Bad behaviour

Why do pharmacists and doctors divert or supply drugs for non-medical use? Australian researchers find out

A small proportion of health practitioners contribute to the growing problem of pharmaceutical diversion in Australia, say researchers from the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney.

They identified 117 tribunal cases between 2010 and 2016, with most of these from New South Wales and Queensland.

Three quarters (74%) of the health practitioners involved in the tribunal cases were male, according to the article published in Drug and Alcohol Review.

The cases primarily involved doctors (52%), followed by pharmacists (32%) and nurses (15%).

Almost three quarters of all cases (73%) involved inappropriate prescribing and supply, while just under one third (31%) involved misappropriation of drugs from the workplace.

The main pharmaceutical drugs involved were oxycodone, morphine, diazepam, temazepam, alprazolam and pethidine.

Compared with pharmacists, doctors involved in inappropriate prescribing were significantly more likely to involve opioids, sedatives and Schedule 8 drugs, and this was more likely to be attributed to them lacking the temperament for managing the demands of drug-seeking patients.

Meanwhile supply cases involving pharmacists were more likely to involve pseudoephedrine and Schedule 3 drugs (such as codeine at the time of the cases), and their conduct was significantly more likely to be financially motivated.

Lack of support was also a common contributor (23%) across all cases due to geographical remoteness as well as inadequate monitoring and oversight within a practice environment.

The tendency to overprescribe was exacerbated in isolated work environments without adequate supports.

Half of all cases were on a large scale, with more than 10 patients affected—with one case having a maximum of 140 patients affected—or with large quantities of drugs involved, for example up to $10,000 value, or 1600 prescriptions.

Misappropriation of drugs from the workplace was more likely to involve women, nurses rather than doctors, and younger practitioners.

These cases were more likely to be small or moderate scale, and more likely to be attributed to personal and health issues such as chronic pain, sleep disorders and mental health problems, or substance use disorders.

In 40% of cases the health practitioner’s registration was cancelled. A further 21% were suspended, while 28% were able to continue practising but with a series of conditions imposed.

It should be noted that while the healthcare practitioners involved in the 117 tribunal cases represented less than 0.001% of the workforce at 2015, the sample omitted cases that were unreported, less serious or heard in private panels.

Real time prescription monitoring may be able to help support health practitioners struggling with drug-seeking patients.

“The challenges for healthcare practitioners in identifying patients at-risk of diversion and negotiating with ‘drug-seekers’, as well as increases in prescribing rates, have provided the basis for the widespread implementation of prescription monitoring programs,” the researchers point out.

“Strategies to reduce diversion should be multifaceted and may include better supporting healthcare practitioners to manage complex patient groups and removing barriers to substance use treatment.”

See the full study here (login required)

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