Drug-seeking behaviour is not limited to users of illicit drugs. Some drug seekers have genuine medical problems but have (or are developing) an iatrogenic dependence.
Drug-seeking activity may also be associated with diversion and sale of prescription medicines. Medicines that have been particularly subject to trafficking are OxyContin® 80 mg, OxyContin® 40 mg, Kapanol® 100 mg, MS-Contin® 100 mg, testorterone and anabolic steroid injections, alprazolam, clonazepam, dexamphetamine, methylphenidate and medicines containing pseudoephedrine.
Medical practitioners are advised to be especially alert for patients seeking these medicines, even if the person does not appear to be a drug-dependent person.
It is quite easy to create a fraudulent document and give it a look of authenticity, by cutting and pasting banners or other information from an internet site. Medical practitioners are strongly advised to check the authenticity of such documents, retain a copy and, if the document is found to be fraudulent, report the matter to the department.
One drug-seeking Victorian resident created numerous fraudulent letters that contained accurate details of different interstate clinics but an after-hours phone number that, if phoned by a suspicious general practitioner, connected with his accomplice.
Patients pretending to be interstate visitors
Some years ago, prescriptions for Schedule 8 medicines could not be dispensed in Victoria unless the prescriber was registered in Victoria. However, with national registration, prescriptions from medical practitioners are valid in Victoria, provided the prescriber is appropriately registered in Australia.
Many drug-seeking patients have fraudulently claimed to be visiting from interstate in order to obtain prescriptions for Schedule 8 medicines from general practitioners. Some patients presented medication containers which had been dispensed at interstate pharmacies, to convince the medical practitioner that they were from interstate.
To address this problem, transient interstate visitors can be advised to obtain prescriptions from their regular prescribers or, in an emergency, have their regular prescribers phone a Victorian pharmacy to authorise supply of Schedule 8 medicines.
Patients who claim they can’t see their regular doctor
Some drug seekers claim that their ‘regular doctor’ is unavailable (on leave, away sick, retired or other reason) or that they have just moved and that their previous clinic is too far away to visit. Such claims are commonly used by drug-seeking patients to obtain prescriptions for drugs of dependence from medical practitioners to whom they are not known.
One Victorian resident, with a genuine therapeutic need and genuine documents, obtained prescriptions from more than 200 general practitioners on more than 300 occasions. Some clinics phoned Medicare Australia’s Prescription Shopper Information Service, but the patient was not identified as a prescription shopper because the cost of his medicine was being subsidised by Veterans’ Affairs rather than Medicare Australia.
To address this type of drug-seeking activity, a medical practitioner prescribing a Schedule 8 medicine for a person who is not thought to be a drug dependent person must immediately apply for a Schedule 8 treatment permit if they believe that the prescription will contribute to the patient being treated for a continuous period greater than 8 weeks when the preceding period of treatment is taken into consideration. This is the case even if no further prescriptions are intended. A permit is always required to prescribe a Schedule 8 medicine for a drug-dependent person.
Although a permit application must be submitted immediately, to avoid delaying treatment for a genuine therapeutic need, a medical practitioner is authorised to continue treating the patient until the outcome of the permit application has been determined. In such circumstances, the prescription of less than the maximum Pharmaceutical Benefits Scheme (PBS) quantity might be considered prudent.
Private (non-PBS) prescriptions
Medical practitioners have been prosecuted for prescribing without Schedule 8 treatment permits because they confused PBS requirements with state law and/or mistakenly believed that Victorian legislation does not apply in some cases. Permit requirements for medical practitioners are applicable regardless of whether a Schedule 8 medicine is to be prescribed as a PBS item or otherwise.
A number of general practitioners wrote ‘private’ prescriptions for dexamphetamine tablets for a woman who attended with a child and claimed to be visiting from interstate. The woman, who was trafficking the dexamphetamine, convinced the medical practitioners that it was lawful to prescribe the drug without a permit on a private prescription; this is not the case.
Forgeries by trusted patients, staff and family members
Prescription pads and pages for computer-generated prescriptions should be locked away and should never be left unattended where members of the public, staff members or anyone else can access them. Examples of forgeries include the following:
- A patient wrote dozens of forged prescriptions by helping himself to one or two pages from the top of the prescription pad that was left in the consulting room when he was waiting for the medical practitioner.
- A clinic receptionist created dozens of fraudulent computer-generated prescriptions and used them at multiple pharmacies. When pharmacists phoned the clinic, the receptionist is understood to have claimed the prescriber was unavailable and confirmed the prescriptions had been issued. Medical practitioners must ensure that their passwords are not known or accessible to another person.
- A general practitioner’s spouse created fraudulent computer-generated prescriptions in the name of one of the other medical practitioners at the clinic. Pharmacists did not contact the purported prescriber because the patient was known to be the spouse of the other practitioner.
Fraudulent computer-generated prescriptions
To address the growing problem of fraudulent computer-generated prescriptions, medical practitioners in Victoria must handwrite significant components of computer-generated scripts for all drugs of dependence, and must not manually alter computer scripts.
An offender successfully presented more than 40 forgeries during a 2-month period, after using his computer printer to copy the details of genuine prescriptions onto stolen script pages.
Another offender successfully presented more than 100 computer-generated prescriptions for morphine ampoules. The prescriber had issued each prescription for 5 ampoules but the patient had manually altered the prescriptions to obtain between 25 and 75 ampoules on each prescription.
Contacting other agencies
To obtain clinical advice from specialist consultants, health professionals (only) may phone the Drug and Alcohol Clinical Advisory Service (DACAS) on 1800 812 804. For 24-hour confidential drug and alcohol counselling and treatment information, patients, family or health professionals may phone DirectLine.