Topics

Technology is revolutionising medicine, and telemedicine is having a measurable impact on stroke care

Technology is revolutionising medicine, and telemedicine for patients with stroke (telestroke) is now having a measurable impact on outcomes. Acute stroke care is challenging for many reasons: stroke mimics are common (about 30% of all cases initially suspected to be stroke);1 patients with intracerebral haemorrhage and ischaemic stroke can present with identical syndromes, making brain imaging essential for diagnosis; treatments must be initiated without delay, and some require transfer for tertiary intervention (eg, endovascular thrombectomy). The lack of specialist stroke physicians in regional Australia and underinvestment in stroke care results in poor access for many Australians. Unwarranted clinical variation is unacceptable, so why do some regions of Australia, even today, have no access to specialist stroke care? The answers are complex, but some are clear (too few specialists in regional areas), while some are more difficult to understand (health providers declining offers of help).

1 Westmead Applied Research Centre, University of Sydney, Sydney, NSW
2 The George Institute for Global Health, Sydney, NSW

Correspondence: richard.lindley@sydney.edu.au

Acknowledgements:

I am supported by a National Health and Medical Research Council program grant (APP1149987: Clinical, public health and policy interventions to combat cardiovascular diseases).

Competing interests:

No relevant disclosures.

1. Bladin C, Kim J, Bagot KL, et al. Improving acute stroke care in regional hospitals: clinical evaluation of the Victorian Stroke Telemedicine program. Med J Aust 2020; 212: 371–376.
2. National Institute of Neurological Disorders and Stroke rt‐PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–1587.
3. Stroke Foundation. Stroke symptoms. Undated. https://strokefoundation.org.au/About-Stroke/Stroke-symptoms (viewed Mar 2020).
4. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta‐analysis of individual patient data from randomised trials. Lancet 2014; 384: 1929–1935.
5. Saver JL. Time is brain‐quantified. Stroke 2006; 37: 263–266.
6. Saver JL, Fonarow GC, Smith EE, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA 2013; 309: 2480–2488.
7. Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2013; CD000197.
8. Wang Y, Johnston SC, Bath PM, et al. BMJ 2019; 364: l895.
9. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large‐vessel ischaemic stroke: a meta‐analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731.
10. Parry‐Jones AR, Sammut‐Powell C, Paroutoglou K, et al. An intracerebral hemorrhage care bundle is associated with lower case fatality. Ann Neurol 2019; 86: 495–503.
11. Anderson CS, Heeley E, Huang Y, et al. Rapid blood‐pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 2013; 368: 2355–2365.
12. Reed SD, Cramer SC, Blough DK, et al. Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals. Stroke 2001; 32: 1832–1840.

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Editorials

Hepatitis C elimination in Australia: progress and challenges

Marianne Martinello, Behzad Hajarizadeh and Gregory J Dore

Med J Aust 2020; 212 (8): . || doi: 10.5694/mja2.50584
Published online: 4 May 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Infectious diseases

Health services administration

Early empirical evidence provides grounds for optimism about eliminating HCV by 2030

Curative direct‐acting antiviral (DAA) therapy for people with chronic hepatitis C virus (HCV) infections1 has transformed clinical management and spurred ambitious World Health Organization elimination targets for 2030.2 WHO service targets encompass marked improvements in prevention, diagnosis, and treatment; impact targets include a 65% reduction in HCV‐related deaths and an 80% reduction in new HCV infections compared with 2015.2

Kirby Institute, UNSW, Sydney, NSW

Correspondence: mmartinello@kirby.unsw.edu.au

Competing interests:

Gregory Dore is an advisory board member and has received honoraria, research grant funding, and travel sponsorship from Merck, Gilead, and Abbvie.

