Inquiry into the misuse/abuse of benzodiazepines and other forms of pharmaceutical drugs in Victoria : final report / Drugs and Crime Prevention Committee.

  • Victoria. Parliament. Drugs and Crime Prevention Committee
Date:
2007
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Licence: In copyright

Credit: Inquiry into the misuse/abuse of benzodiazepines and other forms of pharmaceutical drugs in Victoria : final report / Drugs and Crime Prevention Committee. Source: Wellcome Collection.

    145/524 (page 123)
    ¢ Duped doctors are those who unintentionally prescribe drugs to a user based on false information provided by the patient (Forgione, Neuenschwander & Vermeer 2001, pp.66—68). Some dishonest medical practitioners, termed ‘script doctors’, prescribe benzodiazepines, narcotics or other misused pharmaceuticals to patients who they know will abuse them, in exchange for money, sexual favours or other forms of recompense. Such doctors are in essence using their medical licence to deal drugs illegally (CASA 2005). Pharmacists or other pharmacy staff can also divert pharmaceutical drugs by forging prescriptions for drugs that they then sell illegally, or using patient and provider information from the pharmacy database to ‘create’ prescriptions (CASA 2005). Whilst the above literature draws from the American experience, similar classifications have been made in Australia. For example, a submission from Mr John Galloway, Chief Pharmacist, Pharmaceutical Services Branch, Tasmanian Department of Health, outlines the various ‘subgroups’ of doctors from whom ‘doctor shoppers’ may access prescription drugs; Doctor Subgroup 1 (The regular doctor) These doctors form the great majority of general practitioners. We believe that their judgement is generally reasonably good. They are willing to prescribe opioids for patients with severe chronic pain. They are generally cautious about initiating opioids but they often inherit patients already on opioids who are problematic. As the practice of using opioids in chronic pain is a relatively recent change, many have had little structured training in employing opioids for this purpose or in management of drug dependency. They are often reluctant to look closely for evidence of aberrant drug use behaviour (eg. injection sites)... Doctor Subgroup 2 (The intimidated doctor) These doctors are sometimes elderly, or are isolated. They are pressured or threatened by patients in various ways into prescribing drugs which may be abused. They also know that they will not have a policeman [sic] nearby all of the time to protect them from aggressive patients. Doctor Subgroup 3 (The “soft” prescriber) These are relatively few in number. They are usually sympathetic doctors trying earnestly to do good for each patient and they believe that they are doing good. However, their judgement is essentially poor and they are easily persuaded and manipulated by patients. They sometimes volunteer to become pharmacotherapy prescribers. They sometimes attract large numbers of difficult patients who, in some cases, other doctors unfairly pass on to them. Sometimes the doses they prescribe are high. Doctor Sub-group 4 (The rogue doctor) Fortunately these cases are very rare. These doctors turn a blind eye and supply drugs for non-medical purposes. Their actions are essentially criminal. They may have social links with those who abuse or sell drugs, and enjoy risk taking. They are also likely to be using drugs themselves. Their activities attract attention and reports would be referred to the police and to the Medical Council for investigation. !78 One of the useful aspects of the American state drug monitoring systems discussed in Section Four of this Report is their ability not only to monitor ‘doctor shopping’ but also to ascertain which doctors may be over-prescribing prescription medications either inadvertently, negligently or with criminal intent. This was certainly the view of many of the representatives from health and law enforcement agencies with whom the Committee met during its tour of North America. For example, Carla Watkins of the Californian 198 Submission of Mr John Galloway, Chief Pharmacist and Ms Mary Sharpe, Deputy Chief Pharmacist, Pharmaceutical Services Branch, Department of Health and Human Services, Tasmania, to the Drugs and Crime Prevention Committee, Inquiry into the Misuse/Abuse of Benzodiazepines and Other Forms of Pharmaceutical Drugs in Victoria, June 2007.