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.

    146/524 (page 124)
    CURES (Controlled Substances Utilisation Review and Evaluation System) programme, discussed in Chapter 4.1, stated that the reports generated by CURES could ‘pick up doctors’: [w]e can look at the standard report and are able to identify why is this doctor writing 1,000 tablets a month. We can then go into our medical board website, and identify what the doctor’s specialty is before we start investigating the doctor.!?? But [if it does seem suspect behaviour] doctors end up going through the same investigatory process as [a suspect] patient.. Rese Similar results have been achieved with KASPER (Kentucky All Schedule Prescription Electronic Reporting) in Kentucky. Mr Dave Sallengs, Manager, Drug Enforcement and Professional Practices Branch of the Kentucky Cabinet for Health and Family Services, told the Committee that: As a result of KASPER, in 2004 42 prescribers were sanctioned either criminally or administratively, in other words they lost their privileges to prescribe controlled substances, and some of them lost their medical license. In 2005 the number was 37 practitioners...that’s a significant number as far as action is taken that results in a lawsuit.20! The above discussion relates for the most part to inappropriate behaviours of doctors in their role of prescribing drugs for other people. It is not unknown, however, for health care professionals themselves to abuse the drugs over which they may have control or access. Diversion by healthcare providers for their own use There has also been a longstanding recognition that doctors, nurses and pharmacists are at increased risk of using drugs for non-medical purposes, associated with their high levels of access to these drugs. A recent study of diversion cases involving healthcare workers in Cincinnati from 1992 to 2002 (Inciardi et al 2006) found that opioids followed by benzodiazepines were the drugs most often diverted, with nurses (63.4%) responsible for most of the cases, followed by physicians (8.7%), medical assistants (6.4%), pharmacists (6.0%) and nursing assistants (5.0%). Hydrocodone (20.0%) was the most widely diverted drug, followed by oxycodone (immediate release) (15.6%). OxyContin® was only mentioned in 2 per cent of cases, as apparently it was not routinely available through much of the period of the analysis, and because of media scrutiny special care was taken to restrict diversion (Inciardi et al 2006). Most of the diversions in this study appeared to be for the healthcare providers’ own use.202 Nurses Drug diversion can certainly occur in the context of nursing. In August 2007 the Committee met with Ms Carol Stanford, Probation Program Manager with the California Board of Nursing’s Treatment Program for registered nurses who have problems with substance abuse. She stated that the combination of high levels of stress in the workplace and relatively easy access to prescription drugs, mostly opioids, meant that nurses, particularly those working in emergency departments, had fairly high levels of substance abuse problems compared to other professions.2° 199 Such a step is necessary to exclude doctors who may legitimately be prescribing large amounts of certain drugs, for example for cancer patients or registered pharmacotherapy clients. 200 Ms Carla Watkins, Supervisor of Criminal Identification and Intelligence, CURES programme, Meeting with Drugs and Crime Prevention Committee, Inquiry into the Misuse/Abuse of Benzodiazepines and Other Forms of Pharmaceutical Drugs in Victoria, Sacramento, 3 August 2007. 201. Mr Dave Sallengs, Manager, Drug Enforcement and Professional Practices Branch, Kentucky Cabinet for Health and Family Services, Meeting with the Drugs and Crime Prevention Committee, Inquiry into the pfu tht of Benzodiazepines and Other Forms of Pharmaceutical Drugs in Victoria, Frankfort, 31 July Zi 202 The legal consequences of such behaviour are discussed in Chapter 3.2 of this Final Report. 203. Ms Carol Stanford, Program Director, Board of Registered Nursing, Meeting with the Drugs and Crime Prevention Committee, Inquiry into the Misuse/Abuse of Benzodiazepines and Other Forms of Pharmaceutical Drugs in Victoria, Sacramento, 2 August 2007.