispense.
      
      Electronic prescriptions are safe, secure and generally convenient for patients and
      health practitioners.1 This convenience largely stems from the rapid transfer of
      prescriptions and their digital tokens without the need for a physical paper
      prescription.
      
      This transfer is so fast there’s often no lag between a dispensing label being printed
      and the patient receiving a new repeat token on their phone via SMS. So what
      happens if that repeat is sent to the wrong number?
      

      What happens if a pharmacy sends a token to the wrong phone number?

      The wrong person will receive the token. While the design of tokens (no name, limited information) limits the likelihood of a privacy breach, it provides the recipient with unauthorised access to the prescription (and therefore unauthorised access to the prescribed medicine).

      What can cause the token to be associated with the wrong phone number?

      A person’s phone numbers in dispensing software may be incorrect when:
      • imported from details associated with the electronic prescription (e.g. another pharmacy or medical centre)
      • patient has a new phone number
      • pharmacist has transcribed number incorrectly
      • a temporary contact number (e.g. another pharmacy/medical centre) was previously added to the profile and not removed from this field
      • number has been entered on incorrect record
      • patient or legal guardian no longer wishes person associated with the phone number to access the prescription (e.g. divorce, phone shared between multiple adults, child becomes an adult, child custody, intimate partner violence etc.)
      Apart from the last dot point, each example above is a very simple and easy-to-make error. And an error type which pharmacy workflows need to effectively eliminate through routine checks during the dispensing process.

      Will correcting the number and reissuing the token ‘fix everything’?

      No. Once a token has been issued, it cannot be retrieved. Simply changing the phone number in the patient profile and reissuing the token will send the token to the patient’s preferred mobile number, but will not cancel the incorrectly issued token, which will still be sitting in the SMS inbox of the person who received it.

      Then what should I do?

      While a token can’t be retrieved, it can be cancelled. In dispensing software cancelling the dispensing event which caused the token to be generated will cancel the repeat token which was issued because of it. The patient contact details in their profile in the dispensing software should then be updated, including verifying their electronic prescription preferences. The prescription should then be re-dispensed through the dispensing system.2

      Do I need to report this to my indemnity insurer?

      Yes, especially if the issue is not identified at the time of dispensing. A note should be added to the patient profile documenting the incident. Documentation may also be required in the pharmacy’s incident log.

      How can this be avoided?

      Check patient mobile phone numbers at every dispense event prior to authorising dispensing and generating the dispensing label. There are multiple different approaches to workflow for achieving this, including at prescription intake or in forward dispensing – for example, including mobile phone number in information check at scripts-in. As one of the approved identifiers, mobile phone number is a good choice of identifier to use as one of the three identifiers at scripts-in, patient selection and/or scripts-out.3,4

      References

      1. digitalhealth.gov.au. Electronic prescribing: for dispensers. 2025. At: www.digitalhealth.gov.au/ealthcare-providers/initiatives-and-programs/electronic-prescribing/for-dispensers/
      2. Pharmaceutical Defence Limited. Electronic prescriptions: National Practice Alerts. 22 December 2023. At: www.pdl.org.au/electronicprescriptions-2/
      3. Pharmaceutical Society of Australia. Professional practice standards 2023 Version 6. 2025. At: www.psa.org.au/practice-support-industry/pps
      4. Australian Commission on Safety and Quality in Health Care. Correct identification and procedure matching. 2025. At: www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safetystandard/correct-identification-and-procedurematching
      [post_title] => Managing eScripts sent to the wrong phone [post_excerpt] => From cancelling the dispensing event to reissuing the prescription, these key steps ensure no token is left active in unauthorised hands. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => managing-escripts-sent-to-the-wrong-phone [to_ping] => [pinged] => [post_modified] => 2025-07-16 15:16:46 [post_modified_gmt] => 2025-07-16 05:16:46 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29876 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Managing eScripts sent to the wrong phone [title] => Managing eScripts sent to the wrong phone [href] => https://www.australianpharmacist.com.au/managing-escripts-sent-to-the-wrong-phone/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29881 [authorType] => )

      Managing eScripts sent to the wrong phone

      medicinal cannabis
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                  [post_date] => 2025-07-14 09:04:41
                  [post_date_gmt] => 2025-07-13 23:04:41
                  [post_content] => The Australian Health Practitioner Regulation Agency (AHPRA) has cracked down on medicinal cannabis, with new guidance to tighten up the rules and put practitioners ‘on notice’.
      
      Poor prescribing practices have placed patients at significant harm, with AHPRA stepping in to remind prescribers and dispensers that medicinal cannabis should be treated as any other Controlled Drug (Schedule 8 medicine).
      
      ‘We don’t prescribe opioids to every patient who asks for them, and medicinal cannabis is no different,’ said Medical Board of Australia Chair, Dr Susan O’Dwyer. ‘Patient demand is no indicator of clinical need.’
      
      AHPRA has already taken action against 57 medical practitioners, pharmacists and nurses over medicinal cannabis prescribing practices, with AHPRA CEO Justin Untersteiner confirming that the regulator is currently investigating 60 more.
      
      Australian Pharmacist investigates the issue and pharmacists' obligations going forward.
      

      Booming business, bad practice

      Demand for medicinal cannabis has grown significantly in recent years. Australians spent approximately $402 million on medicinal cannabis in the first half of 2024, nearly matching the $448 million spent in all of 2023. This surge in demand has led to a significant upswing in prescribing, with APHRA identifying eight practitioners who issued more than 10,000 scripts over a 6-month, and one who appears to have issued more than 17,000 scripts. Nearly all medicinal cannabis products are unapproved Schedule 8 medicines, meaning prescribers must use the Special Access Scheme or Authorised Prescriber pathway to prescribe them. But the development of closed loop arrangements, where medicinal cannabis is prescribed via telehealth appointments, has meant that the required level of scrutiny and investigation by prescribing doctors has perhaps not been conducted, said PSA National Vice President and Pharmacy Council of New South Wales Board Member Caroline Diamantis FPS. [caption id="attachment_24130" align="alignright" width="267"]Caroline Diamantis FPS Caroline Diamantis FPS[/caption] ‘Prescribers need to assess if there is a therapeutic need for the prescription and ensure they've developed appropriate management plans.’ AHPRA has said that poor professional standards have been applied, particularly around the volume of medicinal cannabis being prescribed and dispensed. ‘They are looking for stronger safeguards around prescribing, real-time prescription monitoring (RTPM) and S8 controls – prioritising therapeutic need over commercial convenience,’ Ms Diamantis said. The other concern is around various business models that have been ‘conveniently’ created around the demand for medicinal cannabis.  ‘AHPRA’s concern is that the prescriber and dispenser obligations for therapeutic suitability have been overlooked,’ she added. Part and parcel of this new business model is the delivery service for medicinal cannabis adopted by some pharmacists. ‘The very real concern is there's minimal human contact,’ she said. ‘The patient does not have an opportunity to speak with the dispensing pharmacist about any concerns or questions.’

      A real danger for patients

      Medicinal cannabis comes in various dosage formulations with various levels of activity including gummies, tinctures or vaporisers. Patients can sometimes walk away with several different dose forms without prescribers investigating their:
      • mental health
      • medical history
      • underlying illnesses.
      ‘Prescribers have to do their due diligence when they are selecting medicinal cannabis [products],’ Ms Diamantis said. And because these medicines are often prescribed and dispensed via a standalone service, the patient’s regular GP and pharmacist may never know.  ‘I’ve looked after vulnerable young patients, who are 16 and 18 years old and are being carefully monitored by their psychiatrists, GPs and pharmacists – yet without our knowledge, they have been accessing medicinal cannabis for a couple of years through third party online programs,’ she said. ‘The medicinal cannabis was prescribed online and sent through to partner pharmacies, who simply prepared the prescription and forwarded the medication – perhaps with minimal communication and not understanding the full [history] of that patient's health. It's fragmented healthcare at its worst.’  An investigation by the ABC revealed that some patients with a history of psychosis had been hospitalised after being prescribed medicinal cannabis – with one patient dying following inappropriate prescribing.

      Your professional obligations

      Pharmacists have a right to question prescribers, and an obligation to communicate with prescriber if they have concerns, Ms Diamantis said. ‘I have seen cases at the Pharmacy Council where volumes of medicinal cannabis have been provided to a single patient, with pharmacists not recognising that they have the final autonomy as the gatekeeper of the medication,’ she said. Pharmacists should be accessing RTPM systems for every dispense event for medicinal cannabis, whether or not there is a legal compulsion upon them to do so. RTPM allows pharmacists to identify that a person has been prescribed medicinal cannabis or that may not have been disclosed or on a pharmacy’s dispensing system. It also highlights medicinal cannabis supply patterns which indicate overuse or potential drug-drug interactions with other high-risk medicines such as opioids.
      ‘It’s illegal in NSW to dispense an S8 unregistered item on a fax or email. YOu either need a token or a real paper script.' CAROLINE DIAMANTIS FPS 
      However, pharmacists should also be aware there may be gaps in these records. While all electronic prescriptions and computer-generated paper scripts with an eScript barcode will automatically be recorded in RTPM as unapproved therapeutic goods, human coding errors mean sometimes medicinal cannabis prescription or dispense events are not visible. Other reasons the script may not be visible include:
      • forgery
      • system glitch
      • the script being from a state that does not allow the person's history to be seen in the state where the script is presented.
      Pharmacists should also be aware of the regulations in their state or territory around dispensing an unapproved Controlled Drug (S8). ‘[For example], it’s illegal in NSW to dispense an S8 unregistered item on a fax or email,’ Ms Diamantis said. ‘You either need a token or a real paper script.’ This is not something that many pharmacists know. ‘We have seen it time and time again at the Pharmacy Council where people have found themselves in trouble because they don't know that,’ she said.

      Time for a change

      The use of loopholes and prioritising commercial interests over patient health and safety has created a ballooning public health challenge. The challenge for regulators will be maintaining access to medicinal cannabis to people with a therapeutic need, while cracking down on problematic prescribing practices. ‘We do need to keep the standard quite high,’ she said. ‘And if [individual patients] do have valid therapeutic reasons for it, there shouldn't be a problem in the end – we just need everyone on the same page.’ Overall, it has been a learning process, Ms Diamantis believes. ‘As time has passed, I think AHPRA has realised that the regulation needs to be reviewed and that there has to be an increased awareness of the harm that could be inflicted on the public,’ she said. ‘There's nothing wrong with reviewing the legislation, rules and guidelines to make sure that we are in alignment as prescribers and dispensers in keeping the public safe, because that is the ultimate goal for everyone.’ [post_title] => What pharmacists need to know about the medicinal cannabis shake up [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => what-pharmacists-need-to-know-about-the-medicinal-cannabis-shake-up [to_ping] => [pinged] => [post_modified] => 2025-07-14 14:29:16 [post_modified_gmt] => 2025-07-14 04:29:16 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29885 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => What pharmacists need to know about the medicinal cannabis shake up [title] => What pharmacists need to know about the medicinal cannabis shake up [href] => https://www.australianpharmacist.com.au/what-pharmacists-need-to-know-about-the-medicinal-cannabis-shake-up/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29890 [authorType] => )

      What pharmacists need to know about the medicinal cannabis shake up

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                  [post_date] => 2025-07-09 10:22:04
                  [post_date_gmt] => 2025-07-09 00:22:04
                  [post_content] => Endometriosis, affecting approximately one in seven Australian women, remains under-recognised, under-funded and misunderstood. 
      
