An expert report received in a recently successfully litigated case explained the scope of the duty of care doctors have to drug dependent patients who are addicted to prescription medicines.
It is vital that treating practitioners are aware of a patient’s history and how that may impact on their treatment and continuing health. When prescribing addictive medication to a person with a history of addiction to prescription medicine it is the doctor’s duty to carefully manage and implement an effective plan to minimise harm. The doctor should take precautions aimed at avoiding a fatal overdose, particularly where the patient has overdosed on a prior occasion(s).
In NSW, the policies and legal requirements are set down by NSW Health. In March 2016, they released a document, Legal Requirements for an Authority to prescribe drugs of addiction in New South Wales. The document sets out the circumstances when a doctor can legally prescribe a drug of addiction to a drug dependent person in NSW.
A drug dependent person was defined as a person who had acquired as a result of repeated administration of a drug of addiction or a prohibited drug an overpowering desire for such a drug.
NSW Health has also published a guide “recognising and managing drug dependent persons – notes for Medical Practitioners”. Three key points were highlighted:
- Referring drug dependent persons to a specialist Drug and Alcohol Unit for assessment and management;
- Telephoning the 24-hour NSW Drug and Alcohol Specialist Advisory Service DASAS on telephone 1800 023687 or (02) 9361 8006 for immediate clinical advice on the management of drug dependent persons; and
- Telephoning the Ministry of Health (Duty Pharmaceutical Officer, Pharmaceutical Services Unit on 02 9391 9944 during office hours) for further information.
Following the referral to a specialist team it is imperative that the treating GP consistently follows any plan which has been put in place.
Where prescriptions of addictive medicines such as Endone and Murelax are required for patients with a history of addiction, it is the duty of the treating doctor to continually monitor the patient. NSW Health also provided advice to help identify concerns and potential misuse early.
For example, where a patient:
- Loses a prescription or tablets;
- Requires interim supply as a takeaway or an “emergency” situation.
Additionally, the risks of overdose or death was pointed out to warn doctors who are prescribing drugs of addiction to drug dependent people.
The document went further and clearly spelled out that in addition to the potential harms by prescribing Schedule 8 drugs of addiction on request or in the above circumstances, prescribing to drug dependent patients without the prior written authority from the NSW Ministry of Health is a breach of the Poisons and Therapeutic Goods Regulation 2008 (NSW).
The expert GP referred to the March 2017 issue of Medicine Today, a publication widely read by GPs, which had an Opioid misuse supplement. Among the recommendations for managing opioid medication, it was recommended that opioid use should be limited to a 4-week trial, a pain diary should be encouraged and short-acting opioids such as Endone should be avoided, management plans and contracts should be utilised. Following the trial a comprehensive assessment should be performed.
The expert GP referred to current research about the efficacy of opioids for chronic non-cancer pain, which had found that there were clinical consequences beyond addiction which included; loss of bone density, hypogonadism and an increased risk of a heart attack.