Before prescribing a drug of dependence, a medical practitioner must take all reasonable steps to ensure a therapeutic need exists, and must take all reasonable steps to confirm the identity of the patient. Issuing a prescription merely because another prescriber has done so is unlikely to satisfy these requirements.
Medicines that attract prescription shoppers
Some medicines that attract prescription shopping include:
- Benzodiazepines – especially alprazolam, flunitrazepam and clonazepam
- opioids – especially oxycodone, morphine, fentanyl and methadone
- psychostimulants – dexamphetamine and methylphenidate
- testosterone and anabolic steroids
To help them decide whether to prescribe a drug of dependence, prescribers can seek information from:
- Medicare Australia's Prescription Shopping Information Service
- Drugs and Poisons Regulation
Using the Prescription Shopping Information Service
The Prescription Shopping Information Service (PSIS) may be phoned at any time (1800 631 181) to discover if a patient has been identified as a prescription shopper. Each individual medical practitioner must register with Medicare Australia before they can be provided information by the PSIS.
When phoning PSIS, the practitioner will be required to provide their name and other information to confirm their identity, before providing the patient’s full name, Medicare number and date of birth.
Medicare Australia will be able to inform the practitioner whether the patient has been identified, under the criteria of the Prescription Shopping Program, as a prescription shopper. The criteria relate to a person having obtained more than a specified number of particular medicines under the Pharmaceutical Benefits Scheme (PBS) or having obtained PBS items from six or more prescribers (excluding specialists) in a 3-month period.
Where the PSIS has identified a person, it can provide a patient summary report of the recent extent of drug-seeking activity.
Some drug-dependent (or other drug-seeking) persons may not be identified by the PSIS because Medicare Australia’s data does not include information relating to medicines for which there is no co-payment, including:
- ‘private’ prescriptions and prescriptions for items that are not listed as PBS items
- ‘repat’ prescriptions for which the co-payment is made by Veterans’ Affairs
- less-expensive medicines for which there is no co-payment unless patients hold entitlement cards
- prescriptions relating to the provision of opioid replacement therapy to opioid-dependent patients.
Contacting Drugs and Poisons Regulation
A medical practitioner must notify Drugs and Poisons Regulation (DPR) if they believe a patient is a drug-dependent person and the patient seeks a drug of dependence or the medical practitioner intends to prescribe a drug of dependence. This notification is a legislative requirement that enables departmental officers to assist prescribers who might seek advice or apply for a permit to treat a person, or to intervene to address concurrent prescribing, when it is identified.
Medical practitioners may also phone DPR to discuss legislative concerns or to seek information about specific patients. Information available from DPR differs from that of the PSIS, because it is not limited to medicines that are PBS items and is not limited to a 3-month period. However, in most cases, DPR does not have details of prescriptions that have been recently dispensed for a patient.
The collection, storage and disclosure of information by the department are governed by legislation, including the Health Records Act 2001. Accordingly, information held by the department about a patient will only be released to a medical practitioner with a legitimate need to access that information to treat the patient. Medical practitioners who contact the department may be able to establish:
- whether any other medical practitioner holds a permit to treat a patient with Schedule 8 medicines, including patients receiving methadone or buprenorphine to treat opioid dependence
- aliases that have reportedly been used by drug-seeking patients
- whether the department has been notified that other medical practitioners believed a patient was a drug-dependent person, and whether another practitioner had indicated an intention to treat the patient
- whether reports of forged or fraudulent prescriptions, or of obtaining drugs of dependence by false representation, had been received in relation to the patient.
Deciding whether to prescribe
Medical practitioners must ultimately decide whether to prescribe a drug of dependence for a patient. Drugs and Poisons Regulation and Medicare Australia can only provide information or advice that might help in reaching a decision, including when an unfamiliar patient is seeking a drug of dependence.
Having sought information or advice from Drugs and Poisons Regulation or Medicare Australia, or both, medical practitioners are encouraged to consider the following points in making a decision:
- A patient with a valid therapeutic need for ongoing treatment with drugs of dependence should have a principal medical practitioner managing or attempting to manage the patient’s medication regime. Concurrent prescribing by other medical practitioners may be detrimental to the patient, especially when the patient’s principal prescriber is unaware of the additional prescribing or its extent.
- The fact that a person has a demonstrable therapeutic need for a drug of dependence does not preclude the possibility that the person is drug dependent; drug dependence is not limited to illicit drug users.
- The success of drug-seeking activity is often facilitated by the fact that some medical practitioners prescribe the maximum PBS quantity when consulted by patients who claim that their regular prescriber is not available and who present themselves at times when it is difficult to contact the regular prescriber or the department.
- Medical practitioners are not obliged to prescribe the maximum PBS quantity.Doing so may be detrimental, especially when the patient’s principal prescriber is unaware of the additional medication.
To obtain clinical advice from specialist consultants, registered health practitioners (only) may phone the Drug and Alcohol Clinical Advisory Service (DACAS).
For 24-hour confidential drug and alcohol counselling and treatment information, patients, family or health practitioners may phone DirectLine.