A psychiatrist* received a letter of complaint from a patient’s relative alleging they had inappropriately prescribed the Schedule 8 medications, Xanax and Oxycontin, after treating a drug dependent patient who also suffered from attention deficit hyperactivity disorder (ADHD).
The psychiatrist admitted that they had felt pressured by the patient and relented when pushed for the prescriptions. They also failed to obtain authorisation to prescribe the S8 medications from their state and territory authority by applying for a permit. Subsequently, the member received a letter from AHPRA advising they were undertaking an investigation into their prescribing practices.
This scenario can have serious ramifications for psychiatrists including having their prescribing authorities for drugs of dependence cancelled for up to five years or permanently cancelled, and in some cases, having their registration suspended or their registration cancelled altogether.
This scenario is not uncommon, and we often refer members to our Risk Advisory team to help them to understand the legal requirements for prescribing drugs of dependence in their state, signs of drug dependency and how to deal with drug seeking patients. In many cases, Avant is able to successfully submit on behalf of the doctor in professional conduct matters, that they have gained insight into their standards of practice regarding prescribing drugs of dependence to optimise the outcome for the doctor, including the matter being discontinued at an early stage in low level matters. Sometimes, the member may be assigned a supervisor who will hold scenario-based discussions with the doctor to improve their understanding of appropriate prescribing of drugs of dependency.
Know your legal obligations
Drugs of dependence, or Schedule 8 (S8) drugs, associated with abuse and addiction, such as opioid analgesics, sedative hypnotics and stimulants, present several challenges for the doctors prescribing them. Some doctors may be unsure about their legal obligations for prescribing and some may be susceptible to manipulation by patients.
You require approval from the relevant state or territory authority if you wish to prescribe a drug of dependence:
- In most states, to a patient for more than two months (this time frame includes prescribing by previous doctors)
- If the patient requiring the drug is considered ‘drug dependent’
- Before prescribing certain drugs e.g. amphetamines or methadone.
Note: The requirements of the state and territory authorities differ slightly so familiarise yourself with the regulations of the state/territory you practice in. If in doubt, contact your local authority for further information.
Applying for a permit
A permit can be obtained from your local authority by completing the relevant application form. This form requests clinical information about your patient's condition and may require you to prepare a report (WA only).
Only one permit per patient – If you are taking over the care of a patient using a drug of dependence, the doctor currently holding their permit must cancel this before a new one for this patient can be issued with you as their prescriber.
- Another doctor in your practice can prescribe for the patient, but he/she must check and abide by the conditions on your permit, and it is wise that he/she endorses the prescription ‘deputising for Dr X, the permit holder’.
Recognising drug-seeking behaviour
Drug-seeking behaviour by patients dependent on S8 drugs is often sophisticated, manipulative, and demanding. Generally, doctors can be trusting of the information they receive from patients, but there are certain behaviours that may raise suspicion about a patient’s intent.
Familiarising yourself with these behaviours can avoid you being unknowingly manipulated by these patients to obtain S8 drugs. Strategies such as taking a full patient drug history and tamper-resistant prescriptions can help protect your practice.
Register for access to Medicare's Prescription Shopping Information Service. This service holds a list of identified ‘doctor shoppers’ – you can contact them 24 hours a day, seven days a week on 1800 631 181 for information about a patient’s habits and prescriptions.
Being vigilant when prescribing drugs of dependence means you can protect yourself from having a claim or complaint made against you
- Understand when a permit is required for prescribing drugs of dependence
- Look for drug-seeking behaviours in patients prescribed S8 drugs
- Comply with all the relevant drug prescribing guidelines and legislation.
Find out more
For more information, download the factsheet Prescribing drugs of dependence or complete our eLearning course, Prescribing: principles and practices.
To speak with an expert for advice regarding prescribing drugs of dependence, call Avant’s Medico-legal Advisory Service on 1800 128 268.
*This scenario is based on several cases where Avant has supported members.
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