      Despite the profound impact endometriosis has on health and wellbeing, its diagnosis and management is complex –  with an average of 6–8 years between the onset of symptoms and diagnosis.
      
      ‘This delay is where pharmacists have a crucial role in recognising the symptoms of endometriosis and referring women promptly for diagnosis and treatment,’ said Grace Wong, Medication Safety Pharmacist at The Royal Women's Hospital – who will be leading a session on Championing change for endometriosis care at PSA25 next month.
      

      Why does endometriosis take so long to diagnose?

      There are several interrelated factors at play. Historically, a definitive diagnosis of endometriosis required laparoscopic surgery with histopathological confirmation.  But the limited availability of trained gynaecologists to perform these procedures has created a bottleneck in timely diagnosis. Additionally, the variable and often non-specific nature of endometriosis symptoms – such as chronic pelvic pain, fatigue, dysmenorrhea, cyclical hematuria, dysuria and gastrointestinal disturbances – can lead to misdiagnosis of other conditions such as irritable bowel syndrome. Patients experiencing chronic pelvic or abdominal pain may present repeatedly for symptom relief, with opioids or high-dose non-steroidal anti-inflammatory drugs (NSAIDs) often supplied without further investigation into the underlying cause. This pattern not only delays appropriate diagnosis but also increases the risk of adverse effects and medicine overuse. Societal stigmas surrounding menstruation can lead many to normalise menstrual pain, delaying medical attention. ‘Removing stigma and making women feel confident and comfortable to speak to their pharmacist for advice is something pharmacists and pharmacy support staff can continue to improve,’ Wong said.

      When should endometriosis be suspected?

      Endometriosis should be considered in anyone of reproductive age presenting with persistent pelvic pain – especially when it’s acyclical, unresponsive to first-line treatments, or associated with other gynaecological symptoms such as dyspareunia (painful intercourse) or dysmenorrhoea. Atypical symptoms of endometriosis include:
      • cyclical gastrointestinal symptoms (such as painful bowel movements)
      • dyschesia (difficult defecation)
      • chronic fatigue
      • urinary urgency
      • pain in the lower back, legs, upper abdomen or chest.
      ‘Once diagnosed, pharmacists can help women manage their symptoms through providing evidence-based advice, appropriate counselling for any prescribed medicines, and support women in their journey to managing their condition and leading high quality and productive lives,’ Wong said.

      What’s the role of pharmacists?

      Pharmacists are often the first health professionals that people with endometriosis speak to about menstrual pain or gastrointestinal discomfort. So understanding the pathophysiology, risk factors, and wide-ranging symptoms of endometriosis is essential.  Pharmacists can play a critical role by recognising these red flags, challenging the stigma of normalising menstrual pain and shifting symptomatic management with: 
      • over-the-counter pain relief
      • investigating the presentation and symptoms
      • seeking appropriate medical assessment aids in the timely diagnosis of endometriosis
      • inquiring about patients who present prescriptions for menstrual-related analgesia, who may have underlying red flags that went unrecognised by prescribers.
      Validating patient experiences means avoiding the following terminology:
      • ‘It's just period pain’ or ‘That's normal for women’: these phrases are dismissive and contribute to delayed diagnosis and stigma
      • ‘Everyone goes through this’: minimises the patient's pain and experience
      • ‘Are you sure it's not just stress?’: while stress can exacerbate symptoms, it should not be suggested as the sole cause
      • ‘You don't look sick’: many chronic illnesses, including endometriosis, are invisible.
      Instead, pharmacists could ask:
      • ‘Could you describe if you’ve experienced painful intercourse or pain during bowel movements, particularly around your menstrual cycle?’
      • ‘Do you have any urinary symptoms, such as pain or blood in your urine, and do these seem to relate to your period?’
      • ‘Would you be willing to track your symptoms daily to help us identify any patterns?’
      Pharmacists should also inquire about the impact of symptoms on quality of life and well-being to help break through the ‘suck it up’ mentality that’s often dismissed as normal menstrual pain or hormonal fluctuations. ‘As trusted health professionals, pharmacists have an important role in raising awareness about this condition and supporting efforts to improve services for women with endometriosis,’ Wong said.

      What are the treatment options?

      Treatment of endometriosis is often medical, with a patient-centred approach based on symptoms and reproductive goals. When pharmacological treatment is appropriate, pharmacists hold a critical role in supporting medicine adherence and counselling.  Common pharmacological treatments include:
      • hormonal therapies such as combined oral contraceptive pill (COCP), progestogen-only pills, or levonorgestrel-releasing intrauterine devices (IUDs)
      • non-hormonal options including NSAIDs for pain control
      • emerging therapies including GnRH antagonists (e.g. elagolix, relugolix) and selective progesterone receptor modulators, particularly for refractory cases.
      As medicines experts, pharmacists play a critical role in counselling patients on endometriosis treatments, and managing adverse effects such as reduced bone density associated with GnRH therapy.

      What does the future hold?

      Until recently, endometriosis had been largely overlooked in national funding and research priorities. However, there has been a recent welcome shift in public health policy towards acknowledging endometriosis as a serious chronic condition requiring coordinated care.  The federal government’s National Action Plan for Endometriosis, launched in 2018, marked the first significant step toward national recognition. Since then, investment in awareness campaigns have helped improve visibility and care pathways. Building on this, the 2025–26 federal budget introduced pivotal investments in women’s health, including the establishment of 11 specialist endometriosis and pelvic pain clinics and the addition of a new Medicare Benefits Schedule item for advanced diagnostic ultrasound techniques. ‘Pharmacists are an integral part of the healthcare system, and I envisage there is potential for pharmacists to be more involved directly and indirectly in care of women with endometriosis, to help support the National Action Plan's vision,’ Wong said. ‘To prepare for further involvement, I would encourage pharmacists to find ways to upskill now to be ready and confident to step up when the time comes.’ Hear more from Grace Wong about the role of pharmacists in endometriosis by attending the ‘Championing change for endometriosis care’ session at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => Empowering pharmacists to spot endometriosis early [post_excerpt] => Endometriosis, affecting approximately one in seven Australian women, remains under-recognised, under-funded and misunderstood. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => empowering-pharmacists-to-spot-endometriosis-early [to_ping] => [pinged] => [post_modified] => 2025-07-09 17:51:13 [post_modified_gmt] => 2025-07-09 07:51:13 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29844 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Empowering pharmacists to spot endometriosis early [title] => Empowering pharmacists to spot endometriosis early [href] => https://www.australianpharmacist.com.au/empowering-pharmacists-to-spot-endometriosis-early/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29846 [authorType] => )

      Empowering pharmacists to spot endometriosis early

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                  [ID] => 29824
                  [post_author] => 3410
                  [post_date] => 2025-07-07 12:34:12
                  [post_date_gmt] => 2025-07-07 02:34:12
                  [post_content] => On  1 July 2025, new vaping standards came into force for all therapeutic vaping products for smoking cessation and nicotine dependence.
      
      The Therapeutic Goods Administration's (TGA’s) strengthened standards, designed to reduce harm from vape use, are the culmination of the national vaping reforms, said PSA Project Manager Nikita Dalla Venezia, who worked closely on the PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
      
      ‘Because the changes were fairly substantial, my understanding is that they were staggered,’ she said. ‘This is just the next step of that comprehensive approach to mitigating risk for people who use therapeutic vapes.’
      
      The principal purpose of the reforms is to minimise youth uptake of vaping – an objective that, according to the Cancer Council’s iterative Generation Vape study, appears to be succeeding.
      
      ‘In Wave 7 of the study, which came out after the reforms were introduced, over 50% of youths said they would decline a vape if offered one from a friend, which is a substantial increase from Wave 2 data (less than 40%) that was collected prior to the reforms,’ Ms Dalla Venezia said.
      

      What key changes are introduced in the updated standards?

      Changes to the packaging, labelling and design of vaping products have been introduced. Vaping devices and accessories now need to appear as therapeutic products to reduce their appeal for recreational use among both adolescents and adults, Ms Dalla Venezia said. ‘The packaging needs to be plain, and the design has to be simple with very limited colours,’ she said. New labelling, usage instructions and information leaflets are also required, along with name restrictions. ‘The permitted ingredients have changed, to now only include nicotine, propylene glycol glycerol, and water,’ she  said. ‘And the only flavours allowed are mint, menthol or tobacco.’ Vaping devices and accessories must also meet stricter standards for:
      • medical device quality
      • risk management
      • battery and electrical safety
      • specific design and construction
      • toxicological risk assessment.

      What previously met the standards but now breaches them?

      Concentrations of nicotine over 50 mg/mL. The permitted concentration of nicotine has now changed to a maximum of 50 mg/mL, so vapes exceeding this level cannot be supplied. While the primary onus is on manufacturers of vaping products to ensure they're adhering to the standards, pharmacists need to check that their stock is compliant.

      How can I comply with the new standards?

      By checking all vaping products in your pharmacy against the TGA’s Notified vape list, which has changed since the reforms were initiated last year, Ms Dalla Venezia said. ‘I understand that the TGA conducts compliance assessments as part of ongoing compliance monitoring for these products,’ she said. ‘And since the reforms, a number of those items have been withdrawn.’ Therapeutic vaping products on the list of notified vapes have not been assessed by the TGA for quality, safety, efficacy or performance. But product sponsors must notify the TGA that their good complies with the minimum requirements for notified vaping goods, adhering to the product standards: 
      • Therapeutic Goods (Standard for Therapeutic Vaping Goods) (TGO 110) Order 2021
      • Therapeutic Goods (Medical Device Standard – Therapeutic Vaping Devices) Order 2023 (MDSO).
      In addition to the notified vape list, there's a separate database on the TGA website that pharmacists can check to see which products have been withdrawn or ceased. ‘If pharmacists suspect a product they have is no longer consistent with these changes, they can  look at that withdrawn database,’ Ms Dalla Venezia said. ‘These lists can also be filtered by date.’ It’s also important to educate all pharmacy staff to ensure they are aware of the strengthened product standards, product compliance and availability – and alternative brands. 

      Do the changes apply to both prescription and Pharmacist Only vapes?

      Yes. All therapeutic vapes, whether prescribed or supplied after a consultation with a pharmacist, must comply with the new standards.  To ensure a smooth transition, pharmacists should communicate with prescribers – and patients – about the changes to vaping product standards, and available products. ‘The federal Department of Health, Disability and Ageing is continuously monitoring the products on the list and making sure that they adhere to the standards for vaping products,’ Ms Dalla Venezia said.  ‘So it’s a good idea to take note of all of your inventory, and if there’s anything you know you’re dispensing on a regular basis, cross reference it with the notified vape list.’  For more information on prescribing and dispensing vapes, refer to these PSA checklists:
      • Pharmacist Workflow for Prescribing and Dispensing Therapeutic Vapes
      • Pharmacist Workflow for Dispensing Nicotine Vaping Products.

      Can I sell my existing products until the stock is exhausted?

      Only if it’s on the notified vape list. Since the standards came into effect last week on 1 July, all supplied vaping products must adhere to the new requirements. Pharmacists should contact the manufacturer of non-compliant stock, Ms Dalla Venezia said. ‘The TGA has directed pharmacists to return non-compliant products to the supplier,’ she said. ‘If they're not able to return the products, they should dispose of them as per their state or territory regulations.’