1. Spearman CW, Dusheiko GM, Hellard M, Sonderup M. Hepatitis C. Lancet 2019; 394: 1451–1466.
2. Word Health Organization. Global health sector strategy on viral hepatitis, 2016–2021 (WHO/HIV/2016.06). Geneva: WHO, 2016. https://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/ (viewed Mar 2020).
3. Hajarizadeh B, Grebely J, Matthews GV, et al. Uptake of direct‐acting antiviral treatment for chronic hepatitis C in Australia. J Viral Hepat 2018; 25: 640–648.
4. Iversen J, Dore GJ, Catlett B, et al. Association between rapid utilisation of direct hepatitis C antivirals and decline in the prevalence of viremia among people who inject drugs in Australia. J Hepatol 2019; 70: 33–39.
5. Iranpour N DG, Martinello M, Matthews G, et al. Estimated uptake of hepatitis C direct‐acting antiviral treatment among individuals with HIV co‐infection in Australia: a retrospective cohort study. Sexual Health 2020; https://doi.org/10.1071/sh19101 [Epub ahead of print].
6. Moon S, Erickson E. Universal medicine access through lump‐sum remuneration: Australia's approach to hepatitis C. N Engl J Med 2019; 380: 607–610.
7. Alavi M, Law MG, Valerio H, et al. Declining hepatitis C virus‐related liver disease burden in the direct‐acting antiviral therapy era in New South Wales, Australia. J Hepatol 2019; 71: 281–288.
8. Scott N, Sacks‐Davis R, Wade AJ, et al. Australia needs to increase testing to achieve hepatitis C elimination. Med J Aust 2020; 212: 365–370.
9. NSW Government. NSW hepatitis B and hepatitis C strategies 2014–2020 data report: 2018 annual data report. 2018. https://www.health.nsw.gov.au/hepatitis/Publications/2018-annual-data-report.pdf (viewed Mar 2020).
10. Larney S, Peacock A, Leung J, et al. Global, regional, and country‐level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. Lancet Glob Health 2017; 5: e1208–e1220.
11. Fraser H, Zibbell J, Hoerger T, et al. Scaling‐up HCV prevention and treatment interventions in rural United States‐ model projections for tackling an increasing epidemic. Addiction 2017; 113: 173–182.
12. The Kirby Institute. Monitoring hepatitis C treatment uptake in Australia (issue 10). June 2019. https://kirby.unsw.edu.au/report/monitoring-hepatitis-c-treatment-uptake-australia-issue-10-june-2019 (viewed Mar 2020).

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Editorials

Environmentally sustainable health care: now is the time for action

Diana L Madden, Anthony Capon and Philip G Truskett

Med J Aust 2020; 212 (8): . || doi: 10.5694/mja2.50586
Published online: 4 May 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Excellence in environmentally sustainable health care must be the goal of the Australian medical profession

The bushfires that recently raged across south‐eastern Australia have again shown that climate change has serious health consequences. Thirty‐four people died, and half the Australian population was exposed to sustained, hazardous levels of air pollution.1 Mental health experts are flagging rising levels of eco‐anxiety about bushfires and climate change in general.2 The intensity and scale of the bushfires, which were amplified by climate change, have highlighted the urgent need for climate action.3 It is timely for clinicians and health care managers to reflect on the environmental footprint — including the carbon footprint — of the health care we provide, and to act to reduce it.

1 University of Notre Dame Australia, Sydney, NSW
2 Monash Sustainable Development Institute, Monash University, Melbourne, VIC
3 University of New South Wales, Sydney, NSW
4 Royal Australasian College of Surgeons, Melbourne, VIC

Correspondence: lynne.madden@nd.edu.au

Competing interests:

No relevant disclosures.

