Views on dispensing a private prescription issued by a consultant for his own use

[abbie]

A fellow pharmacist friend of mine called me up the other day with this dilemma.

She had a private prescription handed in, all legal, correctly filled in etc. It was for a significant amount of Temazepam, 100 I think and was written by a consultant who said it was for her own use. She needed it dispensed straight away as she was going to work abroad for a few months. SHe was taking the drug for insomnia which was chronic and if she didn't have a supply, it could be disabling. She wanted such a large supply because she was concerned about being able to obtain a supply abroad and the impact it would have on her work should she have to go without.

It was clear to me that there weren't any laws being broken since doctors can prescribe for themselves but I couldn't be sure of the ethical issues related to such a case. Such a large suppy of benzos is a big issue in itself.

Anyone got any thoughts??

[bleepholder]

i'm sure it isn't allowed. From what i have heard from the hospital I work in, is that doctors are unable to prescribe for themselves as stated by the GMC. I thought it was our hospital being picky and awkward but its something comes from the GMC.

It is an awkward position to be put in, especially when they say they need a large quantity of an addictive drug....i've always seen some sort of sob story being used....not sure if anyone else has any bright(er) ideas about doctors prescribing for themselves. As a consultant you would think that they would know better...and you have to question where they have previously been getting their temazepam...i'm sure its not first line treatment in insomnia....i would have thought zopiclone would have been used first, as well as possibly treating the underlying condition as to why she has chronic insomnia

Also if Drs can prescribe for themselves as temazepam is a schedule 3....isn't it that a maximum of 28day supply can be issued...(I don't have a copy of the MEP to hand to check)

was the script dispensed???

[bleepholder]

GMC | Good practice in prescribing medicines - guidance for doctors

just found this...maybe a bit of help for you..

Prescribing controlled drugs for yourself or someone close to you
13. Doctors should, wherever possible, avoid treating themselves or anyone with whom they have a close personal relationship and should be registered with a GP outside their family. Controlled drugs can present particular problems, occasionally resulting in a loss of objectivity leading to drug misuse and misconduct.
14. You should not prescribe a controlled drug for yourself or someone close to you unless:
a. No other person with the legal right to prescribe is available to assess the patient's clinical condition and to prescribe without a delay which would put the patient's life or health at risk, or cause the patient unacceptable pain, and
b. That treatment is immediately necessary to:
i. Save life
ii. Avoid serious deterioration in the patient's health, or
iii. Alleviate otherwise uncontrollable pain.
15. You must be able to justify your actions and must record your relationship and the emergency circumstances that necessitated your prescribing a controlled drug for yourself or someone close to you.

[roper]

I'll be interested to read replies to this one too. The maximum of 28 days treatment is not an absolute rule - we need to contact prescribers and confirm large quantity (in normal circumstances when not self prescribing.) We once had a situation (prior to Shipman) where a GP's wife was regularly presenting private scripts for a patient we never met. (This was temazepam too.) We did suspect that they were for his personal use. Since Shipman I feel we would need to report these circumstances - but who to, and what are the consequences? We never did anything about it back then.

[lamzee]

You aren't breaking any laws in supplying it. The doctor may be breaking his/her own code of ethics, but again that is not a legal position, merely an ethical one.

[johnep]

Several years ago there was an article in the BMJ which I copied and used to show to Drs in this situation. The problem is, it would appear that Drs can break their code of ethics with impunity whereas we are expected to toe the line or else. Several Drs said that while it was not approved, it was not illegal, until it was, they would continue.
johnep

[Defblade]

Several Drs said that while it was not approved, it was not illegal, until it was, they would continue.
johnep

I've met with a similar position. My response is, "Not here." Any further protest is met with "would you like me to ring the GMC and have a chat about it?"

Had one about 2 weeks ago - he was somewhat out of his local area and attempting to prescribe hypnotics for his partner. I suggested as it wasn't an emergency, and they were scheduled drugs, that it would be more appropriate for her GP to see her.... "he won't prescribe them. I'm a consultant somethingorother and I know these will work."
"Well, possibly; that's a discussion for the 2 of you and her GP."
"It's not illegal."
"I know." Straight look.
Folds script back up and leaves. Probably to go to another shop and get served without a blink, ho hum. I did have a sneaky suspiscion that if I rang a pharmacy in the small town he came from, they'd instantly know who I was talking about....

[Batfink]

We had a situation where a retired GP was prescribing benzodiazepines for his wife and had been for some time. When I suggested that it wasn't really the correct thing to do and I was no longer happy to dispense such prescriptions he returned with another Rx written by a friend of his. What can you do?

[Defblade]

he returned with another Rx written by a friend of his. What can you do?

Ask if his wife is registered with the friend as GP.

Explain that they appear to be taking the mick (I'm used to doing this with, for example, relatives who say "well, if you won't serve them, I'll buy some") and I will still not dispense the script, and that furthermore I will be contacting the GMC and the PCT's Concerns Committee (or similar) regarding both doctor's conduct. Then wait for the RPS Inspector to come round with the complaint against me

People who take the mick bring out the worst (or best?) in me.

[johnep]

This is a question for the new body to decide policy.
johnep