The impact of Victoria’s real time prescription monitoring system (SafeScript) in a cohort of people who inject drugs

In reply: The response to our letter1 highlights how SafeScript, like other real time prescription monitoring (RTPM) systems, is intended to have a number of positive impacts, including helping prescribers and pharmacists provide appropriate clinical care. However, RTPM systems are known to have a range of unintended consequences.2 It is not clear whether SafeScript is being rigorously evaluated for these unintended consequences through outcome measures that capture what happens when high risk medicines are refused, particularly for people who do not intend to seek prescriptions from their doctors in the future.1 On this point, although no figures or citation are given, the commentary suggests that a positive impact of SafeScript is that the number of multiple provider episodes and the average morphine equivalent dose have been consistently decreasing since the introduction of this RTPM system. However, it is unclear whether this represents a benefit because, while people may have accessed fewer providers or accessed fewer opioids, only rigorous evaluation can determine whether people have switched to illegal or “black market” equivalents, an unintended consequence of RTPM implementation overseas.2 To date, there has been no evidence to demonstrate that appropriate clinical care automatically follows from use of RTPM systems. This is an important gap in our understanding of what the implementation of prescription monitoring achieves for people who have been prescribed these pharmaceuticals. Identifying patients does not ensure that they receive the appropriate medical care they may require. In addition, people who use drugs already experience stigma as a barrier to care.3 Therefore, measures to minimise any stigma experienced when being identified by SafeScript should be part of the steps to provide appropriate care for patients. We agree with the commentary that SafeScript has the potential to support clinical decision making and welcome the increased funding for alcohol and other drug services, but we look forward to evidence demonstrating the clinical outcomes that follow this new initiative, particularly for marginalised patients.