1. Yu P, Xu R, Abramson MJ, et al. Bushfires in Australia: a serious health emergency under climate change. Lancet Planet Health 2020; 4: e7–e8.
2. Ducharme J. As bushfires rage, Australia faces another challenge: protecting national mental health. Time (New York) 8 Jan 2020. https://time.com/5759685/australian-bushfires-mental-health (viewed Mar 2020).
3. Australian Bureau of Meteorology. Annual climate statement 2019. Jan 2020. http://www.bom.gov.au/climate/current/annual/aus/#tabs=Influences (viewed Feb 2020).
4. Malik A, Lenzen M, McAllistar S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27–e35.
5. South Eastern Sydney Local Health District. SESLHD environmental sustainability plan 2019–2021. June 2019. https://www.seslhd.health.nsw.gov.au/sites/default/files/groups/Planning_Population_and_Equity/Health_Plans/SESLHD_ESP_2019-2021.pdf (viewed Feb 2020).
6. Sustainable Development Unit (NHS England, Public Health England). Sustainable, resilient, healthy people and places: a sustainable development strategy for the NHS, Public Health and Social Care system: 2014 to 2020. Jan 2014. https://www.sduhealth.org.uk/documents/publications/2014%20strategy%20and%20modulesNewFolder/Strategy_FINAL_Jan2014.pdf (viewed Mar 2020).
7. Australian Medical Association. Environmental sustainability in health care: 2019 [position statement]. 20 Mar 2019. https://ama.com.au/position-statement/environmental-sustainability-health-care-2019 (viewed Feb 2020).
8. Sustainable Development Unit (NHS England, Public Health England). What is sustainable health? [webpage]. Undated. https://www.sduhealth.org.uk/policy-strategy/what-is-sustainable-health.aspx (viewed Mar 2020).
9. Sutton B, Mulvenna V, Voronoff D, Humphrys T. Acting on climate change and health in Victoria. Med J Aust 2020; 212: 345–346.
10. McAlister S, Barratt AL, Bell KJL, McGain F. The carbon footprint of pathology testing. Med J Aust 2020; 212: 377–382.
11. Weeramanthri TS, Joyce S, Bangor‐Jones R. Climate health inquiry: where sustainability, public health law and climate action intersect. Med J Aust 2020; 212: 347–349.
12. Zhao B, Johnston FH, Salimi F, et al. Short‐term exposure to ambient fine particulate matter and out‐of‐hospital cardiac arrest: a nationwide case‐crossover study in Japan. Lancet Planet Health 2020; 4: e15–e23.
13. Vardoulakis S, Jalaludin BB, Morgan GG, et al. Bushfire smoke: urgent need for a national health protection strategy. Med J Aust 2020; 212: 349–353.
14. World Health Organization. 2018 WHO health and climate change survey report: tracking global progress (WHO/CED/PHE/EPE/19.11). Geneva: WHO, 2019. https://www.who.int/globalchange/publications/country-profiles-global-report-2019/en (viewed Mar 2020).
15. Madden DL, McLean M, Horton GL. Preparing medical graduates for the health effects of climate change: an Australasian collaboration. Med J Aust 2018; 208: 291–292. https://www.mja.com.au/journal/2018/208/7/preparing-medical-graduates-health-effects-climate-change-australasian (viewed Mar 2020).
16. Sainsbury P, Charlesworth K, Madden D, et al. Climate change is a health issue: what can doctors do? Intern Med J 2019; 49: 1044–1048.
17. Madden DL, Horton GL, McLean M. Preparing Australasian medical students to practise environmentally sustainable health care: the MDANZ initiative on climate change and health in medical education. Med J Aust 2020; 212: 354–356.
18. Climate and Health Alliance. National strategy for climate, health and well‐being [webpage]. 2017. https://www.caha.org.au/national-strategy-climate-health-wellbeing (viewed Mar 2020).

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Editorial

A sustainable future in health: ensuring as health professionals our own house is in order and leading by example

Nicholas J Talley

Med J Aust 2020; 212 (8): . || doi: 10.5694/mja2.50574
Published online: 4 May 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Infectious diseases

It is time for health professionals to step up and lead to ensure a sustainable environment and health

The year 2020 is fast becoming the year of planetary crises, from global warming and the unprecedented bushfire season in Australia over the summer to the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic striking around the globe, with its health and financial implications.1,2,3 Social media is littered with often uninformed opinions about both issues, from those unconcerned and arguing the problems are exaggerated or worse to those who are deeply concerned and searching for better solutions. The facts about the climate crisis and health are more stark, as pointed out by Madden and Capon4 in this issue of the Journal and by the most recent Lancet–MJA countdown report5 — overwhelming evidence points to a warming planet because of human activity and to the potential for very severe adverse health consequences, including other infectious disease outbreaks, if prompt action is not taken now. The recent unprecedented bushfire season may have shifted views about the potential for severe impacts of global warming on health, just as the unfolding health crisis with COVID‐19 has highlighted how vulnerable our health systems are to new pathogens. There has not been political inertia in the United Kingdom, where all sides of politics recognise the global emergency we all face because of climate change.6 However, more effective political action is needed here and around the world in terms of ensuring a sustainable future.

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University of Newcastle, Newcastle, NSW

Correspondence: Nicholas.Talley@newcastle.edu.au

Competing interests:

Nicholas Talley is Editor‐in‐Chief of the Medical Journal of Australia. A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor-chief-professor-nick-talley.

