Are you ready for SafeScript?
SafeScript NSW is a ‘real-time’ system that allows prescribers and dispensers to access your medication history while you wait. What does this new system mean for you?
Background
Your medical records are more accessible than ever. Information about your scripts, your doctor visits and pathology tests are all online and can be accessed by researchers and government, but with a number of controls in place to safeguard your privacy. The uses of health information have been in place for many years with relatively few privacy breaches. But now, more than ever, your online health footprint is accessible to healthcare providers. The My Health Record system went online in 2018 with the rationale that clinicians knowing more about your medical history should lead to improved care. An important feature of the My Health Record is that it is a system you can ‘opt out’ of — you have a choice over whether your health data is accessible or not. Want to opt out of the My Health Record system? Click here.
At the moment, NSW Health is rolling out an additional new system called SafeScript NSW. What is SafeScript NSW and what does it mean for you? How is NUAA working on this issue to ensure the concerns of our community are addressed?
What is SafeScript NSW?
SafeScript NSW is a database that prescribers (doctors, nurse practitioners and dentists) and pharmacists can use to look up your medication history. The information is in ‘real-time’ and only includes information about prescriptions you have had filled for medicines that are considered ‘high risk’ — such as opioids (drugs like codeine, morphine and oxycodone) and benzodiazepines (drugs like Valium, Mogadon and Xanax).
All Schedule 8 medicines will be included in SafeScript NSW (see more detailed list below). Your medication history will be searchable back to 7 April 2021. The system sends an ‘alert’ to prescribers and pharmacists who have signed up for the system when they are writing or filling your script for one of the medicines included in SafeScript NSW. Your information will also be searchable at any time but only by health practitioners involved in your care.
Unlike the My Health Record, you will not be able to ‘opt out’ of SafeScript NSW.
SafeScript NSW is part of the national Real Time Prescription Monitoring program. The system was developed in response to concerns around overdose and drug dependency.
NUAA’s involvement in the SafeScript NSW roll out
NUAA has been working on issues related to the implementation of these online systems for a few years now, particularly when the My Health Record was rolled out and now on the SafeScript NSW.
The NSW Health SafeScript NSW team held multiple discussions with clinicians and community members (including NUAA), and we prepared a formal submission for the SafeScript NSW consultation, which can be accessed here or on our website.
The concerns
Many of our community members raised concerns about the new system during the consultation. Our community frequently experiences stigma when health care professionals find out about our drug use or hepatitis C, even if it is in the past. Many of the people who participated in the consultations were anxious about SafeScript NSW and already have difficulty getting pain relief and other prescriptions:
“I've had a couple of barriers getting my prescriptions, the psychiatrist I see, I pretty much have to see him because he's the only one who will bulk bill me… He's fine with prescribing benzos for panic attacks but people on the authority line will challenge him around why he's prescribing me as much as he is and his motives and will often bargain with him to prescribe half the amount he's trying to prescribe. That's already happening…” (Chris)
A key concern about systems like SafeScript NSW is that they will push people onto the black market and riskier medication use.
“If my request for pain relief gets refused, I'll go to the black market or someone I know who's using the medication or has access to it. Or I'll find a similar substance.” (Shannon)
We can also experience discrimination when our history of drug use and hepatitis C is known.
“I was new in NA (Narcotics Anonymous) and I relatively recently stopped taking narcotics and just thought that I had to be honest about everything. They just treated me as if I was gonna want to scam them.” (Morgan talking about presenting to hospital with a collapsed lung).
Many of us see different health care providers for different concerns, not to scam the system but to protect our privacy and many of us have concerns about an additional set of hoops where both the prescriber and the pharmacist can question our medications.
“I am on prescribed opioids for chronic pain resulting from cancer treatment and had a prescription for another medication from my doctor who has a thorough understanding of me and my medical history. When I took that script to my local pharmacy, I was quizzed by the pharmacist who said he was ‘worried’ about the script. It created an intrusive, unnecessary hoop to jump through to get access to health care.” (Bernie, NUAA member)
In order to reduce negative unintended consequences for consumers, NSW Health have worked with NUAA to ensure that the voices and concerns of our NSW community of people who use or have used drugs are heard. NUAA has received funding for this work. We have been working to produce better resources for clinicians and consumers and have worked with a community advisory committee to ensure we are getting our feedback right. This article is to provide you with a detailed look at SafeScript NSW so you understand what will happen when SafeScript NSW comes to your area (by mid-2022 at the latest) and know your rights in relation to this new system.
What medicines are tracked by SafeScript?
The medicines that will be tracked by SafeScript NSW include all substances listed in Schedule 8 of the Poisons List and some medications from Schedule 4.