      Do the new standards mean vapes are now first-line therapy?

      Vapes are absolutely not the first-line treatment option for smoking cessation, Ms Dalla Venezia emphasised. ‘PSA’s recommendations and guidelines haven't [needed to] change in response to the standard changes,’ she said. The recommended pathway for smoking cessation includes:
      • Behavioural support: essential for all patients attempting to quit smoking, either alone or in combination with pharmacotherapy
      • First-line pharmacotherapy:
        • Nicotine Replacement Therapy (NRT)  – patches, gum, lozenges, mouth spray
        • Varenicline
        • Bupropion
      Using combination NRT with behavioural support is more effective than NRT monotherapy. Although therapeutic vapes are not first-line therapy for smoking cessation, the use of a therapeutic vape from the list of notified vapes is considered to be less harmful than smoking, Ms Dalla Venezia said. ‘We don’t want people to fear considering therapeutic vapes if they’re therapeutically appropriate,’ she said. ‘They are still an option for people who have gone through all the approved, first-line NRT steps and still are not able to quit smoking.’

      Is there a first-line therapy specifically for vaping cessation?

      Not definitively, Ms Dalla Venezia said. ‘There isn't a substantial body of evidence for vaping cessation at the moment,’ she said. ‘But within the PSA guidelines, we take the same approach to vaping as we take to smoking cessation.’  That means pharmacists should recommend combination NRT for vaping cessation as the most effective first-line treatment option. ‘As evidence evolves, we'll continue to revisit the guidelines. But that's the best approach that we have with the evidence that's available to us at the moment,’ Ms Dalla Venezia said. ‘As recreational vapes are becoming less accessible, a new subset of the population who are nicotine dependent through vapes as the medium are going to need ongoing support from pharmacists.’ Historically, Australia's tobacco control and marketing around the harms of smoking have been successful, however they no longer reach the primary demographic – youth. To engage young people aged 14–17 on a platform they actually use through people who speak their language, the federal Department of Health, Ageing and Disability engaged 10 influencers – one of which alone has 1.7 million followers on Tiktok in that age bracket. ‘It's a really great opportunity to reach young people  because that's the group of people who were beginning to use vapes at such rapidly increasing rates,’ Ms Dalla Venezia said. Pharmacists should refer to the TGA vaping hub for a comprehensive overview of all changes. Keen to learn more about smoking and vaping cessation? Attend the 'Clearing the air on smoking and vaping cessation' workshop at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => The new vaping standards explained [post_excerpt] => On  1 July 2025, new vaping standards came into force for all therapeutic vaping products for smoking cessation and nicotine dependence. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => the-new-vaping-standards-explained [to_ping] => [pinged] => [post_modified] => 2025-07-07 15:10:03 [post_modified_gmt] => 2025-07-07 05:10:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29824 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The new vaping standards explained [title] => The new vaping standards explained [href] => https://www.australianpharmacist.com.au/the-new-vaping-standards-explained/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29826 [authorType] => )

      The new vaping standards explained

  • CPD
    • Bridget Totterman
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                  [post_date] => 2025-07-16 13:04:44
                  [post_date_gmt] => 2025-07-16 03:04:44
                  [post_content] => Pharmacist scope of practice is expanding at a rapid rate. With more services, training courses and learning opportunities on offer – it can be difficult to know which direction to choose.
      
      Australian Pharmacist spoke with Bridget Totterman MPS – multi-pharmacy owner and PSA Board Director – about how she’s paving her own path to become a pharmacist prescriber.
      

      Tell us about your journey to becoming a prescribing pharmacist.

      It’s still ongoing! I’m currently enrolled in PSA’s Pharmacist Prescribing Scope of Practice Training Program – which is in-depth, and certainly challenging, but in a good way.  I chose the PSA course because it’s self-paced and the team is so supportive. I know PSA will continue to support me through the implementation of new services, and beyond. The training has two arms – a prescribing and clinical practice training program. The prescribing component involves theory-based learning focused on the prescribing cycle, including information gathering, clinical decision making, communicating decisions to patients and other healthcare professionals and reviewing those decisions.  Meanwhile, the clinical component focuses on differential diagnosis. While we learn about that at uni, the clinical training takes a more rigorous approach. It reminds us of the step-by-step process, practical implications and alternative explanations for each symptom.  Even if you’re 99% confident in a patient’s diagnosis, it’s great to challenge yourself and think about what else it could be. This helps to build confidence in the diagnosis and offer the appropriate treatment plan. It also highlights red flags for certain conditions and reiterates the need for referral in these cases – ensuring we are always working as part of a broader healthcare team in the best interests of the patient.

      Are you offering expanded services in your pharmacies?

      Some of our pharmacists have completed the training and are already practicing as prescribing pharmacists.  As of 1 July 2025, the Queensland pharmacy prescribing pilots became permanent for listed acute conditions and medication management services, such as therapeutic substitution and adaptation, and PBS Continued Dispensing Arrangements. So appropriately trained pharmacists can prescribe hormonal contraception and medicines for a raft of acute conditions, such as ear infections and skin conditions. They can also prescribe and administer travel vaccines and provide smoking cessation and weight management services.  If someone comes into the pharmacy with shingles, our trained pharmacists can now prescribe the right treatment for the patient. We all know time is of the essence when it comes to antivirals, and if patients have to wait to see their GP, they may miss the window where treatment is effective.

      What impact has this had on patients and staff?

      Patients have always found pharmacy convenient. Every day of the week, patients can walk in and speak to a trained healthcare professional – no appointment needed. With expanded scope and the ability to prescribe more medicines, we now have more tools in our belt to provide quality healthcare solutions to our patients in a timely manner. It's also great for pharmacists’ professional satisfaction. We had a team meeting at one of my pharmacies last week, and the whole team was so excited to get behind the prescribing pharmacists so we can all help patients access the healthcare they need in a timely way. Our amazing pharmacy assistants have also jumped on board and are of vital assistance in triaging patients and letting them know care is available. It lifts everyone's confidence and reminds us why we love this profession and why we chose pharmacy in the first place – to help patients.

      What would you say to pharmacists apprehensive about prescribing?

      Come to PSA25! Listen to the speakers on the scope of practice panels and talk to people offering these services from different states and territories.  Back in 2014, I was lucky enough to be one of the first pharmacists to participate in the Queensland Pharmacist Immunisation Pilot, allowing us to administer flu vaccines to patients. At the time, I had pharmacists working for me who said, ‘I’ll never be able to vaccinate. I couldn't imagine putting a needle in someone’s arm’. But now they are smashing out vaccinations. While it’s normal to be hesitant, remember that PSA has a long history of supporting pharmacists every step of the way, wherever your scope of practice takes you.  You don't have to see the whole staircase, just take the first step. And if you’re comfortable, the next step. Who knows where it'll take you. 

      Which aspect of scope of practice expansion excites you the most?

      Helping more people, more quickly. It’s disheartening when red tape gets in the way – like when a mum walks into the pharmacy at 10:00 pm on a Friday with a sick child, no access to a GP, and you’re limited in your ability to help. Hopefully, scope of practice expansion will help to expand the workforce by attracting more pharmacists to our profession. And if we're all doing more, that should help to improve the healthcare access crisis we're experiencing at the moment. 

      What services are you keen to see pharmacists branch into?

      Preventative care. I think we can have a huge impact on patients’ lives through weight management and smoking cessation. We chat to people all day, every day. While they may feel uncomfortable discussing their weight in other healthcare settings, speaking with the friendly pharmacist they've seen every week for the past 20 years might put them more at ease.

      Where do you see scope of practice going nationally?

      I'm hoping it will be a domino effect. I don't want to see resources wasted with people trying to reinvent the wheel. Other states and other jurisdictions should adopt guidelines and protocols that have been proven to work. We need consistency across the country, and while that may take time, we should aim to make the process as seamless as possible. Let's just take what works and roll it out.

      What scope of practice sessions or panels are you excited to see at PSA25?

      There's so many. I always look forward to hearing from Penny Shakespeare, Deputy Secretary for Health Resourcing at the Department of Health, Disability and Ageing – who's participating in the first Policy Panel on Friday morning (1 August).  Professor Bruce Warner, Honorary Professor of Pharmacy Policy and Practice at theUniversity of Nottingham in the UK, will also be sharing his experiences from an international perspective. I love hearing from people who are actually practicing at full scope.  Pharmacists enhancing Palliative Care across the Health Neighbourhood is another session I hope pharmacists will go along to. Now that PSA’s ASPIRE Palliative Care Foundation Training Program is freely available, pharmacists interested in that field make such a difference in people's lives. 

      Why is it important to connect with other pharmacists at industry events like PSA25?

      To connect with others in our profession. Who knows, you might meet your next employer or someone you want to go into business with. You might even end up with a lifelong mentor or a mentee. It's all about connection, positivity and uplifting each other. Learn more about expanding your scope of practice from Bridget Totterman and others at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => Taking the first steps into pharmacist prescribing [post_excerpt] => Any pharmacist can become a pharmacist prescriber, according to this expert. Here’s how to forge your own path. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => taking-the-first-steps-into-pharmacist-prescribing [to_ping] => [pinged] => [post_modified] => 2025-07-16 15:07:12 [post_modified_gmt] => 2025-07-16 05:07:12 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29898 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Taking the first steps into pharmacist prescribing [title] => Taking the first steps into pharmacist prescribing [href] => https://www.australianpharmacist.com.au/taking-the-first-steps-into-pharmacist-prescribing/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 13579 [authorType] => )

      Taking the first steps into pharmacist prescribing

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                  [post_date] => 2025-07-14 10:15:54
                  [post_date_gmt] => 2025-07-14 00:15:54
                  [post_content] => A practical workflow for cancelling tokens, updating profiles and preventing repeat-token errors at every dispense.
      
      Electronic prescriptions are safe, secure and generally convenient for patients and
      health practitioners.1 This convenience largely stems from the rapid transfer of
      prescriptions and their digital tokens without the need for a physical paper
      prescription.
      
      This transfer is so fast there’s often no lag between a dispensing label being printed
      and the patient receiving a new repeat token on their phone via SMS. So what
      happens if that repeat is sent to the wrong number?
      

      What happens if a pharmacy sends a token to the wrong phone number?

      The wrong person will receive the token. While the design of tokens (no name, limited information) limits the likelihood of a privacy breach, it provides the recipient with unauthorised access to the prescription (and therefore unauthorised access to the prescribed medicine).

      What can cause the token to be associated with the wrong phone number?

      A person’s phone numbers in dispensing software may be incorrect when:
      • imported from details associated with the electronic prescription (e.g. another pharmacy or medical centre)
      • patient has a new phone number
      • pharmacist has transcribed number incorrectly
      • a temporary contact number (e.g. another pharmacy/medical centre) was previously added to the profile and not removed from this field
      • number has been entered on incorrect record
      • patient or legal guardian no longer wishes person associated with the phone number to access the prescription (e.g. divorce, phone shared between multiple adults, child becomes an adult, child custody, intimate partner violence etc.)
      Apart from the last dot point, each example above is a very simple and easy-to-make error. And an error type which pharmacy workflows need to effectively eliminate through routine checks during the dispensing process.

      Will correcting the number and reissuing the token ‘fix everything’?