1. Yu P, Xu R, Abramson MJ, et al. Bushfires in Australia: a serious health emergency under climate change. Lancet Planet Health 2020; 4: e7–e8.
2. Vardoulakis S, Jalaludin BB, Morgan GG, et al. Bushfire smoke: urgent need for a national health protection strategy. Med J Aust 2020; 212: 349–353.
3. Cheng A, Williamson D. An outbreak of COVID‐19 caused by a new coronavirus: what we know so far. Med J Aust 2020; https://doi.org/10.5694/mja2.50530 [Epub ahead of print]. https://www.mja.com.au/journal/2020/212/10/outbreak-covid-19-caused-new-coronavirus-what-we-know-so-far
4. Madden DL, Capon A, Truskett PG. Environmentally sustainable health care: now is the time for action. Med J Aust 2020; 212: 361–362.
5. Beggs PJ, Zhang Y, Bambrick H, et al. The 2019 report of the MJA–Lancet Countdown on health and climate change: a turbulent year with mixed progress. Med J Aust 211: 490–491. https://www.mja.com.au/journal/2019/211/11/2019-report-mja-lancet-countdown-health-and-climate-change-turbulent-year-mixed
6. BBC News. UK Parliament declares climate emergency. BBC News 2019, 1 May. https://www.bbc.com/news/uk-politics-48126677 (viewed Mar 2020).
7. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27–35.
8. Sainsbury P, Charlesworth K, Madden D, et al. Climate change is a health issue: what can doctors do? Intern Med J 2019; 49: 1044–1048.
9. Sutton B, Mulvenna V, Voronoff D, Humphrys T. Acting on climate change and health in Victoria. Med J Aust 2020; 212: 345–346.
10. Weeramanthri TS, Joyce S, Bangor‐Jones R. Climate health inquiry: where sustainability, public health law and climate action intersect. Med J Aust 2020; 212: 347–349.
11. NHS England, Public Health England. Sustainable Development Unit: what is sustainable health? [website] https://www.sduhealth.org.uk/policy-strategy/what-is-sustainable-health.aspx (viewed Mar 2020).
12. Ripple WJ, Wolf C, Newsome TM, et al. World scientists’ warning of a climate emergency. BioScience 2020; 70: 8–12.

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Perspectives

General practice research: an investment to improve the health of all Australians

Jo‐Anne E Manski‐Nankervis, Elizabeth A Sturgiss, Siaw‐Teng Liaw, Geoffrey K Spurling and Danielle Mazza

Med J Aust 2020; 212 (9): . || doi: 10.5694/mja2.50589
Published online: 27 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Health occupations

General medicine

Health services administration

Opportunities to recognise and invest in general practice research need to be realised

General practice research is essential to quality general practice, building an evidence base for over 27 000 general practitioners working within the specialty who provide medical care to the majority of Australians.1 Over eight in ten Australians consult with their GP at least once per year, and two million people are seen each week in general practice.2,3 General practice, a medical specialty, is the first point of access to the health system, providing longitudinal care for all. It is essential for the delivery of efficient, equitable and effective health care services.4 General practice is unique, complex and continuing to evolve. A GP must have a good working knowledge of 167 problems to cover 85% of the conditions that they see most frequently,5 and management of multimorbidity has become the norm. The number of general practices appears to be declining, practices are becoming larger, and the proportion of GPs who are practice owners is decreasing.6 General practice research is key to optimising health care in this evolving context, but needs to be supported by the profession, funders and our professional colleges.

1 University of Melbourne, Melbourne, VIC
2 Monash University, Melbourne, VIC
3 UNSW Sydney, Sydney, NSW
4 Ingham Institute of Applied Medical Research, Sydney, NSW
5 University of Queensland, Brisbane, QLD

Correspondence: jomn@unimelb.edu.au

Competing interests:

All authors are members of the Australasian Association for Academic Primary Care (AAAPC) and the RACGP Expert Committee – Research, for which they receive sitting fees. Jo‐Anne Manski‐Nankervis is supported by an MRFF Next Generation Clinical Researcher TRIP Fellowship and receives research funding from the RACGP Foundation. Elizabeth Sturgiss is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (EL1) and is Conference Subcommittee Chair for the AAAPC. Siaw‐Teng Liaw receives sitting fees as Chair of the RACGP National Research and Evaluation Ethics Committee and has received research funding from the Australian Research Council (ARC), the NHMRC, the Ramaciotti Foundations and the HCF Research Foundation. Geoffrey Spurling is supported by an NHMRC Investigator Grant (EL1) and has received funding from the ARC and RACGP Foundation. Danielle Mazza has received research funding, speaker fees and travel support to attend conferences from Bayer and MSD.