Monitored medicines include:
See the most up-to-date list of ‘monitored medicines’ here. Full list of Schedule 8 substances here.
How does SafeScript NSW work?
SafeScript NSW is an ‘opt in’ system for prescribers and pharmacists meaning they must sign up in order to access the system. Once a prescriber or pharmacist has signed up, they will receive pop-up messages about you when they are writing or filling a script for a monitored medicine. They can also access your records any time when not writing or filling a script, but only for the purposes of providing you with healthcare.
The SafeScript NSW system DOES NOT include clinical notes and test results; however, this information can be accessed via your My Health Record unless your health care provider has used paper notes.
The SafeScript NSW system includes a range of information about your prescriptions: drug type, strength, frequency, route, quantity, date of prescription etc.
Your health professionals are then expected to use this information to make decisions about your health care, including which drugs you will be prescribed and/or which prescriptions will be filled.
What happens if an alert comes up against my name?
Some SafeScript NSW alerts provide information from NSW Health that certain prescribed medications and combinations are risky or that you are accessing health care in a way that is associated with high-risk prescription medicine use. If your prescriber or pharmacist has signed up to SafeScript NSW, they will receive an ‘alert’ on their computer desktop when they prescribe or dispense to you. The alerts use a ‘traffic light’ system — green, amber or red, which we explain on the next page. The alerts are not intended to deny people scripts. The alert does not tell prescribers or pharmacists what to do or whether a medicine should or should not be provided. However, alerts do carry an implied recommendation that health professionals should assess the situation carefully.
It is up to the prescriber and pharmacist to decide if they will give you a particular prescription, balancing the information provided by the SafeScript NSW alert against their understanding of your health needs and circumstances.
This means that just because your medication use triggers an alert, you will not necessarily be denied the medications you rely on. You should have an opportunity to put your side of things to the health provider concerned and to talk about other options for managing your medications.
All health professionals have a duty of care to act responsibly around high dependency drugs to help you manage withdrawal symptoms. It is not appropriate for a health professional to stop your access to opioids and benzos if you are dependent on them, without titrating down your dose and providing a plan for your withdrawal.
When is SafeScript NSW happening?
SafeScript NSW was rolled out to the Hunter New England and Central Coast areas in early November 2021. Anyone who would like to share their experience with SafeScript NSW can do so by completing the consumer survey (click here).
SafeScript NSW will be rolled out in North Coast, the Nepean Blue Mountains area and Northern Sydney in March 2022 with the rest of the state to follow from May 2022.
Who is looking out for me?
During the rollout of SafeScript NSW, NUAA has been a strong advocate for our community to ensure that we are not negatively affected by the program. NUAA advises NSW Health on many issues of importance to people who use drugs. As we said above, NUAA has been consulted extensively by NSW Health during the development of SafeScript NSW to make the path as smooth as possible for people affected by SafeScript NSW (and we are being paid for this work).
We are also providing ongoing input to NSW Health through its consumer committee for SafeScript NSW, along with representatives from Health Consumers NSW and Pain Australia. NUAA and Pain Australia are working with the SafeScript NSW team to try to get better information to prescribers and pharmacists about how to work with people who attract alerts.
We have expressed our deep concern that the SafeScript NSW system may feed into stigma and discrimination against people who use drugs. We are concerned that some people will be treated poorly, including being cut off from medications without any support. People that have a good relationship with their prescriber and a regular chemist should be in a relatively good position after the roll-out, but we know that many people in our community don’t have access to a GP. Many GPs won’t see people who use drugs. Many others will only see people who can afford the gap payment. The reality in NSW is that while everyone with a Medicare card has access to health care, that health care is not equal.
If you feel that a health professional’s use of SafeScript NSW has contributed to you being treated unfairly and you wish to make a complaint about the way you have been treated or you want to challenge a decision, call NUAA’s PeerLine on 1800 644 413. We can support you, including listening to your concerns; helping you raise your issues through the right complaints processes and bodies; and connecting you with support services to match your circumstances. And remember, we are constantly working to fight stigma and improve the system for our community.
How is my privacy protected?
To get into the SafeScript NSW system, health professionals need to enter a password and pin number — this is to keep your health information confidential. There are penalties under the Poisons and Therapeutic Goods Regulation 2008 (NSW) if anyone unlawfully accesses, uses or discloses your information. The system records who accesses the information. You are entitled to access the information held about you (email safescript@health.nsw.gov.au ) and you can request a change to information you believe is incorrect.
Where can I find more information?
Check out the SafeScript NSW website or give PeerLine a call on 1800 644 413 — our peer workers are across all the issues.