Another topic of debate has been the prescription of isotretinoin for acne, which continues to be limited to dermatologists in Australia. The Australasian College of Dermatologists (ACD) advocates that only dermatologists be allowed to prescribe isotretinoin “because of the complexities involved in patient selection and management, in addition to its known teratogenic effects”.
Isotretinoin has been in use in Australia since the 1980s. It remains the most effective treatment of acne and is presently listed on the Pharmaceutical Benefits Scheme for severe cystic acne unresponsive to other therapy.
I was pleasantly surprised to learn that GPs in other countries can prescribe isotretinoin. New Zealand GPs and nurse practitioners have been able to prescribe subsidised isotretinoin since 2009. GPs are now the dominant prescribers in New Zealand and isotretinoin has become more accessible to socially disadvantaged groups. Pregnancy exposures to isotretinoin are similar when comparing GP and dermatologist prescriptions.
Here are some reasons why Australian GPs should be allowed to prescribe isotretinoin:
- GPs are experienced with the aspects of prescribing a medication like isotretinoin: careful patient selection, side effect counselling, blood test monitoring, follow-up and use of recall systems, mental health assessment, assisting patients institute contraceptive measures while using a teratogenic medication.
- GPs are experts on contraception.
- GPs advocate use of long-acting reversible contraception, with some GPs able to perform insertion of contraceptive implants and intrauterine devices.
- The New Zealand experience confirms that GPs can safely prescribe isotretinoin.
- GPs are more accessible than dermatologists.
- GP consultation fees are less than private dermatologists.
- Dermatology appointment wait times will be reduced.
The Royal Australian College of General Practitioners (RACGP) has previously made a submission to the Health Minister advocating GP prescription of isotretinoin. I advocate that GPs undergo a training course, created jointly by the ACD and RACGP, to gain authority to prescribe isotretinoin in a safely monitored environment with strict criteria to ensure best practice is followed.
The RACGP already has an online learning module “treatment of severe acne” that could be expanded to become the training course. Naturally, GPs will self-select to undergo this training and become isotretinoin prescribers.
Dr John O’Bryen is a GP, and Senior Lecturer at Griffith University and the University of Queensland.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.