A case of impairment

More than 20 conditions will be applied to a health practitioner who escaped being struck off, after practising while impaired with severe opioid use disorder

A Sydney GP will continue to practise under strict conditions after a tribunal found he inappropriately obtained drugs of addiction for self-administration.

The GP was found to have accessed either morphine or pethidine using prescriptions he wrote using the names of 23 patients, with a total of 122 incidents between 2003 and 2017.

In doing so, the practitioner also breached an order from 2011 that he neither take possession of a drug of addiction, nor issue a prescription for pethidine.

The GP admitted the conduct, adding that he suffered an impairment at the time and did not recall each incident.

At a hearing on 1 March 2021, the NSW Civil and Administrative Tribunal heard that the doctor had been very seriously injured following a cycling accident in 1992.

He required six major operations in the subsequent years and endured severe and prolonged pain for which he took pethidine, by prescription and under the supervision of his doctors for about two years continuously.

It was during this time that he became addicted to opioids and, by 2003, he began to self-medicate periodically with opioid analgesics for pain.

His self-prescribing ceased in 2007 after participating in treatment programs, only to resume in 2015 after morphine given to him in the wake of emergency abdominal surgery “re-ignited” his opioid use disorder.

He began intermittently prescribing morphine and pethidine for his own use and resumed abusing Panadeine Forte.

By mid-2016, the doctor was self-administering about 200-300mg of pethidine every evening.

A car accident in December 2016, when a hospital blood sample showed he had pethidine in his blood, led to the GP self-reporting to Ahpra in relation to his inappropriate use of self-prescribed S8 drugs.

The Medical Council was notified of his abuse of pethidine. That same month, he was again admitted to hospital for opioid use disorder treatment.

He was assessed in 2017 by a council appointed practitioner and found to be suffering from an impairment, namely severe opioid use disorder, and conditions were imposed upon his registration.

The practitioner was required to notify Ahpra whether he had an impairment that detrimentally affected or was likely to detrimentally affect his capacity to practice medicine, said the Tribunal.

However while he filed renewals of registration in 2017 and 2018, he mistakenly believed he didn’t need to acknowledge the impairment on the applications since Ahpra and the Medical Council knew about it.

He accepted that his view was wrong.

The Tribunal noted that the doctor’s impairment initially arose from circumstances out of his control and did not consider that cancellation or suspension of his registration was necessary for deterrence.

“Nearly 30 years have passed since that time. Addiction medicine has emerged as a discipline, and strategies to address opioid use disorder have greatly improved,” it said.

“In this case, it could fairly be said that all of the deterrence necessary can be gleaned from the knowledge of [his] story and his long struggle with opioid use disorder.”

Since February 2017, the practitioner has abstained from taking morphine and pethidine, assisted through the use of sublingual buprenorphine/naloxone under the supervision of his addiction medicine specialist.

The Tribunal noted that there has not been any complaint about him by a patient.

He has been seeing his GP monthly, and both a psychiatrist and psychologist every 6 to 8 weeks. He sees his addiction medicine specialist, who prescribes Suboxone for him, regularly.

All told the Tribunal they are pleased with his progress and none expressed any reservations about his ability to practice medicine.

“All of the evidence before us indicates that [the doctor’s] impairment does not presently interfere with his ability to practice as a general practitioner,” the Tribunal found in its late April decision.

The GP is allowed to continue practising but must not possess, supply, administer or prescribe any S8 or S4D drug or any drug containing codeine.

He is not to prescribe for self-medication, nor self-administer any S8 or S4D drug, narcotic derivative, non-prescription compound analgesic or cold medication, or any drug containing codeine, unless they are prescribed and taken as directed by his treating practitioner.

The doctor must not to treat or prescribe to himself or immediate family members or their partners, and is to submit to urine drug screening twice weekly and hair drug screening quarterly.

He must continue to see a GP, psychiatrist and addiction specialist for treatment.

The Tribunal ordered him to pay costs to the Health Care Complaints Commission.

Pharmacists’ Support Service provides non-judgmental support over the phone every day of the year between 8am and 11pm AEST on 1300 244 910.

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