Pharmacy Daily | Coroner recommends DORA for S3/4s

PHARMACISTS should be required to record all sales of schedule three and four medicines, an Australian Capital Territory (ACT) coroner believes.

Issuing a series of recommendations following an inquiry into the death of a 48-year-old woman who died as a result of an adverse medication-related reaction, ACT Chief Coroner, Lorraine Walker, urged the territory's Health Minister to consider expanding the use of the DORA system to include monitoring "the entirety of medicines listed in S3 and S4 of the Poisons Standard".

The Coroner's Court of the ACT heard Laureen Maree Johnstone died on 07 Jan 2015, as the result of "the combined toxic effect of prescription and non-prescription medicines including doxylamine, tramadol, codeine, oxycodone, zopiclone and fluoxetine, lawfully prescribed or obtained.

Johnstone, who had been forced to retire from the police force as a result of post-traumatic stress disorder had undergone a number of surgical procedures in the months leading up to her death, including a breast reduction, a bladder reconstruction and a facelift, for which she was prescribed opioid medications by the treating medics, who had not been aware of each others scripts.

Six months prior to her death, Johnstone had entered into a medication contract with her GP, De Antonio Dio, in light of her inappropriate doctor and pharmacy shopping to access prescription medicines.

Under the contract, Johnstone agreed to only obtain medicines from one particular pharmacy.

Johnstone's last meeting with Dr Dio was on 20 Nov, during which she did not mention her use of over-the-counter products containing codeine and doxylamine, nor did she raise the fact that she intended to undergo a facelift in addition to the breast operation.

The surgeon and anaesthetist who were involved in the breast reduction and facelift procedures had relied on Johnstone to outline her medication use, however, the court heard she "was not completely open and forthright with her treating professionals as to the medications she was taking or treatment she was receiving".

As a result the treating physicians prescribed medications which they may not have provided had they been fully aware of the medicines she was using.

Issuing her recommendations, the Chief Coroner noted that the territory's real-time medication monitoring system, DORA, was not mandatory, and also did not cover pharmacist-only products such as doxylamine.

Walker recommended that "the Therapeutic Drugs Authority consider whether promethazine and doxylamine are appropriately scheduled in the Poisons Standard, or whether some further form of restriction to these medications having regard to the risk of misuse (including when taken in combination with other sedating medications) is warranted".

Adding that the ACT Health Minister should consider making accessing and using the DORA system a mandatory requirement for all pharmacists and doctors when writing or dispensing prescriptions.

She also suggested that the Royal Australian College of General Practitioners, the Australian and New Zealand College of Anaesthetists and the Royal Australasian College of Surgeon conduct campaigns to encourage greater awareness of OTC medicine consumption when taking a patient's history.