Why it’s a good idea to have a drugs of dependence policy in your practice
There is strong evidence in Australia of increasing harms from prescription drugs of dependence, including deaths from overdose. Before prescribing any drug of dependence, health professionals require an understanding of the patient’s biopsychosocial status, and the evidence-based indications and potential significant harms of these drugs.
People who misuse prescription drugs most commonly seek prescriptions for opioids and benzodiazepines. Other prescription drugs that are misused include the newer antipsychotics such as quetiapine and olanzapine, and stimulants such as dexamphetamine and methylphenidate.
Health professionals should be aware of behaviours that may indicate drug seeking, but dependency on prescription drugs can occur at any age, within any cultural group and across any educational class. Patients with dependencies may not necessarily display obvious drug-seeking behaviours.
In the clinical context of chronic pain, mental illness and addiction medicine, it can be difficult to balance benefits and harms. Some practitioners may be more vulnerable to excessive patient expectations than others.
To prevent variation and ensure that all patients are treated equally and fairly in your practice, you could consider having a policy regarding prescribing of drugs of dependence. This should be an agreed policy aimed at a unified approach, which supports individual GPs to prescribe these drugs safely and appropriately.
What are some suggested components of the policy? (adapted from RACGP Prescribing drugs of dependence in general practice, Part A – the full list of recommendations is available here)
- Continuity of care with one GP and one pharmacy
- All prescribers to have access to and use SafeScript
- Plan clearly documented in patient notes
- No prescriptions of drugs of dependence to new patients
- Appropriate triaging and management of patients who are assessed as high risk (eg referral to specialised services)
- Prescription pad security
How to communicate the policy to patients
You may choose to include some of the information from your policy on a sign in the waiting room or on your website so that patients are aware of prescribing conditions in your practice. This might include the following:
- No drugs of dependence will be prescribed on the first visit
- No drugs of dependence will be prescribed by telephone
- No replacement of lost scripts
- No drugs of dependence will be provided on a private script
How does this help my business?
Up-to-date policies are important as it helps to reinforce and clarify standards expected of employees. Having consistent policies around such a difficult area improves prescriber wellbeing, and hence practice culture. Patients also receive better care.
Where can I find more information?
The RACGP has a guide that includes example practice policies that you can use and adapt for your practice.
The laws and regulations surrounding the storage, supply and prescription and drugs of dependence in Victoria is available on the health.vic website.
An example of a contract that your practice might use between a patient and GP is available on our website.
By Dr Jeannie Knapp.
Disclaimer: This article was provided by Dr Jeannie Knapp. While every effort has been made to ensure the information is accurate, North Western Melbourne Primary Health Network does not warrant or represent the accuracy, currency and completeness of any information or material included within.
