Doctor’s registration cancelled for three years over inappropriate opioid prescribing

Doctors should satisfy themselves that all prescriptions are clinically indicated and in the best interests of the patient. When prescribing drugs of dependence, it is also essential to understand the regulations around prescribing and obtain necessary authorisations.

Prescribing

Dr W was accused of prescribing S8s and benzodiazepines without clinical indication and without required authorisations.

The medical regulator alleged he had:

• prescribed S8 medications without the required authorisations to patients who were registered as drug dependant
• prescribed S8s to five patients (who were not registered as drug-dependent) for longer than 60 days without authorisations
• prescribed combinations and quantities of benzodiazepines that were not clinically indicated
• prescribed opioids without clinical indication and where there was a risk of harmful interactions with other prescribed medications
• prescribed opioids to patients in direct contravention of advice from the patients’ other treating specialists, including pain management specialists
• failed to create an adequate treatment plan or seek specialist review before prescribing benzodiazepines to patients who were drug dependent

He was also accused of having inappropriately prescribed S4 medications.

Providing misleading information

When investigated over one of the incidents of inappropriate prescribing, it emerged that Dr W had unintentionally provided a prescription with five repeats. He was criticised for failing to check the prescription was accurate.

Medical records

Dr W’s record-keeping was also criticised. In medical records for 39 patients he failed to record a reason for the consultation, any relevant clinical history or adequate justification for his prescribing, or details of the medications prescribed.

Dr W claimed he had been omitting details because of a misapprehension about patient confidentiality.

When concerns were first raised about Dr W’s prescribing, the medical regulator imposed conditions including a prohibition on prescribing S8s. He was then reported for inappropriately prescribing S4s. He provided an undertaking not to prescribe S4s or S8s, which he also breached.

The matter was settled at mediation where Dr W admitted the facts and conceded he had behaved in a way that constituted professional misconduct.

Dr W was reprimanded. His registration was cancelled and he was disqualified from applying for registration for three years.

He agreed to pay $30,000 towards the regulator’s legal costs.

Make sure you understand the authorisations required to prescribe drugs of dependence in your state or territory.

Access available advice services such as your local health department drug support service, and engage with addiction management specialists for advice and support if you have concerns.

Only prescribe medications where you are satisfied the prescription is appropriate and in the best interests of the patient.

When prescribing any medications, particularly drugs of dependence, keep careful records and include enough information to allow another doctor to identify the patient and take over their care. Be aware that real time prescription monitoring has been introduced in all states and territories in Australia. Always check before prescribing any drugs of dependence.

Avant factsheet – Prescribing drugs of dependence

Avant factsheet – Identifying drug seekers and doctor shopping behaviours

Avant eLearning – Prescribing principles: Part one – general prescribing issues

Avant eLearning – Prescribing principles: Part two – opioids and other drugs of dependence

Avant factsheet – Medical records: the essentials

For medico-legal advice, please contact us on nca@avant.org.au or call 1800 128 268, 24/7 in emergencies.