1. Medical Board of Australia, Australian Health Practitioner Regulation Agency. Medical Board of Australia registrant data. Reporting period: 01 July 2019 to 30 September 2019. Melbourne: Medical Board of Australia, 2019 https://www.medicalboard.gov.au/documents/default.aspx?record=WD19%2f29236&dbid=AP&chksum=J1PbooZmmy%2fKGWBnMLHLEQ%3d%3d (viewed Dec 2019).
2. Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2015‐16 (General Practice Series No. 40). Sydney: Sydney University Press, 2016.
3. Hayes P. No one knows you like your GP. newsGP 2018; 14 May. https://www1.racgp.org.au/newsgp/racgp/no-one-knows-you-like-your-gp (viewed Mar 2020).
4. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005; 83: 457–502.
5. Cooke G, Valenti L, Glasziou P, et al. Common general practice presentations and publication frequency. Aust Fam Physician 2013; 42: 65–68.
6. Scott A. ANZ‐Melbourne Institute health sector report: general practice trends. Melbourne: ANZ, Melbourne Institute of Applied Economic and Social Research, University of Melbourne, 2017. https://www.anz.com.au/business/industries/health/insights/general-practice-trends/ (viewed Dec 2019).
7. McIntyre EL, Mazza D, Harris NP. NHMRC funding for primary health care research. Med J Aust 2011; 195: 230. https://www.mja.com.au/journal/2011/195/4/nhmrc-funding-primary-health-care-research-2000-2008.
8. Australian Government Department of Health. Budget 2019‐20: investing in health and medical research ‐ Medical Research Future Fund 10 year investment plan. Canberra: Department of Health, 2019. https://www.health.gov.au/resources/publications/budget-2019-20-investing-in-health-and-medical-research-medical-research-future-fund-10-year-investment-plan (viewed Dec 2019).
9. Australian Government. Medical Research Future Fund: Australian medical research and innovation priorities 2018‐2020. Canberra: Australian Government, 2018. https://www.health.gov.au/resources/publications/australian-medical-research-and-innovation-priorities-2018-2020 (viewed Dec 2019).
10. van Driel M, Deckx L, Cooke G, et al. Growing and retaining general practice research leaders in Australia: how can we do better? Aust Fam Physician 2017; 46: 757–762.
11. Winzenberg TM, Gill GF. Prioritising general practice research. Med J Aust 2016; 205: 55–57. https://www.mja.com.au/journal/2016/205/2/prioritising-general-practice-research.
12. McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all‐cause mortality in the healthy elderly. N Engl J Med 2018; 379: 1519–1528.
13. van Driel ML, Scheire S, Deckx L, Gevaert P. What treatments are effective for common cold in adults and children? BMJ 2018; 363: K3786.
14. Heal C, Sriharan S, Buttner PG, Kimber D. Comparing non‐sterile to sterile gloves for minor surgery: a prospective randomised controlled non‐inferiority trial. Med J Aust 2015; 202: 27–31. https://www.mja.com.au/journal/2015/202/1/comparing-non-sterile-sterile-gloves-minor-surgery-prospective-randomised.
15. Mazza D, Watson CJ, Taft A, et al. Increasing long acting reversible contraceptives: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomized trial. Am J Obstet Gynecol. 2019; https://doi.org/10.1016/j.ajog.2019.11.1267 [Epub ahead of print].
16. Russell AW, Donald M, Borg SJ, et al. Clinical outcomes of an integrated primary‐secondary model of care for individuals with complex type 2 diabetes: a non‐inferiority randomised controlled trial. Diabetologia 2018; 62: 41–52.
17. Hegarty K, Bush R, Sheehan M. The composite abuse scale: Further development and assessment of reliability and validity of a multidimensional partner abuse measure in clinical settings. Violence Victims 2005; 20: 529–547.
18. Harris MF, Zwar NA. Reflections on the history of general practice in Australia. Med J Aust 2014; 201 (1 Suppl): S37–S40. https://www.mja.com.au/journal/2014/201/1/reflections-history-general-practice-australia
19. Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross‐sectional study. Lancet 2012; 380: 37–43.
20. Wass V, Gregory S, Petty‐Saphon K, et al. By choice – not by chance: supporting medical students towards future careers in general practice. Medical Schools Council, NHS Health Education England, 2016. https://www.hee.nhs.uk/sites/default/files/documents/By%20choice%20-%20not%20by%20chance.pdf (viewed Dec 2019).
21. Australian Medical Council. Standards for assessment and accreditation of specialist medical programs and professional development programs by the Australian Medical Council 2015. Canberra: AMC Ltd, 2015. https://www.amc.org.au/wp-content/uploads/accreditation_recognition/specialist_edu_and_training/assessment/standards_for_assessment.pdf (viewed Mar 2020).