      No. Once a token has been issued, it cannot be retrieved. Simply changing the phone number in the patient profile and reissuing the token will send the token to the patient’s preferred mobile number, but will not cancel the incorrectly issued token, which will still be sitting in the SMS inbox of the person who received it.

      Then what should I do?

      While a token can’t be retrieved, it can be cancelled. In dispensing software cancelling the dispensing event which caused the token to be generated will cancel the repeat token which was issued because of it. The patient contact details in their profile in the dispensing software should then be updated, including verifying their electronic prescription preferences. The prescription should then be re-dispensed through the dispensing system.2

      Do I need to report this to my indemnity insurer?

      Yes, especially if the issue is not identified at the time of dispensing. A note should be added to the patient profile documenting the incident. Documentation may also be required in the pharmacy’s incident log.

      How can this be avoided?

      Check patient mobile phone numbers at every dispense event prior to authorising dispensing and generating the dispensing label. There are multiple different approaches to workflow for achieving this, including at prescription intake or in forward dispensing – for example, including mobile phone number in information check at scripts-in. As one of the approved identifiers, mobile phone number is a good choice of identifier to use as one of the three identifiers at scripts-in, patient selection and/or scripts-out.3,4

      References

      1. digitalhealth.gov.au. Electronic prescribing: for dispensers. 2025. At: www.digitalhealth.gov.au/ealthcare-providers/initiatives-and-programs/electronic-prescribing/for-dispensers/
      2. Pharmaceutical Defence Limited. Electronic prescriptions: National Practice Alerts. 22 December 2023. At: www.pdl.org.au/electronicprescriptions-2/
      3. Pharmaceutical Society of Australia. Professional practice standards 2023 Version 6. 2025. At: www.psa.org.au/practice-support-industry/pps
      4. Australian Commission on Safety and Quality in Health Care. Correct identification and procedure matching. 2025. At: www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safetystandard/correct-identification-and-procedurematching
      [post_title] => Managing eScripts sent to the wrong phone [post_excerpt] => From cancelling the dispensing event to reissuing the prescription, these key steps ensure no token is left active in unauthorised hands. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => managing-escripts-sent-to-the-wrong-phone [to_ping] => [pinged] => [post_modified] => 2025-07-16 15:16:46 [post_modified_gmt] => 2025-07-16 05:16:46 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29876 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Managing eScripts sent to the wrong phone [title] => Managing eScripts sent to the wrong phone [href] => https://www.australianpharmacist.com.au/managing-escripts-sent-to-the-wrong-phone/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29881 [authorType] => )

      Managing eScripts sent to the wrong phone

      medicinal cannabis
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                  [post_date_gmt] => 2025-07-13 23:04:41
                  [post_content] => The Australian Health Practitioner Regulation Agency (AHPRA) has cracked down on medicinal cannabis, with new guidance to tighten up the rules and put practitioners ‘on notice’.
      
      Poor prescribing practices have placed patients at significant harm, with AHPRA stepping in to remind prescribers and dispensers that medicinal cannabis should be treated as any other Controlled Drug (Schedule 8 medicine).
      
      ‘We don’t prescribe opioids to every patient who asks for them, and medicinal cannabis is no different,’ said Medical Board of Australia Chair, Dr Susan O’Dwyer. ‘Patient demand is no indicator of clinical need.’
      
      AHPRA has already taken action against 57 medical practitioners, pharmacists and nurses over medicinal cannabis prescribing practices, with AHPRA CEO Justin Untersteiner confirming that the regulator is currently investigating 60 more.
      
      Australian Pharmacist investigates the issue and pharmacists' obligations going forward.
      

      Booming business, bad practice

      Demand for medicinal cannabis has grown significantly in recent years. Australians spent approximately $402 million on medicinal cannabis in the first half of 2024, nearly matching the $448 million spent in all of 2023. This surge in demand has led to a significant upswing in prescribing, with APHRA identifying eight practitioners who issued more than 10,000 scripts over a 6-month, and one who appears to have issued more than 17,000 scripts. Nearly all medicinal cannabis products are unapproved Schedule 8 medicines, meaning prescribers must use the Special Access Scheme or Authorised Prescriber pathway to prescribe them. But the development of closed loop arrangements, where medicinal cannabis is prescribed via telehealth appointments, has meant that the required level of scrutiny and investigation by prescribing doctors has perhaps not been conducted, said PSA National Vice President and Pharmacy Council of New South Wales Board Member Caroline Diamantis FPS. [caption id="attachment_24130" align="alignright" width="267"]Caroline Diamantis FPS Caroline Diamantis FPS[/caption] ‘Prescribers need to assess if there is a therapeutic need for the prescription and ensure they've developed appropriate management plans.’ AHPRA has said that poor professional standards have been applied, particularly around the volume of medicinal cannabis being prescribed and dispensed. ‘They are looking for stronger safeguards around prescribing, real-time prescription monitoring (RTPM) and S8 controls – prioritising therapeutic need over commercial convenience,’ Ms Diamantis said. The other concern is around various business models that have been ‘conveniently’ created around the demand for medicinal cannabis.  ‘AHPRA’s concern is that the prescriber and dispenser obligations for therapeutic suitability have been overlooked,’ she added. Part and parcel of this new business model is the delivery service for medicinal cannabis adopted by some pharmacists. ‘The very real concern is there's minimal human contact,’ she said. ‘The patient does not have an opportunity to speak with the dispensing pharmacist about any concerns or questions.’

      A real danger for patients

      Medicinal cannabis comes in various dosage formulations with various levels of activity including gummies, tinctures or vaporisers. Patients can sometimes walk away with several different dose forms without prescribers investigating their:
      • mental health
      • medical history
      • underlying illnesses.
      ‘Prescribers have to do their due diligence when they are selecting medicinal cannabis [products],’ Ms Diamantis said. And because these medicines are often prescribed and dispensed via a standalone service, the patient’s regular GP and pharmacist may never know.  ‘I’ve looked after vulnerable young patients, who are 16 and 18 years old and are being carefully monitored by their psychiatrists, GPs and pharmacists – yet without our knowledge, they have been accessing medicinal cannabis for a couple of years through third party online programs,’ she said. ‘The medicinal cannabis was prescribed online and sent through to partner pharmacies, who simply prepared the prescription and forwarded the medication – perhaps with minimal communication and not understanding the full [history] of that patient's health. It's fragmented healthcare at its worst.’  An investigation by the ABC revealed that some patients with a history of psychosis had been hospitalised after being prescribed medicinal cannabis – with one patient dying following inappropriate prescribing.

      Your professional obligations

      Pharmacists have a right to question prescribers, and an obligation to communicate with prescriber if they have concerns, Ms Diamantis said. ‘I have seen cases at the Pharmacy Council where volumes of medicinal cannabis have been provided to a single patient, with pharmacists not recognising that they have the final autonomy as the gatekeeper of the medication,’ she said. Pharmacists should be accessing RTPM systems for every dispense event for medicinal cannabis, whether or not there is a legal compulsion upon them to do so. RTPM allows pharmacists to identify that a person has been prescribed medicinal cannabis or that may not have been disclosed or on a pharmacy’s dispensing system. It also highlights medicinal cannabis supply patterns which indicate overuse or potential drug-drug interactions with other high-risk medicines such as opioids.
      ‘It’s illegal in NSW to dispense an S8 unregistered item on a fax or email. YOu either need a token or a real paper script.' CAROLINE DIAMANTIS FPS 
      However, pharmacists should also be aware there may be gaps in these records. While all electronic prescriptions and computer-generated paper scripts with an eScript barcode will automatically be recorded in RTPM as unapproved therapeutic goods, human coding errors mean sometimes medicinal cannabis prescription or dispense events are not visible. Other reasons the script may not be visible include:
      • forgery
      • system glitch
      • the script being from a state that does not allow the person's history to be seen in the state where the script is presented.
      Pharmacists should also be aware of the regulations in their state or territory around dispensing an unapproved Controlled Drug (S8). ‘[For example], it’s illegal in NSW to dispense an S8 unregistered item on a fax or email,’ Ms Diamantis said. ‘You either need a token or a real paper script.’ This is not something that many pharmacists know. ‘We have seen it time and time again at the Pharmacy Council where people have found themselves in trouble because they don't know that,’ she said.

      Time for a change

      The use of loopholes and prioritising commercial interests over patient health and safety has created a ballooning public health challenge. The challenge for regulators will be maintaining access to medicinal cannabis to people with a therapeutic need, while cracking down on problematic prescribing practices. ‘We do need to keep the standard quite high,’ she said. ‘And if [individual patients] do have valid therapeutic reasons for it, there shouldn't be a problem in the end – we just need everyone on the same page.’ Overall, it has been a learning process, Ms Diamantis believes. ‘As time has passed, I think AHPRA has realised that the regulation needs to be reviewed and that there has to be an increased awareness of the harm that could be inflicted on the public,’ she said. ‘There's nothing wrong with reviewing the legislation, rules and guidelines to make sure that we are in alignment as prescribers and dispensers in keeping the public safe, because that is the ultimate goal for everyone.’ [post_title] => What pharmacists need to know about the medicinal cannabis shake up [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => what-pharmacists-need-to-know-about-the-medicinal-cannabis-shake-up [to_ping] => [pinged] => [post_modified] => 2025-07-14 14:29:16 [post_modified_gmt] => 2025-07-14 04:29:16 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29885 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => What pharmacists need to know about the medicinal cannabis shake up [title] => What pharmacists need to know about the medicinal cannabis shake up [href] => https://www.australianpharmacist.com.au/what-pharmacists-need-to-know-about-the-medicinal-cannabis-shake-up/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29890 [authorType] => )

      What pharmacists need to know about the medicinal cannabis shake up

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          [post] => WP_Post Object
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                  [ID] => 29844
                  [post_author] => 10574
                  [post_date] => 2025-07-09 10:22:04
                  [post_date_gmt] => 2025-07-09 00:22:04
                  [post_content] => Endometriosis, affecting approximately one in seven Australian women, remains under-recognised, under-funded and misunderstood. 
      
      Despite the profound impact endometriosis has on health and wellbeing, its diagnosis and management is complex –  with an average of 6–8 years between the onset of symptoms and diagnosis.
      
      ‘This delay is where pharmacists have a crucial role in recognising the symptoms of endometriosis and referring women promptly for diagnosis and treatment,’ said Grace Wong, Medication Safety Pharmacist at The Royal Women's Hospital – who will be leading a session on Championing change for endometriosis care at PSA25 next month.
      

      Why does endometriosis take so long to diagnose?

      There are several interrelated factors at play. Historically, a definitive diagnosis of endometriosis required laparoscopic surgery with histopathological confirmation.  But the limited availability of trained gynaecologists to perform these procedures has created a bottleneck in timely diagnosis. Additionally, the variable and often non-specific nature of endometriosis symptoms – such as chronic pelvic pain, fatigue, dysmenorrhea, cyclical hematuria, dysuria and gastrointestinal disturbances – can lead to misdiagnosis of other conditions such as irritable bowel syndrome. Patients experiencing chronic pelvic or abdominal pain may present repeatedly for symptom relief, with opioids or high-dose non-steroidal anti-inflammatory drugs (NSAIDs) often supplied without further investigation into the underlying cause. This pattern not only delays appropriate diagnosis but also increases the risk of adverse effects and medicine overuse. Societal stigmas surrounding menstruation can lead many to normalise menstrual pain, delaying medical attention. ‘Removing stigma and making women feel confident and comfortable to speak to their pharmacist for advice is something pharmacists and pharmacy support staff can continue to improve,’ Wong said.

