I understand that the Labor Party Caucus members will soon be asked to reconsider your objection to the proposed review of the treatment of chronically ill peoples’ access to pain relief. I am sure that you will be given a briefing by the Public Servants concerned. I therefore wish to set before you the arguments in support of the review and the need for change in policy on behalf of our organisation and our members.
Many South Australians suffer illness, injuries etc that result in chronic pain (i.e. pain of greater than three months duration). Pain management Clinics and Rehabilitation Clinics help most to cope with the pain and return to a normal life. Unfortunately some patients (estimated to be in excess of 6,500 in this State!) do not respond to the therapies and treatments advocated by these clinics. These patients, often as a last resort, are prescribed opioid medication in sufficient dose to reduce their pain to a level that enables them to recommence a nearly normal life. Regular reviews are necessary and the treating physician should be prepared to change the dose or medication as necessary to prevent problems arising from these medications (please refer to the attachment).
While the Drugs of Dependency unit was under the control of Health S.A. and Mr. Geoff Anderson the management of opioid medication in this State met best practice as recommended by all first world countries and even conservative organisations, such as The American Pain Society (a body representing a large percentage of U.S. Pain Management Specialists). Nearly two years ago the management of the Drugs of Dependency Unit (DDU) was transferred to the Minister for Mental Health and Substance Abuse and effectively under the control of Drugs and Alcohol S.A. (DASSA) and Mr Anderson retired. As DASSA is the biggest prescriber of opioids in the State there is a colossal conflict of interest in having them managing “the umpire”. Mr. Keith Evans, Executive Director of DASSA, and Dr. Robert Ali have both stated publicly that there has been no change in policy since DASSA took control of DDU. This is not so! DASSA’s philosophy in respect of drugs of dependency appears to be one of intolerance and they have embarked on a campaign to reduce the amount of medicinal opioids that each patient is allowed. They have introduced an arbitrary ceiling on the amount of opioids a Medical Practitioner may prescribe for a patient and have made it difficult for Medical Practitioners to comply with the demands of DDU. Numerous General Practitioners are now refusing to prescribe opioids for their patients. Decisions are being made in camera by DASSA’s Medical Director, Dr. Ali, and DDU’s Medical Review Board (Dr. Ali, Dr. David Cherry and a third unknown Medical Practitioner). Dr. Ali and the other members of the Review Board do not consult with the patients whose medical need for opioids they are assessing. They have a history of ignoring the patient’s Medical Practitioner’s opinion (often a very experienced Medical Specialist) and relying on rumour, innuendo or very outdated opinion. There is no appeal to decisions made by the Minister’s delegates!
Some of the recent decisions of DDU have had very bad effect on the health of seriously ill people. For example, a lady in a large country town was told by the Medical Review Committee that her dose of opioids was too high and as she was dependent she should go to a methadone clinic to be weaned off all opioids. She and her husband tried to get into a program but all the programs within reasonable traveling distance were full and they would not take her on. Whoever she spoke to at DDU apparently did not believe her or did not care and her application for the continuation of her medication was refused. Unlike the usual clientel of DASSA she did not have access to illicit drugs and went into withdrawal. On top of her chronic pain, now unrelieved, she experienced the additional pain of withdrawal and the other unpleasant, undignified symptoms. She has since managed to get onto a methadone program interstate. Unfortunately hers was not an isolated case of forced withdrawal that we are aware of. Most patients who have had their medication interfered with by DDU are too afraid to speak out because of a real fear of retribution!
Because most patients do not get full relief from their medication a small reduction (as measured by the medically unqualified staff at DDU) will be very distressing. A large reduction, change of medication to a less effective one or complete cessation of medication have had and are having very serious effects on the lives of very ill and vulnerable people. To date neither the DDU or the Public Hospital Pain Management Units have offered anybody alternative treatment or therapy to help with their chronic pain! Treatment of patients with chronic pain has, in a very short time, gone from meeting world best practice to that of a third world country. We have many examples of patients who were living a fulfilling life who are now completely unable to work, look after their families and in some cases themselves. These people are your constituents and need your help!
We would like to see the following changes:-
DDU moved back to the control of the Minister of Health but with some independence from the senior management of his department (i.e, answerable to the Minister directly).
The Manager of the DDU should be a Medical Practitioner or Pharmacist with experience in both drugs of addiction and pain management.
A right of appeal for patients should be introduced.
If you would like to receive a more complete briefing or any other information we can provide please contact me on <suppressed>.
Yours faithfully,
George Seabrook,
Hon. Secretary,
Dignity for Chronic Pain Sufferers Incorporated