President’s Report – July 2015

From Dr Geoffrey Speldewinde

As we settled down to our hot drinks, heating, and the first naturally ski-able snow of winter let me tell you about a couple of interesting newsworthy issues and then news of a Parliament enquiry of some importance to all of us.

1. Over-the-counter codeine (OTC codeine) made the news around the time of our Annual Scientific Meeting in March nationally.  As Public Health physician Dr Malcolm Dobbin soberingly showed us at the ASM, there is great concern from relevant acute care specialists about the rising morbidity and mortality being seen from the readily available over-the-counter analgesics.  These contain not only codeine (a congener of, and metabolised to, morphine in our livers, with its attendant not insignificant prevalence of dependency) but also paracetamol and ibuprofen.
   Of course this is a major concern for the health of our community in general, but whether the suggestion that OTC analgesics containing codeine should be available only by prescription is a workable solution is yet to be determined.  Clearly there is a community health issue that needs to be addressed but perhaps tighter controls on the OTC availability within pharmacies and smaller packets may be a start.  Of course it also begs the question of wider availability of informed pain management and education about other strategies within the community.
2. The use of cannabis for health or medical purposes continues to make headlines.  Funding and resources are starting to be made available in Australia for quality scientific study around the use of cannabis (which contains at least nine separate medicinal compounds perhaps the most promising of which is cannabidiol CBD which appears not to have psychotropic activity).
   Your Australian Pain Society takes the view that the widespread use of cannabis in its current forms for managing pain and pain related issues has little scientific merit with no clinically meaningful effect size demonstrated.  Moreover we have learnt from the current difficulties associated with the widespread misuse and abuse of prescribed opioids that caution needs to prevail before releasing another prescribed agent with significant psychotropic properties.
   However research internationally is increasing exponentially and the next decade may well see clinically acceptable medical use for analgesic purposes.  The recently published updated Guidelines for the Pharmacological Treatment of Neuropathic Pain from the Neuropathic Pain SIG of the IASP tellingly gave cannabis a negative recommendation.
3. However most importantly I want to make you all aware of an Inquiry by the Commonwealth Parliament House of Representatives Standing Committee on Health on “Chronic Disease Prevention and Management in Primary Health Care”.  As the media release says, the committee will examine opportunities for Primary Health Networks to coordinate and support the prevention and management of chronic disease in primary health care, and we will look at the roles of State and Territory Governments as well as private health insurance, in preventing managing chronic disease.
   This is a significant opportunity for us and your Board on your behalf is supporting a major submission through Painaustralia (of which The Australian Pain Society is a major sponsor and board member).
   I also urge you to ensure that each of your professional associations are aware of this enquiry and hopefully making their own submissions relevant to the efficacious and efficient management of all the current diseases with which each association has involvement.  I would ask that each association include the management of acute and persistent non-cancer pain in the range of diseases to which they may refer.
   One could hope that an outcome will be a greater resourcing of health professionals, based in the community, who are educated about and trained to address the social and psychological domains of chronic disease.   This would reduce the need for hospital-based care, reduce the long-term use of health resources for such conditions by implementing prevention before management is required, and importantly keep our ageing populations working productively and meaningfully despite their chronic disease for a longer period of time.  Heaven forbid, will we see a resurrection of the Commonwealth Rehabilitation Services?!

Terms of Reference for the Parliamentary Inquiry into Chronic Disease Prevention and Management in Primary Health Care (submissions due by 31 July 2015)

The standing committee on Health will inquire into and report on best practice on chronic disease prevention and management in primary health care, specifically:

1. Examples of best practice in chronic disease prevention and management, both in Australia and internationally;
2. Opportunities for the Medicare payment system to reward and encourage best practice and quality improvement in chronic disease prevention and management;
3. Opportunities for the Primary Health Networks to coordinate and support chronic disease prevention and management in primary health care;
4. The role of private health insurers in chronic disease prevention and management;
5. The role of State and Territory Governments in chronic disease prevention and management;
6. Innovative models which incentivise access, quality and efficiency in chronic disease prevention and management;
7. Best practice of Multidisciplinary teams chronic disease management in primary health care and Hospitals; and
8. Models of chronic disease prevention and management in primary health care which improve outcomes for high end frequent users of medical and health services