12 February 2018

GPs reported to AHPRA over codeine scripts

Addiction Drugs Pharmacy

Doctors have already been reported to authorities for inappropriate prescribing amid changes to codeine scheduling.

Some pharmacies around the country have reportedly been asked for unusually large doses and frequent repeats, with one Queensland pharmacy receiving a prescription for 20 boxes of Mersyndol Forte with five repeats – a total of 2400 tablets.

Medical groups have hoped the codeine rescheduling would push Australians with hidden pain and dependence problems out of the woodwork, enabling the underlying issues to be appropriately addressed.

But Jarrod McMaugh, vice-president of the Pharmaceutical Society of Australia’s Victorian branch, told The Medical Republic that some patients might have experienced the opposite.

This included two instances in his own pharmacy where patients had been identified as having codeine dependence problems and referred to a GP, only to return to the pharmacy with prescriptions for both codeine and benzodiazepines, as well as a refusal to see the patient in the future.

Not only was it potentially illegal to prescribe opioids to dependent patients without authority or a permit, but best practice was to introduce dependent patients to opioid replacement treatments such as suboxone or methadone, or to at least discuss detoxification with them, he said.

In the case of detox, the benzodiazepines would have been appropriate to manage withdrawal symptoms, but not with a concurrent codeine prescription and a lack of ongoing management, he said.

There were other instances where inappropriately large doses of codeine or too-frequent repeats were issued to patients, but Mr McMaugh said that almost all GPs had been receptive to reassessing the management. In one case, he and the prescriber realised an especially large prescription of tramadol was the result of a typing error.

What was particularly concerning about the two instances he reported to AHPRA was the distress it caused the patients to be “dumped” and told to see a different doctor in future, he said.

“The GPs were not just unreceptive [to his concerns] but unsympathetic to the patient situation,” he said, explaining that they did not want to deal with someone they perceived as an “addict”.

Not only would the patient be burnt by the experience, but their future GP “is now in a position where they don’t have all the relevant information to make safe decisions, and so they may perpetuate this patient’s dependence without knowing”, he said.

He stressed the majority of prescribers were acting appropriately, and that around the country only about 20 prescriptions had been flagged with him as particularly excessive or inappropriate.

“So it is low volumes, but for those particular individuals, it’s a high-risk.”

Dr Shane Jackson, president of the PSA, said the red flags of potentially dangerous prescribing he looked for included excessively high doses, mixing of drugs like opioids and benzodiazepines and a high number of repeat scripts.

So far, Dr Jackson said that estimates suggested one in three patients who visited their doctor as a result of the codeine rescheduling were receiving no codeine, only ibuprofen and paracetamol, another third received a prescription for codeine at a similar strength to what they were previously taking over-the-counter, and a third were prescribed higher doses of opioids.

AMA Vice President Dr Tony Bartone said that during the transition period there were likely to be “unfortunate” incidents, but stressed that taking an educative approach rather than a punitive one was key to the ultimate goal of reducing levels of codeine in the community.

Something to say?

Leave a Reply

7 Comments on "GPs reported to AHPRA over codeine scripts"

Notify of
avatar

Sort by:   newest | oldest | most voted
Glenn Rosendahl
Guest
Glenn Rosendahl
2 months 9 days ago
Jarrod, intriguing… look you up on Google. “The latest Tweets from Jarrod McMaugh MPS (@pharmerfour). Opinionated Primary Care Pharmacist. often disgruntled; always correct. Beer & pop culture & politics.” You are always on the other side of the counter to the customer. In an open room with numbers of customers about. No one will approach you with a request for a narcotic – without a signed script from a doctor. And they will have to wait 15 to 30 minutes, depending on your workload. Indeed, you are commonly up there in front of your computer terminal, nevertheless with a view… Read more »
Jarrod McMaugh
Guest
Jarrod McMaugh
2 months 8 days ago
G’Day Dr Rosendahl One of the things about having the description on my twitter account that you have quoted here is that I ca never make assumptions. I have found this is a generally good piece of advice for all people. Very little of what you have written here is an accurate description of my circumstances. If you wish to expand on your use of google on this topic, try the subject line “armed robbery pharmacy.” No health professional is exempt from the violence of people who feel it is the quickest way to achieve their ends. I’ve been lucky… Read more »
Glenn Rosendahl
Guest
Glenn Rosendahl
2 months 12 days ago
I think the administrators of the present and the future ‘drug of addiction management and surveillance systems’ do not understand the exigency of a GP in his or her consulting room, confronted with the demand for new or further prescription of drugs of addiction. One is vulnerable. Within the week I had a patient in my office who took the time (my time) to describe the event of his discharge from a local public hospital, where he had been admitted for numbers of days with multiple large boils in one axilla, the drainage of which had left gaping holes –… Read more »
Jarrod McMaugh
Guest
2 months 10 days ago
Dr Rosendahl – I’m not unsympathetic to the situation you described, but there are a few things you need to be aware of that will be the direct result of the interaction you described. First and foremost, oxycodone MR 5mg does in fact still exist. While the original brand is no longer available, there is an alternative. Your prescription is therefore completely valid, and this patient may well have been able to obtain the prescribed dose of medication that you thought was actually a diversion. Second, if there was in fact no ability to obtain this medication that you had… Read more »
Glenn Rosendahl
Guest
Glenn Rosendahl
2 months 10 days ago
Jarrod, you said ‘the outcome has been to increase the risks for everyone involved in this scenario’. Compared to what course of action? What are you suggesting I should have done? I observe he was a very smart cookie. I think, deliberately. He took up 15 minutes of my time describing his circumstance. (Are you saying I should have given him only 5 minutes, and then chucked him out?) He insisted I look at the three deep holes in his axilla – requesting, expecting me to take over management. I told him we did not have the resources, he would… Read more »
Jarrod McMaugh
Guest
Jarrod McMaugh
2 months 8 days ago
G’Day Dr Rosendahl I have no doubt that the reason the patient in question wanted a prescription was to divert it. The issue is, the path you chose to take put three distinct sets of people in harm’s way, given the knowledge of this person’s propensity for violence. The first is your reception staff and/or yourself. The second is the staff of the pharmacy(pharmacies) that this person presents a prescription to The third is the person themselves. It would be exceedingly difficult to eliminate all three; the way forward should be a consideration of how to minimise the total potential… Read more »
Glenn Rosendahl
Guest
Glenn Rosendahl
2 months 8 days ago
Jarrod, the one difference between your interaction, and mine, is that I am expected by patients to see them in a sound insulated confidential room. No one is looking over our shoulders. My concern – from experience – is that once a drug dependent person gets ‘what they want’ (in this case, 60 mg of endone a day for two weeks) – 12 x 20 or 240 pills, each probably able to be exchanged for at least $50 on the black market (Total of $12,000) particularly if on the basis of simple psychologic intimidation, with no overt physical threat, he… Read more »
wpDiscuz