      When should endometriosis be suspected?

      Endometriosis should be considered in anyone of reproductive age presenting with persistent pelvic pain – especially when it’s acyclical, unresponsive to first-line treatments, or associated with other gynaecological symptoms such as dyspareunia (painful intercourse) or dysmenorrhoea. Atypical symptoms of endometriosis include:
      • cyclical gastrointestinal symptoms (such as painful bowel movements)
      • dyschesia (difficult defecation)
      • chronic fatigue
      • urinary urgency
      • pain in the lower back, legs, upper abdomen or chest.
      ‘Once diagnosed, pharmacists can help women manage their symptoms through providing evidence-based advice, appropriate counselling for any prescribed medicines, and support women in their journey to managing their condition and leading high quality and productive lives,’ Wong said.

      What’s the role of pharmacists?

      Pharmacists are often the first health professionals that people with endometriosis speak to about menstrual pain or gastrointestinal discomfort. So understanding the pathophysiology, risk factors, and wide-ranging symptoms of endometriosis is essential.  Pharmacists can play a critical role by recognising these red flags, challenging the stigma of normalising menstrual pain and shifting symptomatic management with: 
      • over-the-counter pain relief
      • investigating the presentation and symptoms
      • seeking appropriate medical assessment aids in the timely diagnosis of endometriosis
      • inquiring about patients who present prescriptions for menstrual-related analgesia, who may have underlying red flags that went unrecognised by prescribers.
      Validating patient experiences means avoiding the following terminology:
      • ‘It's just period pain’ or ‘That's normal for women’: these phrases are dismissive and contribute to delayed diagnosis and stigma
      • ‘Everyone goes through this’: minimises the patient's pain and experience
      • ‘Are you sure it's not just stress?’: while stress can exacerbate symptoms, it should not be suggested as the sole cause
      • ‘You don't look sick’: many chronic illnesses, including endometriosis, are invisible.
      Instead, pharmacists could ask:
      • ‘Could you describe if you’ve experienced painful intercourse or pain during bowel movements, particularly around your menstrual cycle?’
      • ‘Do you have any urinary symptoms, such as pain or blood in your urine, and do these seem to relate to your period?’
      • ‘Would you be willing to track your symptoms daily to help us identify any patterns?’
      Pharmacists should also inquire about the impact of symptoms on quality of life and well-being to help break through the ‘suck it up’ mentality that’s often dismissed as normal menstrual pain or hormonal fluctuations. ‘As trusted health professionals, pharmacists have an important role in raising awareness about this condition and supporting efforts to improve services for women with endometriosis,’ Wong said.

      What are the treatment options?

      Treatment of endometriosis is often medical, with a patient-centred approach based on symptoms and reproductive goals. When pharmacological treatment is appropriate, pharmacists hold a critical role in supporting medicine adherence and counselling.  Common pharmacological treatments include:
      • hormonal therapies such as combined oral contraceptive pill (COCP), progestogen-only pills, or levonorgestrel-releasing intrauterine devices (IUDs)
      • non-hormonal options including NSAIDs for pain control
      • emerging therapies including GnRH antagonists (e.g. elagolix, relugolix) and selective progesterone receptor modulators, particularly for refractory cases.
      As medicines experts, pharmacists play a critical role in counselling patients on endometriosis treatments, and managing adverse effects such as reduced bone density associated with GnRH therapy.

      What does the future hold?

      Until recently, endometriosis had been largely overlooked in national funding and research priorities. However, there has been a recent welcome shift in public health policy towards acknowledging endometriosis as a serious chronic condition requiring coordinated care.  The federal government’s National Action Plan for Endometriosis, launched in 2018, marked the first significant step toward national recognition. Since then, investment in awareness campaigns have helped improve visibility and care pathways. Building on this, the 2025–26 federal budget introduced pivotal investments in women’s health, including the establishment of 11 specialist endometriosis and pelvic pain clinics and the addition of a new Medicare Benefits Schedule item for advanced diagnostic ultrasound techniques. ‘Pharmacists are an integral part of the healthcare system, and I envisage there is potential for pharmacists to be more involved directly and indirectly in care of women with endometriosis, to help support the National Action Plan's vision,’ Wong said. ‘To prepare for further involvement, I would encourage pharmacists to find ways to upskill now to be ready and confident to step up when the time comes.’ Hear more from Grace Wong about the role of pharmacists in endometriosis by attending the ‘Championing change for endometriosis care’ session at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => Empowering pharmacists to spot endometriosis early [post_excerpt] => Endometriosis, affecting approximately one in seven Australian women, remains under-recognised, under-funded and misunderstood. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => empowering-pharmacists-to-spot-endometriosis-early [to_ping] => [pinged] => [post_modified] => 2025-07-09 17:51:13 [post_modified_gmt] => 2025-07-09 07:51:13 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29844 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Empowering pharmacists to spot endometriosis early [title] => Empowering pharmacists to spot endometriosis early [href] => https://www.australianpharmacist.com.au/empowering-pharmacists-to-spot-endometriosis-early/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29846 [authorType] => )

      Empowering pharmacists to spot endometriosis early

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                  [ID] => 29824
                  [post_author] => 3410
                  [post_date] => 2025-07-07 12:34:12
                  [post_date_gmt] => 2025-07-07 02:34:12
                  [post_content] => On  1 July 2025, new vaping standards came into force for all therapeutic vaping products for smoking cessation and nicotine dependence.
      
      The Therapeutic Goods Administration's (TGA’s) strengthened standards, designed to reduce harm from vape use, are the culmination of the national vaping reforms, said PSA Project Manager Nikita Dalla Venezia, who worked closely on the PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
      
      ‘Because the changes were fairly substantial, my understanding is that they were staggered,’ she said. ‘This is just the next step of that comprehensive approach to mitigating risk for people who use therapeutic vapes.’
      
      The principal purpose of the reforms is to minimise youth uptake of vaping – an objective that, according to the Cancer Council’s iterative Generation Vape study, appears to be succeeding.
      
      ‘In Wave 7 of the study, which came out after the reforms were introduced, over 50% of youths said they would decline a vape if offered one from a friend, which is a substantial increase from Wave 2 data (less than 40%) that was collected prior to the reforms,’ Ms Dalla Venezia said.
      

      What key changes are introduced in the updated standards?

      Changes to the packaging, labelling and design of vaping products have been introduced. Vaping devices and accessories now need to appear as therapeutic products to reduce their appeal for recreational use among both adolescents and adults, Ms Dalla Venezia said. ‘The packaging needs to be plain, and the design has to be simple with very limited colours,’ she said. New labelling, usage instructions and information leaflets are also required, along with name restrictions. ‘The permitted ingredients have changed, to now only include nicotine, propylene glycol glycerol, and water,’ she  said. ‘And the only flavours allowed are mint, menthol or tobacco.’ Vaping devices and accessories must also meet stricter standards for:
      • medical device quality
      • risk management
      • battery and electrical safety
      • specific design and construction
      • toxicological risk assessment.

      What previously met the standards but now breaches them?

      Concentrations of nicotine over 50 mg/mL. The permitted concentration of nicotine has now changed to a maximum of 50 mg/mL, so vapes exceeding this level cannot be supplied. While the primary onus is on manufacturers of vaping products to ensure they're adhering to the standards, pharmacists need to check that their stock is compliant.

      How can I comply with the new standards?

      By checking all vaping products in your pharmacy against the TGA’s Notified vape list, which has changed since the reforms were initiated last year, Ms Dalla Venezia said. ‘I understand that the TGA conducts compliance assessments as part of ongoing compliance monitoring for these products,’ she said. ‘And since the reforms, a number of those items have been withdrawn.’ Therapeutic vaping products on the list of notified vapes have not been assessed by the TGA for quality, safety, efficacy or performance. But product sponsors must notify the TGA that their good complies with the minimum requirements for notified vaping goods, adhering to the product standards: 
      • Therapeutic Goods (Standard for Therapeutic Vaping Goods) (TGO 110) Order 2021
      • Therapeutic Goods (Medical Device Standard – Therapeutic Vaping Devices) Order 2023 (MDSO).
      In addition to the notified vape list, there's a separate database on the TGA website that pharmacists can check to see which products have been withdrawn or ceased. ‘If pharmacists suspect a product they have is no longer consistent with these changes, they can  look at that withdrawn database,’ Ms Dalla Venezia said. ‘These lists can also be filtered by date.’ It’s also important to educate all pharmacy staff to ensure they are aware of the strengthened product standards, product compliance and availability – and alternative brands. 

      Do the changes apply to both prescription and Pharmacist Only vapes?

      Yes. All therapeutic vapes, whether prescribed or supplied after a consultation with a pharmacist, must comply with the new standards.  To ensure a smooth transition, pharmacists should communicate with prescribers – and patients – about the changes to vaping product standards, and available products. ‘The federal Department of Health, Disability and Ageing is continuously monitoring the products on the list and making sure that they adhere to the standards for vaping products,’ Ms Dalla Venezia said.  ‘So it’s a good idea to take note of all of your inventory, and if there’s anything you know you’re dispensing on a regular basis, cross reference it with the notified vape list.’  For more information on prescribing and dispensing vapes, refer to these PSA checklists:
      • Pharmacist Workflow for Prescribing and Dispensing Therapeutic Vapes
      • Pharmacist Workflow for Dispensing Nicotine Vaping Products.

      Can I sell my existing products until the stock is exhausted?

      Only if it’s on the notified vape list. Since the standards came into effect last week on 1 July, all supplied vaping products must adhere to the new requirements. Pharmacists should contact the manufacturer of non-compliant stock, Ms Dalla Venezia said. ‘The TGA has directed pharmacists to return non-compliant products to the supplier,’ she said. ‘If they're not able to return the products, they should dispose of them as per their state or territory regulations.’

      Do the new standards mean vapes are now first-line therapy?

      Vapes are absolutely not the first-line treatment option for smoking cessation, Ms Dalla Venezia emphasised. ‘PSA’s recommendations and guidelines haven't [needed to] change in response to the standard changes,’ she said. The recommended pathway for smoking cessation includes:
      • Behavioural support: essential for all patients attempting to quit smoking, either alone or in combination with pharmacotherapy
      • First-line pharmacotherapy:
        • Nicotine Replacement Therapy (NRT)  – patches, gum, lozenges, mouth spray
        • Varenicline
        • Bupropion
      Using combination NRT with behavioural support is more effective than NRT monotherapy. Although therapeutic vapes are not first-line therapy for smoking cessation, the use of a therapeutic vape from the list of notified vapes is considered to be less harmful than smoking, Ms Dalla Venezia said. ‘We don’t want people to fear considering therapeutic vapes if they’re therapeutically appropriate,’ she said. ‘They are still an option for people who have gone through all the approved, first-line NRT steps and still are not able to quit smoking.’

      Is there a first-line therapy specifically for vaping cessation?

