An expert is calling for all GPs to develop practice policies that clearly state their approach to prescribing drugs of dependence.
“All general practices should have a practice policy on prescribing drugs of dependence, as appropriate and safe prescribing is not possible unless there is a team approach,” Dr Jenny James, Medical Coordinator for the Substance Misuse Program at the Sydney West Aboriginal Health Service, says in Australian Prescriber.
“I see how the harms of prescription-drug misuse extend far and wide into the community,” Dr James says.
“Between 2001 and 2012 more than 800 Australians died from use of the prescription painkiller oxycodone, and more than half of these people died accidentally.
“Options such as opioid substitution therapy, controlled prescribing and controlled dispensing should be considered.”
Indicators of drug-seeking behaviour include aggressive complaining about the need for a drug, asking for specific drugs by name, and anger when questioned about symptoms such as pain.
The author says, “Harms from prescription drugs, including deaths from overdose, continue to rise in Australia. Dependency on prescription drugs can occur at any age, within any cultural group and across any educational class.”
Dr James says, “GP practices need to respond to the strong evidence that serious harms can result from misuse of prescription drugs of dependence.”
People who misuse prescription drugs are most commonly seeking prescriptions for opioids and benzodiazepines. Other misused prescription drugs include the new antipsychotics such as quetiapine and olanzapine, and stimulants such as dexamphetamine and methylphenidate. Anabolic steroids are also increasingly misused.
There have been large increases in opioid prescribing in Australia, with the total number of prescriptions on the PBS increasing threefold between 1992 and 2007 (2.4 million to 7 million). Oxycodone was the seventh leading drug prescribed in general practice in 2014.
Dr James recommends that general practices have a practice policy on prescribing drugs of dependence. All Australian GPs should register with the Prescription Shopping Information Service, where they can ask if a patient has been identified as a prescription shopper in the previous three months. The patient’s consent is not necessary for this inquiry.
“When a patient is asking for a drug of dependence, it is a challenging situation, with GPs put in a difficult position,” she says.
“GPs can say ‘I don’t prescribe drugs of dependence’, then shift the focus towards seeing what other strategies can be used to help the patient with their presenting problem.
“If a patient requires an ongoing prescription for a drug of dependence, a full biopsychosocial assessment needs to be done. Clear boundaries need to be set with prescribing as well, such as no telephone requests for extension or allowances for ‘lost’ scripts.”