So i just got a warning slapped on me by Victoria’s new Safescript system for 'filling prescriptions from 4 different doctors in the last 90 days'. Here's why that's bullshit

I have multiple complex chronic illnesses, including difficult-to-treat chronic pain. Like most people in this situation, I see multiple doctors: I have a multidisciplinary team looking after me. My gp, the pain clinic, the neurology team and my psychiatrist - with a rheumatologist soon to be added to this mix. With this in mind you can see how it’s pretty much impossible NOT to have multiple doctors prescribing things in practice (pun not intended).

The Safescript system came into being to try and stop people from ‘doctor shopping/pharmacy shopping’ - it’s a real time monitoring system to track when and where patients are filling scripts and the doctors writing them, and gives warnings if it thinks the above is occurring. I try very hard to only have the same couple of doctors write scripts for the 'naughty' medicines (in my case, oxycodone and diazepam) specifically to avoid this happening - but it's not always possible. So here’s yet another example of computer algorithms making life difficult for the marginalised:

My GP prescribes my Targin (oxycodone) for severe chronic pain not responding to other medication I am on, and has done so for 18 months. However, he was off with bronchitis recently so another doctor at the same clinic wrote it up for me. He had no problem with doing that, it's all on my file what I get and why, and it’s not like I could just wait for the regular GP to come back - this is a drug you only renew when your prescribed supply has run out and for me that’s every 4 weeks on the dot. It would be cruel and nonsensical to make me wait for the regular GP.

My psychiatrist prescribes my diazepam (Valium), however she was away for a fortnight on conferences and I forgot to ask her for a renewed script before she left. These things happen, when you’ve got so much going on you can lose track. This was during the terminal phase of my late cat's cancer so my life admin skills took somewhat of a hit. I happened to have an old Valium script written up from a hospital discharge in August that I specifically never filled because of Safescript, however I was forced to use it because this is not a medication you can just stop taking if you’re on it regularly. The withdrawal is incredibly unpleasant and physically dangerous. I take it for anxiety and painful muscle spasms, which would go into overdrive were I to stop suddenly.

Every time I do this with scripts, I explain to the doctors and pharmacists what's happened. I’m well educated in medicine, neat looking and well spoken so it’s never a problem. I try to use the same pharmacy every time but again it's not always possible because, y’know, life and all that. They’re only open until 4.30 daily and as someone with a disability and severe pain, who frequently has appointments all over the city, it can be simply too onerous to factor another trip into my day.

These two little aberrations have now left me with a big warning on my Safescript file. 4 doctors in three months. That’s all it takes. If you see a multidisciplinary team, especially in public hospitals, different doctors are going to write these scripts. If your regular doctor is away, another will have to write it up. If your regular pharmacy is closed, you'll have to go to another one. To then tag ill people as ‘drug seekers’ as a result of this is pure insanity. Pregabalin (Lyrica), another med many chronic pain patients are prescribed, will soon be added to the ‘watch list’ in Safescript. I can only imagine how much harder my life is going to get then.

I understand the need to try and stop people 'doctor shopping' but this is ludicrous. I use as directed, I never fill early, I'm not out getting multiple scripts from all over the place and trying to fill them every 3 days. But now the PBS has me listed as a drug seeker because of these incidents and if it happens again, I could be refused dispensing of the medications. My GP told me he’s at risk of having his prescribing authority taken away. It's insanely strict if you're someone in my position, and it’s a stark highlight of how adversarial the health system can be (and the ableism built into it) for those with chronic illnesses, especially chronic pain. Safescript was not designed with the chronically ill, disabled or pain patients in mind and it actively punishes us.

You'll never stop people who abuse drugs with this kind of thing - they'll always find a way. What it does do is hurt people with chronic illness, especially pain. And we KNOW from the experience in the US, when the prescribing of painkillers was severely restricted, what happens. People abusing them pivoted to illegal drugs and the legitimate patients were left to suffer. Some also turned to illegal drugs. Many turned to suicide. 

In Australia we've NEVER had the overprescription issues the US faced. This is not a model to emulate, unless you believe that causing suffering in order to make the ‘problem’ you’re trying to fix magnitudes worse is somehow the answer. Governments love algorithms because they’re cheaper than good old fashioned people-power, but as we’ve seen with robodebt, lack of human oversight can extract a far greater toll than the issue they’re designed to solve.