      Not definitively, Ms Dalla Venezia said. ‘There isn't a substantial body of evidence for vaping cessation at the moment,’ she said. ‘But within the PSA guidelines, we take the same approach to vaping as we take to smoking cessation.’  That means pharmacists should recommend combination NRT for vaping cessation as the most effective first-line treatment option. ‘As evidence evolves, we'll continue to revisit the guidelines. But that's the best approach that we have with the evidence that's available to us at the moment,’ Ms Dalla Venezia said. ‘As recreational vapes are becoming less accessible, a new subset of the population who are nicotine dependent through vapes as the medium are going to need ongoing support from pharmacists.’ Historically, Australia's tobacco control and marketing around the harms of smoking have been successful, however they no longer reach the primary demographic – youth. To engage young people aged 14–17 on a platform they actually use through people who speak their language, the federal Department of Health, Ageing and Disability engaged 10 influencers – one of which alone has 1.7 million followers on Tiktok in that age bracket. ‘It's a really great opportunity to reach young people  because that's the group of people who were beginning to use vapes at such rapidly increasing rates,’ Ms Dalla Venezia said. Pharmacists should refer to the TGA vaping hub for a comprehensive overview of all changes. Keen to learn more about smoking and vaping cessation? Attend the 'Clearing the air on smoking and vaping cessation' workshop at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => The new vaping standards explained [post_excerpt] => On  1 July 2025, new vaping standards came into force for all therapeutic vaping products for smoking cessation and nicotine dependence. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => the-new-vaping-standards-explained [to_ping] => [pinged] => [post_modified] => 2025-07-07 15:10:03 [post_modified_gmt] => 2025-07-07 05:10:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29824 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The new vaping standards explained [title] => The new vaping standards explained [href] => https://www.australianpharmacist.com.au/the-new-vaping-standards-explained/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29826 [authorType] => )

      The new vaping standards explained

  • People
    • Bridget Totterman
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                  [post_date] => 2025-07-16 13:04:44
                  [post_date_gmt] => 2025-07-16 03:04:44
                  [post_content] => Pharmacist scope of practice is expanding at a rapid rate. With more services, training courses and learning opportunities on offer – it can be difficult to know which direction to choose.
      
      Australian Pharmacist spoke with Bridget Totterman MPS – multi-pharmacy owner and PSA Board Director – about how she’s paving her own path to become a pharmacist prescriber.
      

      Tell us about your journey to becoming a prescribing pharmacist.

      It’s still ongoing! I’m currently enrolled in PSA’s Pharmacist Prescribing Scope of Practice Training Program – which is in-depth, and certainly challenging, but in a good way.  I chose the PSA course because it’s self-paced and the team is so supportive. I know PSA will continue to support me through the implementation of new services, and beyond. The training has two arms – a prescribing and clinical practice training program. The prescribing component involves theory-based learning focused on the prescribing cycle, including information gathering, clinical decision making, communicating decisions to patients and other healthcare professionals and reviewing those decisions.  Meanwhile, the clinical component focuses on differential diagnosis. While we learn about that at uni, the clinical training takes a more rigorous approach. It reminds us of the step-by-step process, practical implications and alternative explanations for each symptom.  Even if you’re 99% confident in a patient’s diagnosis, it’s great to challenge yourself and think about what else it could be. This helps to build confidence in the diagnosis and offer the appropriate treatment plan. It also highlights red flags for certain conditions and reiterates the need for referral in these cases – ensuring we are always working as part of a broader healthcare team in the best interests of the patient.

      Are you offering expanded services in your pharmacies?

      Some of our pharmacists have completed the training and are already practicing as prescribing pharmacists.  As of 1 July 2025, the Queensland pharmacy prescribing pilots became permanent for listed acute conditions and medication management services, such as therapeutic substitution and adaptation, and PBS Continued Dispensing Arrangements. So appropriately trained pharmacists can prescribe hormonal contraception and medicines for a raft of acute conditions, such as ear infections and skin conditions. They can also prescribe and administer travel vaccines and provide smoking cessation and weight management services.  If someone comes into the pharmacy with shingles, our trained pharmacists can now prescribe the right treatment for the patient. We all know time is of the essence when it comes to antivirals, and if patients have to wait to see their GP, they may miss the window where treatment is effective.

      What impact has this had on patients and staff?

      Patients have always found pharmacy convenient. Every day of the week, patients can walk in and speak to a trained healthcare professional – no appointment needed. With expanded scope and the ability to prescribe more medicines, we now have more tools in our belt to provide quality healthcare solutions to our patients in a timely manner. It's also great for pharmacists’ professional satisfaction. We had a team meeting at one of my pharmacies last week, and the whole team was so excited to get behind the prescribing pharmacists so we can all help patients access the healthcare they need in a timely way. Our amazing pharmacy assistants have also jumped on board and are of vital assistance in triaging patients and letting them know care is available. It lifts everyone's confidence and reminds us why we love this profession and why we chose pharmacy in the first place – to help patients.

      What would you say to pharmacists apprehensive about prescribing?

      Come to PSA25! Listen to the speakers on the scope of practice panels and talk to people offering these services from different states and territories.  Back in 2014, I was lucky enough to be one of the first pharmacists to participate in the Queensland Pharmacist Immunisation Pilot, allowing us to administer flu vaccines to patients. At the time, I had pharmacists working for me who said, ‘I’ll never be able to vaccinate. I couldn't imagine putting a needle in someone’s arm’. But now they are smashing out vaccinations. While it’s normal to be hesitant, remember that PSA has a long history of supporting pharmacists every step of the way, wherever your scope of practice takes you.  You don't have to see the whole staircase, just take the first step. And if you’re comfortable, the next step. Who knows where it'll take you. 

      Which aspect of scope of practice expansion excites you the most?

      Helping more people, more quickly. It’s disheartening when red tape gets in the way – like when a mum walks into the pharmacy at 10:00 pm on a Friday with a sick child, no access to a GP, and you’re limited in your ability to help. Hopefully, scope of practice expansion will help to expand the workforce by attracting more pharmacists to our profession. And if we're all doing more, that should help to improve the healthcare access crisis we're experiencing at the moment. 

      What services are you keen to see pharmacists branch into?

      Preventative care. I think we can have a huge impact on patients’ lives through weight management and smoking cessation. We chat to people all day, every day. While they may feel uncomfortable discussing their weight in other healthcare settings, speaking with the friendly pharmacist they've seen every week for the past 20 years might put them more at ease.

      Where do you see scope of practice going nationally?

      I'm hoping it will be a domino effect. I don't want to see resources wasted with people trying to reinvent the wheel. Other states and other jurisdictions should adopt guidelines and protocols that have been proven to work. We need consistency across the country, and while that may take time, we should aim to make the process as seamless as possible. Let's just take what works and roll it out.

      What scope of practice sessions or panels are you excited to see at PSA25?

      There's so many. I always look forward to hearing from Penny Shakespeare, Deputy Secretary for Health Resourcing at the Department of Health, Disability and Ageing – who's participating in the first Policy Panel on Friday morning (1 August).  Professor Bruce Warner, Honorary Professor of Pharmacy Policy and Practice at theUniversity of Nottingham in the UK, will also be sharing his experiences from an international perspective. I love hearing from people who are actually practicing at full scope.  Pharmacists enhancing Palliative Care across the Health Neighbourhood is another session I hope pharmacists will go along to. Now that PSA’s ASPIRE Palliative Care Foundation Training Program is freely available, pharmacists interested in that field make such a difference in people's lives. 

      Why is it important to connect with other pharmacists at industry events like PSA25?

      To connect with others in our profession. Who knows, you might meet your next employer or someone you want to go into business with. You might even end up with a lifelong mentor or a mentee. It's all about connection, positivity and uplifting each other. Learn more about expanding your scope of practice from Bridget Totterman and others at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => Taking the first steps into pharmacist prescribing [post_excerpt] => Any pharmacist can become a pharmacist prescriber, according to this expert. Here’s how to forge your own path. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => taking-the-first-steps-into-pharmacist-prescribing [to_ping] => [pinged] => [post_modified] => 2025-07-16 15:07:12 [post_modified_gmt] => 2025-07-16 05:07:12 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29898 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Taking the first steps into pharmacist prescribing [title] => Taking the first steps into pharmacist prescribing [href] => https://www.australianpharmacist.com.au/taking-the-first-steps-into-pharmacist-prescribing/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 13579 [authorType] => )

      Taking the first steps into pharmacist prescribing

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                  [post_date] => 2025-07-14 10:15:54
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                  [post_content] => A practical workflow for cancelling tokens, updating profiles and preventing repeat-token errors at every dispense.
      
      Electronic prescriptions are safe, secure and generally convenient for patients and
      health practitioners.1 This convenience largely stems from the rapid transfer of
      prescriptions and their digital tokens without the need for a physical paper
      prescription.
      
      This transfer is so fast there’s often no lag between a dispensing label being printed
      and the patient receiving a new repeat token on their phone via SMS. So what
      happens if that repeat is sent to the wrong number?
      

      What happens if a pharmacy sends a token to the wrong phone number?

      The wrong person will receive the token. While the design of tokens (no name, limited information) limits the likelihood of a privacy breach, it provides the recipient with unauthorised access to the prescription (and therefore unauthorised access to the prescribed medicine).

      What can cause the token to be associated with the wrong phone number?

      A person’s phone numbers in dispensing software may be incorrect when:
      • imported from details associated with the electronic prescription (e.g. another pharmacy or medical centre)
      • patient has a new phone number
      • pharmacist has transcribed number incorrectly
      • a temporary contact number (e.g. another pharmacy/medical centre) was previously added to the profile and not removed from this field
      • number has been entered on incorrect record
      • patient or legal guardian no longer wishes person associated with the phone number to access the prescription (e.g. divorce, phone shared between multiple adults, child becomes an adult, child custody, intimate partner violence etc.)
      Apart from the last dot point, each example above is a very simple and easy-to-make error. And an error type which pharmacy workflows need to effectively eliminate through routine checks during the dispensing process.

      Will correcting the number and reissuing the token ‘fix everything’?

      No. Once a token has been issued, it cannot be retrieved. Simply changing the phone number in the patient profile and reissuing the token will send the token to the patient’s preferred mobile number, but will not cancel the incorrectly issued token, which will still be sitting in the SMS inbox of the person who received it.

      Then what should I do?

      While a token can’t be retrieved, it can be cancelled. In dispensing software cancelling the dispensing event which caused the token to be generated will cancel the repeat token which was issued because of it. The patient contact details in their profile in the dispensing software should then be updated, including verifying their electronic prescription preferences. The prescription should then be re-dispensed through the dispensing system.2

      Do I need to report this to my indemnity insurer?

      Yes, especially if the issue is not identified at the time of dispensing. A note should be added to the patient profile documenting the incident. Documentation may also be required in the pharmacy’s incident log.

      How can this be avoided?

