Australasian Chapter of Addiction Medicine
The Australasian Chapter of Addiction Medicine (AChAM) is a Chapter of the Royal Australasian College of Physicians (RACP) Adult Internal Medicine Division that connects and represents Addiction Medicine Fellows and trainees in Australia and New Zealand. AChAM advances the study of addiction medicine in Australia and New Zealand through training, research and collaboration with health professionals and organisations. The Chapter provides training and continuing professional development to ensure excellence in skills, expertise, and ethical standards. AChAM advocates on behalf of its members and acts as an authoritative body for consultation in addiction medicine to ensure quality care for individuals with addiction disorders.
5.
Use a 'universal precautions' approach for all psychoactive medications that have known potential or liability for abuse including opioids, benzodiazepines, antipsychotic medications, gabapentinoids, cannabinoids and psychostimulants.
Use a 'universal precautions' approach for all psychoactive medications that have known potential or liability for abuse including opioids, benzodiazepines, antipsychotic medications, gabapentinoids, cannabinoids and psychostimulants.
The misuse of a prescription drug or drug class (e.g. benzodiazepines, opioids) is often followed by warnings to medical practitioners to avoid use of that medication or drug class. This may result in doctors using alternative psychoactive medications (e.g. quetiapine, pregabalin) which, in turn, become identified as ‘drugs of misuse’ and become ‘problem drugs’. Underlying this trend is an overreliance on medication in preference to psychosocial and physical therapies and a failure to adopt a broader universal precautions approach to the use of psychoactive medications.
As all psychoactive medications have the potential to be abused, a universal precautions approach to prescribing such medicines is recommended, based upon the following principles:
1. risk screening: identifying patients at risk of poor adherence to medications and/or at risk of developing harms related to their use of a medication
2. identifying clear treatment goals with the patient and considering the role of medication and other treatment options, including the potential harms and benefits of use of a medication
3. structuring treatment according to patient risk including instalment dispensing, approaches to increase medication adherence such as urine drug screens and prescription monitoring, written treatment agreements and regular clinical reviews and
4. regular monitoring of patient outcomes and medication-related issues associated with adherence and adverse events.
Supporting evidence
Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005 Mar-Apr;6(2):107-12.
Heilbronn C, Lloyd B, McElwee P, Eade A, Lubman DI. Trends in quetiapine use and non-fatal quetiapine-related ambulance attendances. Drug Alcohol Rev. 2013;32(4):405–411.
Murnion B, Conigrave KM. Pregabalin misuse: the next wave of prescription medication problems. Med J Aust. 2019;210(2):72–73.
How this list was made
Through the RACP Evolve program, the Chapter Committee of the Australasian Chapter of Addiction developed a draft Evolve Top-5 Recommendations of low-value practices and interventions that pertain to the specialty. After several rounds of internal consultations and revisions, the list of recommendations was subject to an extensive review process that involved key College societies with an interest or professional engagement with addiction medicine.
The list was then consulted with other medical colleges including through Choosing Wisely Australia. The recommendations were also reviewed by the College’s Aboriginal and Torres Strait Islander Health Committee to ensure that the list adequately reflects the health needs of Indigenous Australians with substance use disorders.
Feedback received in the consultations led to further fine tuning of the list, which was then finalised and approved by the AChAM President and President-Elect.
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1
Do not undertake elective withdrawal management in the absence of a post-withdrawal treatment plan agreed with the patient that addresses their substance use and related health issues.
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2
Do not prescribe pharmacotherapies as stand-alone treatment for Substance Use Disorders (SUD) but rather as part of a broader treatment plan that identifies goals of treatment, incorporates psychosocial interventions and identifies how outcomes will be monitored
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3
Do not deprescribe or stop opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality from discontinuation of opioid medications
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4
While managing patients with Substance Use Disorder (SUD), exercise caution in the use of treatment approaches that are not supported by current evidence or involve unlicensed therapeutic products.
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5
Use a 'universal precautions' approach for all psychoactive medications that have known potential or liability for abuse including opioids, benzodiazepines, antipsychotic medications, gabapentinoids, cannabinoids and psychostimulants.