It is an offence for any healthcare practitioner to disregard rules surrounding the prescription, administering and supply of controlled drugs; the rules are specific with regards to the circumstances of a consultation – and it is vital that healthcare practitioners are aware of them.
Section 24 of the Misuse of Drugs Act 1975 states that a practitioner must not prescribe, administer, or supply controlled drugs to a person that the practitioner believes to be dependent on that or any other controlled drug, unless treatment is for that dependency. In that instance, (treatment for dependency) treatment must be carried out by a gazetted practitioner (and sometimes at a location) nominated by the Minister of Health, or by a practitioner who has the express written authorisation of the gazetted practitioner.
There are few exceptions – emergency treatment in a hospital care institution for up to three days, treatment in an institution pursuant to the Alcoholism and Drug Addiction Act 1966, and treatment of a person subject to a Restriction Notice.
Upholding the law: Medicines Control The Medical Officer of Health for Medicines Control holds a designation by the Director-General of Health to uphold functions within two major pieces of legislation: the Misuse of Drugs Act 1975 and Medicines Act 1981, and regulations made under these Acts. Medicines Control staff deal with licensing, auditing and drug abuse containment activities in the medicines supply chain. Medicines Control advisers are experienced pharmacists who will liaise with the regulatory authorities for health professionals, particularly where prescribing issues are identified.
Medicines Control drug abuse containment activities include: surveillance of the dispensing of controlled drugs; investigation of unusual prescribing patterns; collation of information on drug abusers or drug seekers from doctors, pharmacists, practice nurses, and Drug and Alcohol clinics; advice to health professionals about drug seekers and trends in the misuse of drugs; issuing and revocation of Restriction Notices; receiving and monitoring of GP Authority to Prescribe Controlled Drugs (eg, authorisation of GPs to prescribe methadone for treatment of dependency).
There are common knowledge gaps for prescribers, which include the addiction potential of prescription medication, complications of longterm drug administration, awareness of controlled drugs prescribing requirements, restricted persons and authorities to prescribe. Prescribing competence issues requiring interface with the Medical Council often relate to an inability to resist inappropriate prescription requests (the doctor with a ‘soft touch for drugs’ reputation).
Prescriber advice is also provided on a one-onone basis to GPs and health services, palliative care and pain clinic clinicians. This advice may include alerts, known past history of a particular individual, issuing of Restriction Notices or Privileged Statements. A Restriction Notice is a legal document issued by the Medical Officer of Health. The restriction limits prescribing to a named person and often one pharmacy for dispensing.
A Restriction Notice is issued in one of two circumstances:
- Where there is clear evidence that the person has been obtaining medication from a number of different practitioners, over a prolonged period and is likely to seek further supplies, or
- Is addicted or habituated to a medicine or has been obtaining it from several sources and is likely to seek further supplies. A Restriction Notice relates to the specific conditions for that person.
Approximately twice a year a list of currently restricted persons throughout New Zealand is provided to doctors, pharmacists and appropriate services. A Privileged Statement is a means of notifying others about a person who is, or is likely to become, dependent on any prescription medicine or restricted medicine. The purpose of the Privileged Statement is to prevent or restrict the supply of medicines to that person, require a supply from only a named source, or to assist in the cure, mitigation, or avoidance of the dependence.
Generally there is the expectation that health professionals will only share pertinent information with other health professionals involved in that person’s care. The Privilege extends beyond this, and allows the notification of interested others, not just health professionals. The following case is an example of drug abuse containment in action, where many of the functions described above were put into play (identifying details have been altered).