      Check patient mobile phone numbers at every dispense event prior to authorising dispensing and generating the dispensing label. There are multiple different approaches to workflow for achieving this, including at prescription intake or in forward dispensing – for example, including mobile phone number in information check at scripts-in. As one of the approved identifiers, mobile phone number is a good choice of identifier to use as one of the three identifiers at scripts-in, patient selection and/or scripts-out.3,4

      References

      1. digitalhealth.gov.au. Electronic prescribing: for dispensers. 2025. At: www.digitalhealth.gov.au/ealthcare-providers/initiatives-and-programs/electronic-prescribing/for-dispensers/
      2. Pharmaceutical Defence Limited. Electronic prescriptions: National Practice Alerts. 22 December 2023. At: www.pdl.org.au/electronicprescriptions-2/
      3. Pharmaceutical Society of Australia. Professional practice standards 2023 Version 6. 2025. At: www.psa.org.au/practice-support-industry/pps
      4. Australian Commission on Safety and Quality in Health Care. Correct identification and procedure matching. 2025. At: www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safetystandard/correct-identification-and-procedurematching
      [post_title] => Managing eScripts sent to the wrong phone [post_excerpt] => From cancelling the dispensing event to reissuing the prescription, these key steps ensure no token is left active in unauthorised hands. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => managing-escripts-sent-to-the-wrong-phone [to_ping] => [pinged] => [post_modified] => 2025-07-16 15:16:46 [post_modified_gmt] => 2025-07-16 05:16:46 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29876 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Managing eScripts sent to the wrong phone [title] => Managing eScripts sent to the wrong phone [href] => https://www.australianpharmacist.com.au/managing-escripts-sent-to-the-wrong-phone/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29881 [authorType] => )

      Managing eScripts sent to the wrong phone

      medicinal cannabis
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                  [post_date] => 2025-07-14 09:04:41
                  [post_date_gmt] => 2025-07-13 23:04:41
                  [post_content] => The Australian Health Practitioner Regulation Agency (AHPRA) has cracked down on medicinal cannabis, with new guidance to tighten up the rules and put practitioners ‘on notice’.
      
      Poor prescribing practices have placed patients at significant harm, with AHPRA stepping in to remind prescribers and dispensers that medicinal cannabis should be treated as any other Controlled Drug (Schedule 8 medicine).
      
      ‘We don’t prescribe opioids to every patient who asks for them, and medicinal cannabis is no different,’ said Medical Board of Australia Chair, Dr Susan O’Dwyer. ‘Patient demand is no indicator of clinical need.’
      
      AHPRA has already taken action against 57 medical practitioners, pharmacists and nurses over medicinal cannabis prescribing practices, with AHPRA CEO Justin Untersteiner confirming that the regulator is currently investigating 60 more.
      
      Australian Pharmacist investigates the issue and pharmacists' obligations going forward.
      

      Booming business, bad practice

      Demand for medicinal cannabis has grown significantly in recent years. Australians spent approximately $402 million on medicinal cannabis in the first half of 2024, nearly matching the $448 million spent in all of 2023. This surge in demand has led to a significant upswing in prescribing, with APHRA identifying eight practitioners who issued more than 10,000 scripts over a 6-month, and one who appears to have issued more than 17,000 scripts. Nearly all medicinal cannabis products are unapproved Schedule 8 medicines, meaning prescribers must use the Special Access Scheme or Authorised Prescriber pathway to prescribe them. But the development of closed loop arrangements, where medicinal cannabis is prescribed via telehealth appointments, has meant that the required level of scrutiny and investigation by prescribing doctors has perhaps not been conducted, said PSA National Vice President and Pharmacy Council of New South Wales Board Member Caroline Diamantis FPS. [caption id="attachment_24130" align="alignright" width="267"]Caroline Diamantis FPS Caroline Diamantis FPS[/caption] ‘Prescribers need to assess if there is a therapeutic need for the prescription and ensure they've developed appropriate management plans.’ AHPRA has said that poor professional standards have been applied, particularly around the volume of medicinal cannabis being prescribed and dispensed. ‘They are looking for stronger safeguards around prescribing, real-time prescription monitoring (RTPM) and S8 controls – prioritising therapeutic need over commercial convenience,’ Ms Diamantis said. The other concern is around various business models that have been ‘conveniently’ created around the demand for medicinal cannabis.  ‘AHPRA’s concern is that the prescriber and dispenser obligations for therapeutic suitability have been overlooked,’ she added. Part and parcel of this new business model is the delivery service for medicinal cannabis adopted by some pharmacists. ‘The very real concern is there's minimal human contact,’ she said. ‘The patient does not have an opportunity to speak with the dispensing pharmacist about any concerns or questions.’

      A real danger for patients

      Medicinal cannabis comes in various dosage formulations with various levels of activity including gummies, tinctures or vaporisers. Patients can sometimes walk away with several different dose forms without prescribers investigating their:
      • mental health
      • medical history
      • underlying illnesses.
      ‘Prescribers have to do their due diligence when they are selecting medicinal cannabis [products],’ Ms Diamantis said. And because these medicines are often prescribed and dispensed via a standalone service, the patient’s regular GP and pharmacist may never know.  ‘I’ve looked after vulnerable young patients, who are 16 and 18 years old and are being carefully monitored by their psychiatrists, GPs and pharmacists – yet without our knowledge, they have been accessing medicinal cannabis for a couple of years through third party online programs,’ she said. ‘The medicinal cannabis was prescribed online and sent through to partner pharmacies, who simply prepared the prescription and forwarded the medication – perhaps with minimal communication and not understanding the full [history] of that patient's health. It's fragmented healthcare at its worst.’  An investigation by the ABC revealed that some patients with a history of psychosis had been hospitalised after being prescribed medicinal cannabis – with one patient dying following inappropriate prescribing.

      Your professional obligations

      Pharmacists have a right to question prescribers, and an obligation to communicate with prescriber if they have concerns, Ms Diamantis said. ‘I have seen cases at the Pharmacy Council where volumes of medicinal cannabis have been provided to a single patient, with pharmacists not recognising that they have the final autonomy as the gatekeeper of the medication,’ she said. Pharmacists should be accessing RTPM systems for every dispense event for medicinal cannabis, whether or not there is a legal compulsion upon them to do so. RTPM allows pharmacists to identify that a person has been prescribed medicinal cannabis or that may not have been disclosed or on a pharmacy’s dispensing system. It also highlights medicinal cannabis supply patterns which indicate overuse or potential drug-drug interactions with other high-risk medicines such as opioids.
      ‘It’s illegal in NSW to dispense an S8 unregistered item on a fax or email. YOu either need a token or a real paper script.' CAROLINE DIAMANTIS FPS 
      However, pharmacists should also be aware there may be gaps in these records. While all electronic prescriptions and computer-generated paper scripts with an eScript barcode will automatically be recorded in RTPM as unapproved therapeutic goods, human coding errors mean sometimes medicinal cannabis prescription or dispense events are not visible. Other reasons the script may not be visible include:
      • forgery
      • system glitch
      • the script being from a state that does not allow the person's history to be seen in the state where the script is presented.
      Pharmacists should also be aware of the regulations in their state or territory around dispensing an unapproved Controlled Drug (S8). ‘[For example], it’s illegal in NSW to dispense an S8 unregistered item on a fax or email,’ Ms Diamantis said. ‘You either need a token or a real paper script.’ This is not something that many pharmacists know. ‘We have seen it time and time again at the Pharmacy Council where people have found themselves in trouble because they don't know that,’ she said.

      Time for a change

      The use of loopholes and prioritising commercial interests over patient health and safety has created a ballooning public health challenge. The challenge for regulators will be maintaining access to medicinal cannabis to people with a therapeutic need, while cracking down on problematic prescribing practices. ‘We do need to keep the standard quite high,’ she said. ‘And if [individual patients] do have valid therapeutic reasons for it, there shouldn't be a problem in the end – we just need everyone on the same page.’ Overall, it has been a learning process, Ms Diamantis believes. ‘As time has passed, I think AHPRA has realised that the regulation needs to be reviewed and that there has to be an increased awareness of the harm that could be inflicted on the public,’ she said. ‘There's nothing wrong with reviewing the legislation, rules and guidelines to make sure that we are in alignment as prescribers and dispensers in keeping the public safe, because that is the ultimate goal for everyone.’ [post_title] => What pharmacists need to know about the medicinal cannabis shake up [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => what-pharmacists-need-to-know-about-the-medicinal-cannabis-shake-up [to_ping] => [pinged] => [post_modified] => 2025-07-14 14:29:16 [post_modified_gmt] => 2025-07-14 04:29:16 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29885 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => What pharmacists need to know about the medicinal cannabis shake up [title] => What pharmacists need to know about the medicinal cannabis shake up [href] => https://www.australianpharmacist.com.au/what-pharmacists-need-to-know-about-the-medicinal-cannabis-shake-up/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29890 [authorType] => )

      What pharmacists need to know about the medicinal cannabis shake up

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                  [post_date] => 2025-07-09 10:22:04
                  [post_date_gmt] => 2025-07-09 00:22:04
                  [post_content] => Endometriosis, affecting approximately one in seven Australian women, remains under-recognised, under-funded and misunderstood. 
      
      Despite the profound impact endometriosis has on health and wellbeing, its diagnosis and management is complex –  with an average of 6–8 years between the onset of symptoms and diagnosis.
      
      ‘This delay is where pharmacists have a crucial role in recognising the symptoms of endometriosis and referring women promptly for diagnosis and treatment,’ said Grace Wong, Medication Safety Pharmacist at The Royal Women's Hospital – who will be leading a session on Championing change for endometriosis care at PSA25 next month.
      

      Why does endometriosis take so long to diagnose?

      There are several interrelated factors at play. Historically, a definitive diagnosis of endometriosis required laparoscopic surgery with histopathological confirmation.  But the limited availability of trained gynaecologists to perform these procedures has created a bottleneck in timely diagnosis. Additionally, the variable and often non-specific nature of endometriosis symptoms – such as chronic pelvic pain, fatigue, dysmenorrhea, cyclical hematuria, dysuria and gastrointestinal disturbances – can lead to misdiagnosis of other conditions such as irritable bowel syndrome. Patients experiencing chronic pelvic or abdominal pain may present repeatedly for symptom relief, with opioids or high-dose non-steroidal anti-inflammatory drugs (NSAIDs) often supplied without further investigation into the underlying cause. This pattern not only delays appropriate diagnosis but also increases the risk of adverse effects and medicine overuse. Societal stigmas surrounding menstruation can lead many to normalise menstrual pain, delaying medical attention. ‘Removing stigma and making women feel confident and comfortable to speak to their pharmacist for advice is something pharmacists and pharmacy support staff can continue to improve,’ Wong said.

      When should endometriosis be suspected?

      Endometriosis should be considered in anyone of reproductive age presenting with persistent pelvic pain – especially when it’s acyclical, unresponsive to first-line treatments, or associated with other gynaecological symptoms such as dyspareunia (painful intercourse) or dysmenorrhoea. Atypical symptoms of endometriosis include:
      • cyclical gastrointestinal symptoms (such as painful bowel movements)
      • dyschesia (difficult defecation)
      • chronic fatigue
      • urinary urgency
      • pain in the lower back, legs, upper abdomen or chest.
      ‘Once diagnosed, pharmacists can help women manage their symptoms through providing evidence-based advice, appropriate counselling for any prescribed medicines, and support women in their journey to managing their condition and leading high quality and productive lives,’ Wong said.

      What’s the role of pharmacists?

