Medical Students / JMOsNews / Opinion

ABC – Doctors probed over narcotic prescriptions

Fifty doctors are being investigated as part of a national crackdown on inappropriate prescribing of narcotics.

Medicare is carrying out the three-month campaign following high levels of prescriptions for drugs such as OxyContin and OxyNorm.

One GP has been found to be writing over 90 per cent of their prescriptions for narcotics.
There are concerns the painkillers are being resold on the black market.

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The problem with narcotic prescriptions seems to be a more complicated version of the age old prescribing problem. That is prescribing a drug is easy but prescribing the right drug, for the right person, over the right period of time is not easy at all. Such is the situation with narcotics and outcome is a situation where these drugs are both under and overutilised in the community. <br />
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This is touched on in a current News article in the BMJ: <a href=http://www.bmj.com/content/342/bmj.d1345>http://www.bmj.com/content/342/bmj.d1345</a><br />
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It's a problem medical students should expect to see an awful lot of once they enter clinical years and one they'll have even more to do with as an intern on the wards as so many patients are taking these drugs. Doctor shopping is just one of the pitiable circumstances opiate prescribing can lead to. Another important one is patients presenting to their GP after their script for painkillers has run out and finding him/her unwilling or unable (by law) to refill it. <br />
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In medical textbooks you'll often read that doctors underutilise opiates in patients who would benefit from them because of fears surrounding addiction. The implicit message is that this fear is poorly founded and not a reasonable excuse to be hesitant about prescribing opiates and yet the number of patients you see in the community who have developed addictions off of the back of prescription medications is high. According to that BMJ news articles it's higher than those who develop addiction from illicit opiates.<br />
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Opiate prescribing is somewhat complicated even before you start thinking about the potential for addiction and is relevant to all medical students and all doctors.
    Although, to be fair, interns very rarely prescribe anything (the regs and bosses do) - they are more likely to be asked to give external scripts by patients, rather than be the one making the decision to begin, continue, alter or cease S8 medications.
      Yes, that's true, but I think opiate prescribing is quite a confusing area even for routine stuff (e.g. with the varying potencies of different drugs). The requests for higher doses are not uncommon among patients and occassionally these are difficult (e.g. in the setting of a person who is dependent on high doses of opioids and already charted for a big dose). Then there's the management of side effects etc. I think it's probably one of the areas that interns have difficulty with at some point or another.
        TBH, I think it's probably a bigger issue for GP Land, wherein the push for prescriptions is greater, and wherein patients are being managed long term (rather than us hospital doctors, who create or habituate a lot of problems, then send them out into the community). Fortunately for interns, at least they are working under supervision - there's the opportunity to learn your stuff well before going out and managing patients on your own.
          Yeah, definitely, GP Land is where the heart of problem lies, of course. That's where most chronic pain is managed and where most doctor shopping goes on. I don't think it's a particularly onerous task for interns, I suppose my point is simply that it's a problem that interns will see and have some involvement in (albeit with plenty of supervision like you say).
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