Coroner calls for checks on neuropathic pain prescribing

By Michael Woodhead

23 Oct 2019

Better co-ordination and monitoring is needed for prescribing of neuropathic pain medications, according to a coroner investigating the death of a Victorian man who overdosed on a cocktail of opioids and pregabalin.

The 52-year old man who had a lengthy and complex medical history of MS, chronic neuropathic  pain and mental health issues died in 2017 after intentional ingesting a mixture of his prescribed medications including fentanyl, pregabalin, tramadol, diazepam and sertraline.

The coroner heard that neurologists at Alfred Health had admitted the Mr Phillip James King for a week of inpatient treatment in 2017 in an unsuccessful attempt to reduce his opioid use for severe neuropathic pain.

The patient stopped the lignocaine infusions he was given after four days because he said they had no effect on his pain symptoms. He was cautioned by Dr Olga Skibina and Dr Cassie Nesbitt at the Alfred Health Neurology Clinic about his use of opioids and pregabalin for chronic pain, and it was suggested he be followed up for further evaluation of the causes of his pain and switching from opioids to different drugs such as carbamazepine.

However the man did not return for his review appointment and continued to use opioids, diazepam and pregabalin prescribed by two GPs, until his death.

The coroner said it was unclear whether the man really needed the large amounts of oxycodone, fentanyl, tramadol, pregabalin and diazepam to treat his pain and mental health problems. He found there was no evidence that the prescribing of these drugs represented neglect by the medical practitioners, but the man’s access to so many drugs that contributed to his fatal overdose showed the need for a Real Time Prescription Monitoring System.

“A more co-ordinated approach to prescribing would have provided Mr King’s treating medical practitioners with richer insight into drug use,” the coroner commented

However the coroner also noted that Victoria’s prescription monitoring system did not cover pregabalin and he recommended that the Victorian department of Health review the rationale for excluding this drug from the SafeScript RTPM scheme that has been adopted in the state since October 2018.

Further recommendations were made that families of people prescribed strong opioids should be given education by practitioners on overdose risk, recognition and response.

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