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Editorials

Providing take home naloxone needs to be improved to prevent opioid overdose deaths

Nicholas Lintzeris

Med J Aust 2020; 212 (7): . || doi: 10.5694/mja2.50561
Published online: 20 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Pharmaceutical preparations

Substance‐related disorders

Health services administration

An effective approach can only be achieved by a national strategy for averting opioid‐related deaths

Opioid overdose‐related deaths in Australia have steadily increased over the past 15 years to more than 1000 each year, more deaths than from motor vehicle accidents.1,2 Twenty years ago, most overdoses were in people who injected heroin, but now 70% of deaths involve opioids prescribed by doctors and dispensed by pharmacists.1,2 Our health system must respond to this growing community and public health problem. A number of strategies have been recommended,3 including better education of health professionals and opioid users; hospital opioid stewardship programs; improving access to multidisciplinary services for patients with complex pain or substance use disorders; better coordination of health care with systems such as My Health Record and prescription monitoring programs; and the expansion of take home naloxone (THN) programs.4

1 The University of Sydney, Sydney, NSW
2 Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW

Correspondence: Nicholas.Lintzeris@health.nsw.gov.au

Competing interests:

I have sat on advisory boards for Mundipharma, Camurus, and Indivior, have received research funding from Camurus, and provided consultancy services for Mundipharma.

1. Australian Institute of Health and Welfare. Opioid harm in Australia and comparisons between Australia and Canada (AIHW Cat. No. HSE 210). Canberra: AIHW, 2018.
2. Penington Institute. Australia's annual overdose report 2019. Melbourne: Penington Institute, 2019. http://www.penington.org.au/australias-annual-overdose-report-2019 (viewed Dec 2019).
3. Royal Australasian College of Physicians. Prescription opioid policy: improving management of chronic non‐malignant pain and prevention of problems associated with prescription opioid use. Sydney: Royal Australasian College of Physicians. 2009. https://www.ranzcp.org/files/resources/college_statements/cnmp-pdf.aspx (viewed Dec 2019).
4. Lenton SR, Dietze PM, Degenhardt L, et al. Naloxone for administration by peers in cases of heroin overdose [letter]. Med J Aust. 2009; 191: 469. https://www.mja.com.au/journal/2009/191/8/naloxone-administration-peers-cases-heroin-overdose
5. Pitt AL, Humphreys K, Brandeau ML. Modeling health benefits and harms of public policy responses to the US opioid epidemic. Am J Public Health 2018; 108: 1394–1400.
6. World Health Organization. Community management of opioid overdose. Geneva: World Health Organization, 2014. http://www.who.int/substance_abuse/publications/management_opioid_overdose/en (viewed Dec 2019).
7. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain: United States, 2016. MMWR Recomm Rep 2016; 65: 1–49.
8. Coffin PO, Sullivan SD. Cost‐effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Int Med 2013; 158: 1–9.
9. Lintzeris N, Monds L, Bravo M, et al. Findings of the implementation of ORTHN (Overdose Response with Take Home Naloxone) in NSW [unpublished presentation]. Australasian Professional Society on Alcohol and other Drugs, national conference, Auckland, New Zealand, 15 Nov 2018. https://az659834.vo.msecnd.net/eventsairaueprod/production-ashm-public/44552975cc7b452cb0f47ad07b933909 (viewed Mar 2020).
10. Dwyer R, Olsen A, Fowlie C, et al. An overview of take‐home naloxone programs in Australia. Drug Alcohol Rev 2018; 37: 440–449.
11. Tse WC, Sanfilippo P, Lam T, et al. Community pharmacy naloxone supply, before and after rescheduling as an over‐the‐counter drug: sales and prescriptions data, 2014–2018. Med J Aust 2020; 212: 314–320.
12. Pharmaceutical Benefits Scheme. Naloxone: 2.2 mg/actuation nasal spray; Nyxoid^®. Updated 5 July 2019. http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/psd/2019-03/naloxone-psd-march-2019 (viewed Dec 2019).
13. Australian Department of Health. About the take home naloxone pilot. Updated 14 Nov 2019. https://www.health.gov.au/initiatives-and-programs/take-home-naloxone-pilot/about-the-take-home-naloxone-pilot (viewed Dec 2019).
14. Nielsen S, Peacock A, Lintzeris N, et al. Knowledge of opioid overdose and attitudes to supply of take‐home naloxone among people with chronic non‐cancer pain prescribed opioids. Pain Med 2018; 19: 533–540.