      Pharmacists are often the first health professionals that people with endometriosis speak to about menstrual pain or gastrointestinal discomfort. So understanding the pathophysiology, risk factors, and wide-ranging symptoms of endometriosis is essential.  Pharmacists can play a critical role by recognising these red flags, challenging the stigma of normalising menstrual pain and shifting symptomatic management with: 
      • over-the-counter pain relief
      • investigating the presentation and symptoms
      • seeking appropriate medical assessment aids in the timely diagnosis of endometriosis
      • inquiring about patients who present prescriptions for menstrual-related analgesia, who may have underlying red flags that went unrecognised by prescribers.
      Validating patient experiences means avoiding the following terminology:
      • ‘It's just period pain’ or ‘That's normal for women’: these phrases are dismissive and contribute to delayed diagnosis and stigma
      • ‘Everyone goes through this’: minimises the patient's pain and experience
      • ‘Are you sure it's not just stress?’: while stress can exacerbate symptoms, it should not be suggested as the sole cause
      • ‘You don't look sick’: many chronic illnesses, including endometriosis, are invisible.
      Instead, pharmacists could ask:
      • ‘Could you describe if you’ve experienced painful intercourse or pain during bowel movements, particularly around your menstrual cycle?’
      • ‘Do you have any urinary symptoms, such as pain or blood in your urine, and do these seem to relate to your period?’
      • ‘Would you be willing to track your symptoms daily to help us identify any patterns?’
      Pharmacists should also inquire about the impact of symptoms on quality of life and well-being to help break through the ‘suck it up’ mentality that’s often dismissed as normal menstrual pain or hormonal fluctuations. ‘As trusted health professionals, pharmacists have an important role in raising awareness about this condition and supporting efforts to improve services for women with endometriosis,’ Wong said.

      What are the treatment options?

      Treatment of endometriosis is often medical, with a patient-centred approach based on symptoms and reproductive goals. When pharmacological treatment is appropriate, pharmacists hold a critical role in supporting medicine adherence and counselling.  Common pharmacological treatments include:
      • hormonal therapies such as combined oral contraceptive pill (COCP), progestogen-only pills, or levonorgestrel-releasing intrauterine devices (IUDs)
      • non-hormonal options including NSAIDs for pain control
      • emerging therapies including GnRH antagonists (e.g. elagolix, relugolix) and selective progesterone receptor modulators, particularly for refractory cases.
      As medicines experts, pharmacists play a critical role in counselling patients on endometriosis treatments, and managing adverse effects such as reduced bone density associated with GnRH therapy.

      What does the future hold?

      Until recently, endometriosis had been largely overlooked in national funding and research priorities. However, there has been a recent welcome shift in public health policy towards acknowledging endometriosis as a serious chronic condition requiring coordinated care.  The federal government’s National Action Plan for Endometriosis, launched in 2018, marked the first significant step toward national recognition. Since then, investment in awareness campaigns have helped improve visibility and care pathways. Building on this, the 2025–26 federal budget introduced pivotal investments in women’s health, including the establishment of 11 specialist endometriosis and pelvic pain clinics and the addition of a new Medicare Benefits Schedule item for advanced diagnostic ultrasound techniques. ‘Pharmacists are an integral part of the healthcare system, and I envisage there is potential for pharmacists to be more involved directly and indirectly in care of women with endometriosis, to help support the National Action Plan's vision,’ Wong said. ‘To prepare for further involvement, I would encourage pharmacists to find ways to upskill now to be ready and confident to step up when the time comes.’ Hear more from Grace Wong about the role of pharmacists in endometriosis by attending the ‘Championing change for endometriosis care’ session at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => Empowering pharmacists to spot endometriosis early [post_excerpt] => Endometriosis, affecting approximately one in seven Australian women, remains under-recognised, under-funded and misunderstood. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => empowering-pharmacists-to-spot-endometriosis-early [to_ping] => [pinged] => [post_modified] => 2025-07-09 17:51:13 [post_modified_gmt] => 2025-07-09 07:51:13 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29844 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Empowering pharmacists to spot endometriosis early [title] => Empowering pharmacists to spot endometriosis early [href] => https://www.australianpharmacist.com.au/empowering-pharmacists-to-spot-endometriosis-early/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29846 [authorType] => )

      Empowering pharmacists to spot endometriosis early

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                  [post_date] => 2025-07-07 12:34:12
                  [post_date_gmt] => 2025-07-07 02:34:12
                  [post_content] => On  1 July 2025, new vaping standards came into force for all therapeutic vaping products for smoking cessation and nicotine dependence.
      
      The Therapeutic Goods Administration's (TGA’s) strengthened standards, designed to reduce harm from vape use, are the culmination of the national vaping reforms, said PSA Project Manager Nikita Dalla Venezia, who worked closely on the PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
      
      ‘Because the changes were fairly substantial, my understanding is that they were staggered,’ she said. ‘This is just the next step of that comprehensive approach to mitigating risk for people who use therapeutic vapes.’
      
      The principal purpose of the reforms is to minimise youth uptake of vaping – an objective that, according to the Cancer Council’s iterative Generation Vape study, appears to be succeeding.
      
      ‘In Wave 7 of the study, which came out after the reforms were introduced, over 50% of youths said they would decline a vape if offered one from a friend, which is a substantial increase from Wave 2 data (less than 40%) that was collected prior to the reforms,’ Ms Dalla Venezia said.
      

      What key changes are introduced in the updated standards?

      Changes to the packaging, labelling and design of vaping products have been introduced. Vaping devices and accessories now need to appear as therapeutic products to reduce their appeal for recreational use among both adolescents and adults, Ms Dalla Venezia said. ‘The packaging needs to be plain, and the design has to be simple with very limited colours,’ she said. New labelling, usage instructions and information leaflets are also required, along with name restrictions. ‘The permitted ingredients have changed, to now only include nicotine, propylene glycol glycerol, and water,’ she  said. ‘And the only flavours allowed are mint, menthol or tobacco.’ Vaping devices and accessories must also meet stricter standards for:
      • medical device quality
      • risk management
      • battery and electrical safety
      • specific design and construction
      • toxicological risk assessment.

      What previously met the standards but now breaches them?

      Concentrations of nicotine over 50 mg/mL. The permitted concentration of nicotine has now changed to a maximum of 50 mg/mL, so vapes exceeding this level cannot be supplied. While the primary onus is on manufacturers of vaping products to ensure they're adhering to the standards, pharmacists need to check that their stock is compliant.

      How can I comply with the new standards?

      By checking all vaping products in your pharmacy against the TGA’s Notified vape list, which has changed since the reforms were initiated last year, Ms Dalla Venezia said. ‘I understand that the TGA conducts compliance assessments as part of ongoing compliance monitoring for these products,’ she said. ‘And since the reforms, a number of those items have been withdrawn.’ Therapeutic vaping products on the list of notified vapes have not been assessed by the TGA for quality, safety, efficacy or performance. But product sponsors must notify the TGA that their good complies with the minimum requirements for notified vaping goods, adhering to the product standards: 
      • Therapeutic Goods (Standard for Therapeutic Vaping Goods) (TGO 110) Order 2021
      • Therapeutic Goods (Medical Device Standard – Therapeutic Vaping Devices) Order 2023 (MDSO).
      In addition to the notified vape list, there's a separate database on the TGA website that pharmacists can check to see which products have been withdrawn or ceased. ‘If pharmacists suspect a product they have is no longer consistent with these changes, they can  look at that withdrawn database,’ Ms Dalla Venezia said. ‘These lists can also be filtered by date.’ It’s also important to educate all pharmacy staff to ensure they are aware of the strengthened product standards, product compliance and availability – and alternative brands. 

      Do the changes apply to both prescription and Pharmacist Only vapes?

      Yes. All therapeutic vapes, whether prescribed or supplied after a consultation with a pharmacist, must comply with the new standards.  To ensure a smooth transition, pharmacists should communicate with prescribers – and patients – about the changes to vaping product standards, and available products. ‘The federal Department of Health, Disability and Ageing is continuously monitoring the products on the list and making sure that they adhere to the standards for vaping products,’ Ms Dalla Venezia said.  ‘So it’s a good idea to take note of all of your inventory, and if there’s anything you know you’re dispensing on a regular basis, cross reference it with the notified vape list.’  For more information on prescribing and dispensing vapes, refer to these PSA checklists:
      • Pharmacist Workflow for Prescribing and Dispensing Therapeutic Vapes
      • Pharmacist Workflow for Dispensing Nicotine Vaping Products.

      Can I sell my existing products until the stock is exhausted?

      Only if it’s on the notified vape list. Since the standards came into effect last week on 1 July, all supplied vaping products must adhere to the new requirements. Pharmacists should contact the manufacturer of non-compliant stock, Ms Dalla Venezia said. ‘The TGA has directed pharmacists to return non-compliant products to the supplier,’ she said. ‘If they're not able to return the products, they should dispose of them as per their state or territory regulations.’

      Do the new standards mean vapes are now first-line therapy?

      Vapes are absolutely not the first-line treatment option for smoking cessation, Ms Dalla Venezia emphasised. ‘PSA’s recommendations and guidelines haven't [needed to] change in response to the standard changes,’ she said. The recommended pathway for smoking cessation includes:
      • Behavioural support: essential for all patients attempting to quit smoking, either alone or in combination with pharmacotherapy
      • First-line pharmacotherapy:
        • Nicotine Replacement Therapy (NRT)  – patches, gum, lozenges, mouth spray
        • Varenicline
        • Bupropion
      Using combination NRT with behavioural support is more effective than NRT monotherapy. Although therapeutic vapes are not first-line therapy for smoking cessation, the use of a therapeutic vape from the list of notified vapes is considered to be less harmful than smoking, Ms Dalla Venezia said. ‘We don’t want people to fear considering therapeutic vapes if they’re therapeutically appropriate,’ she said. ‘They are still an option for people who have gone through all the approved, first-line NRT steps and still are not able to quit smoking.’

      Is there a first-line therapy specifically for vaping cessation?

      Not definitively, Ms Dalla Venezia said. ‘There isn't a substantial body of evidence for vaping cessation at the moment,’ she said. ‘But within the PSA guidelines, we take the same approach to vaping as we take to smoking cessation.’  That means pharmacists should recommend combination NRT for vaping cessation as the most effective first-line treatment option. ‘As evidence evolves, we'll continue to revisit the guidelines. But that's the best approach that we have with the evidence that's available to us at the moment,’ Ms Dalla Venezia said. ‘As recreational vapes are becoming less accessible, a new subset of the population who are nicotine dependent through vapes as the medium are going to need ongoing support from pharmacists.’ Historically, Australia's tobacco control and marketing around the harms of smoking have been successful, however they no longer reach the primary demographic – youth. To engage young people aged 14–17 on a platform they actually use through people who speak their language, the federal Department of Health, Ageing and Disability engaged 10 influencers – one of which alone has 1.7 million followers on Tiktok in that age bracket. ‘It's a really great opportunity to reach young people  because that's the group of people who were beginning to use vapes at such rapidly increasing rates,’ Ms Dalla Venezia said. Pharmacists should refer to the TGA vaping hub for a comprehensive overview of all changes. Keen to learn more about smoking and vaping cessation? Attend the 'Clearing the air on smoking and vaping cessation' workshop at PSA25, held in Sydney from 1–3 August. Register here to attend. [post_title] => The new vaping standards explained [post_excerpt] => On  1 July 2025, new vaping standards came into force for all therapeutic vaping products for smoking cessation and nicotine dependence. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => the-new-vaping-standards-explained [to_ping] => [pinged] => [post_modified] => 2025-07-07 15:10:03 [post_modified_gmt] => 2025-07-07 05:10:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=29824 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The new vaping standards explained [title] => The new vaping standards explained [href] => https://www.australianpharmacist.com.au/the-new-vaping-standards-explained/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 29826 [authorType] => )

      The new vaping standards explained

AUSTRALIAN PHARMACIST Australian Pharmacist
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Banishing bountiful B6

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July 18, 2000
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