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Editorials

From over‐the‐counter to prescription only: early results of the rescheduling of codeine combination analgesics

Malcolm D Dobbin

Med J Aust 2020; 212 (7): . || doi: 10.5694/mja2.50560
Published online: 20 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Anesthesia, analgesia and pain

Substance‐related disorders

Pharmaceutical preparations

Upscheduling has not led to substitution with higher strength analgesics, and has reduced the misuse of codeine‐containing preparations

As rates of problematic opioid use and overdose grow in high income countries,1 epidemiologic signals of exposure and harm have increased year by year. It is therefore encouraging to read evidence of a downward trend for one category of this complex crisis described in two papers in this issue of the Journal.2,3

Monash University, Melbourne, VIC

Correspondence: malcolm.dobbin@health.vic.gov.au

Competing interests:

No relevant disclosures.

1. Organisation for Economic Co‐operation and Development. Addressing problematic opioid use in OECD countries (OECD Health Policy Studies). Paris: OECD Publishing, 2019. https://www.oecd.org/health/addressing-problematic-opioid-use-in-oecd-countries-a18286f0-en.htm (viewed Feb 2020).
2. Schaffer AL, Cairns R, Brown J, et al. Changes in pharmaceutical sales to pharmacies after codeine was rescheduled a prescription only medicine. Med J Aust 2020; 212: 321–327.
3. Harris K, Jiang A, Knoeckel R, Isoardi KZ. Rescheduling codeine‐containing analgesics reduced codeine‐related hospital presentations. Med J Aust 2020; 212: 328.
4. Degenhardt L, Gisev N, Cama M, et al. The extent and correlates of community‐based pharmaceutical opioid utilisation in Australia. Pharmacoepidemiol Drug Saf 2016; 25: 521–538.
5. Annabel B, Scrymgeour M. Fork handles. Australas J Pharm 2017; 98: 74–75.
6. McAllister WB. The global political economy of scheduling: the international–historical context of the Controlled Substances Act. Drug Alcohol Depend 2014; 76: 3–8.
7. Derry S, Karlin SM, Moore RA. Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database Syst Rev 2015; CD010107.
8. Daniels SE, Goulder MA, Aspley S, Reader S. A randomised, five‐parallel‐group, placebo‐controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single‐tablet combination of ibuprofen/paracetamol for postoperative dental pain. Pain 2011; 152: 632–642.
9. Cock V, Edmonds C, Cock C. Complications related to chronic supratherapeutic use of codeine containing compound analgesics in a cohort of patients presenting for codeine withdrawal. Drug Alcohol Rev 2018; 37: 731–737.
10. Frei MY, Nielsen S, Dobbin MDH, Tobin CL. Serious morbidity associated with misuse of over‐the‐counter codeine‐ibuprofen analgesics: a series of 27 cases. Med J Aust 2010; 193: 294–296. https://www.mja.com.au/journal/2010/193/5/serious-morbidity-associated-misuse-over-counter-codeine-ibuprofen-analgesics
11. Mill D, Johnson JL, Cock V, et al. Counting the cost of over‐the‐counter codeine containing analgesic misuse: a retrospective review of hospital admissions over a 5 year period. Drug Alcohol Rev 2018; 37: 247–256.
12. Australian Institute of Health and Welfare. Opioid harm in Australia and comparisons between Australia and Canada (Cat. no. HSE 210): data tables (here: table S2.14). Canberra: AIHW, 2018. https://www.aihw.gov.au/getmedia/a7c50ae7-5150-452d-8fcc-d24dcf862e48/aihw-hse-210-data-tables.xlsx.aspx (viewed Jan 2020).
13. Australian Department of Health, Therapeutic Goods Administration. Codeine re‐scheduling: regulation impact statement, version 1.1 (Office of Best Practice Regulation no. 19826). Dec 2016. https://www.tga.gov.au/sites/default/files/regulation-impact-statement-codeine-re-scheduling.pdf (viewed Feb 2020).
14. Sarantitis I, Gerrard AD, Teasdale R, Pettit S. Small bowel diaphragm disease mimicking malignancy. BMJ Case Rep 2015; bcr2015210174.
15. Dang MH, Wu S, Sia C. Ibuprofen‐induced renal tubular acidosis: a rare cause of rhabdomyolysis: a case report. Oxf Med Case Reports 2016; 8: 212–214.
16. Robertson CG, Kumar B, Bright T, Watson DI. Beware NSAID abuse: think twice before operating! Aust N Z J Surg 2014; 84: 495–496.
17. Cairns R, Scheffer AL, Brown JA, et al. Codeine use and harms in Australia: evaluating the effects of re‐scheduling. Addiction 2020; 115: 451–459.

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Editorials

Prescribing psychotropic medications in residential aged care facilities

Gerard J Byrne

Med J Aust 2020; 212 (7): . || doi: 10.5694/mja2.50562
Published online: 20 April 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Gerontology

Pharmaceutical preparations

Mental disorders

Individualised care plans that take greater account of the behavioural and psychological needs of residents are needed

The prescribing of psychotropic medication for people living in residential aged care facilities (RACFs) is of concern to the community, as reflected in evidence presented to the Royal Commission into Aged Care Quality and Safety.1 Although there is a tendency to blame the prescribers, it is increasingly recognised that many RACFs are poorly equipped for managing cognitively impaired older people with challenging behaviours, particularly ambulant residents with dementia. Not all RACFs have adequate circulation space for reducing the likelihood of aggressive incidents, or accessible outside areas for regular physical exercise. Some RACFs have insufficient natural light for maintaining normal sleep/wake cycles, and many do not have enough staff trained in managing the behavioural and psychological symptoms of their residents. In some locations, public sector mental health services can assist with the assessment and management of RACF residents with mental illness or challenging behaviour, but these services are often under‐resourced and unable to respond quickly. In addition, Dementia Support Australia (https://dementia.com.au) offers multidisciplinary assessment and management advice.

The University of Queensland, Brisbane, QLD

Correspondence: gerard.byrne@uq.edu.au

Competing interests:

No relevant disclosures.

1. Royal Commission into Aged Care Quality and Safety. Restrictive practices. In: Interim report: Neglect, volume 1. Canberra: Commonwealth of Australia, 2019; pp. 193–216. https://agedcare.royalcommission.gov.au/publications/Documents/interim-report/interim-report-volume-1.pdf (viewed Feb 2020).
2. Ballard CG, Waite J. The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer's disease. Cochrane Database Syst Rev 2006; CD003476.
3. Harrison SL, Sluggett JK, Lang C, et al. The dispensing of psychotropic medicines to older people before and after they enter residential aged care. Med J Aust 2020; 212: 309–313.
4. Banerjee S, Hellier J, Romeo R, et al. Study of the use of antidepressants for depression in dementia: the HTA‐SADD trial: a multicentre randomised, double‐blind, placebo‐controlled trial of the clinical effectiveness and cost‐effectiveness of sertraline and mirtazapine. Health Technol Assess 2013; 17: 1–166.
5. Morton R. Outsourcing to hit “dysfunctional” aged‐care system. The Saturday Paper (Melbourne), 2–8 Nov 2019. https://www.thesaturdaypaper.com.au/news/politics/2019/11/02/outsourcing-hit-dysfunctional-aged-care-system/15726132009026 (viewed Mar 2020).
6. Ballard C, Margallo LM, Theodoulou M, et al; Investigators DART AD. A randomised, blinded, placebo‐controlled trial in dementia patients continuing to take or stopping neuroleptics (the DART‐AD trial). PLoS Med 2008; 5: e76.
7. Devanand DP, Mintzer J, Schultz SK, et al. Relapse risk after discontinuation of risperidone in Alzheimer's disease. N Engl J Med 2012; 367: 1497–1507.
8. Patel AN, Lee S, Andrews HF, et al. Prediction of relapse after discontinuation of antipsychotic treatment in Alzheimer's disease: the role of hallucinations. Am J Psychiatry 2017; 174: 362–369.

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