Opioid addiction: Doctor-shopping accounts for increased prescriptions and risk

By Julie Power
Sydney Morning Herald

August 6, 2017

To satisfy her dependence on prescription opioids, Christine Drinnan visited 10 doctors in the last few months of her life, six in the 10 days immediately preceding her death from painkillers taken by millions of Australians every year.

In and out of rehabilitation over the years, Ms Drinnan had been admitted to hospital 15 times for overdoses caused by her addiction to these drugs, including three times in the months before her death.

Despite her growing opioid tolerance – the need to take higher and higher dosages of drugs to achieve the same opioid effect – doctors kept prescribing more, and in stronger doses.

Most were ignorant of her full history, including problems with alcohol, depression and memory. These doctors failed to call other medical professionals who she had seen, or ask sufficient questions about claims that she had lost scripts or had a painful, sore neck, found the coroner’s report.

This is an extreme example of the doctor shopping that experts want to prevent as Australia’s reliance on opioids has reached record levels.

Nearly three million people were prescribed at least one opioid listed by the Pharmaceutical Benefits Scheme in the 12 months to March 2014, the most recent figures available, with oxycodone growing in popularity. Of these people, about 5 per cent (152, 847) accounted for 61 per cent of all opioid consumption.

Doctor shoppers are few in number, says Suzanne Nielsen from the National Drug and Alcohol Research Centre, but very likely represent the “tip of the iceberg”.

Often they are complicated by mental health issues, depression and high rates of suicide, said Dr Nielsen, a senior research fellow and a pharmacist, meaning there was not an easy and straightforward solution to the problem, she said.

About 14 million prescriptions are dispensed every year for opioids, a four-fold increase since 1999.

With accidental overdoses from prescription opioids representing 70 per cent of overdoses, the Minister for Health Greg Hunt said it was time to take a real stand.

He promised to introduce a $16 millon national real-time monitoring system that would raise an instant alert when someone went doctor shopping. It is not clear how this will fit with a similar proposal from Victoria, but Mr Hunt said it would work across borders.

“Many people will use prescription drugs and in some cases they will develop an addiction. That will be an accidental process,” he said.

“And if you think of them as the very strong prescription drugs such as morphine or oxycodone or fentanyl, we know that there have been approximately 600 deaths a year. So it’s about addicts. It’s also about those who are accidently caught up and those who are involved in prescription-shopping. ”

The AMA, the College of GPs and other health professionals had support an alert system for some time, he said.

It would allow pharmacists and doctors to identify “whether or not somebody has been shopping for prescription drugs, which are of the strongest variety which can then be hoarded, either sold or, in cases, used for improper purposes”, said the Minister.

Ms Drinnan’s case is not new. She died sometime between April 29 to April 30, 2010, and the report was issued by the Coroners Court in late 2015.

While her case was extreme, seven years later it is not uncommon, said John Ryan, the CEO of the Penington Institute which releases an annual overdose report.

“There are a lot of people who are dependent on pharmaceutical drugs and address this need by doctor shopping. This is an extreme case with the worst outcome, death through overdose, ” he said.

Mr Ryan said more services are needed to treat people with these problems, and supervised treatment needs to made more affordable.

“It is currently more expensive to be on supervised treatment than doctor shopping [and get opioids on the PBS],” he said.

He warned that in some US states, alert systems had forced people dependent on prescription drugs to buy illegal drugs on the street.

Like Mr Ryan, the CEO of PainAustralia Carol Moore believes the proposed system should be accompanied by improved education about the risks of opioids, and more pain management centres where they are needed.

“Putting an end to doctor-shopping for people addicted to prescription medication will save lives,” she said. But it was equally important that people with legitimate need have access best-practice pain management.

Ms Drinnan’s case illustrated the impact of her addiction on her two children. Her then 15-year-old son tried to alert the medical profession of his mother’s problems, and when he said his mother’s driving under the influence was dangerous, a doctor actively helped his mother keep her licence.

“Her son’s efforts to communicate with his mother’s doctors and pharmacists, to understand what medications and why she had been prescribed them were met with frustration and the common attitude that the mother’s privacy prevailed over her and the family’s safety,” the deputy state coroner Magistrate C Forbes wrote.

Magistrate Forbes said the number of prescriptions written was “alarming”, especially considering there was “no indication that Ms Drinnan had a medical condition that warranted the opioids”.

In the last three weeks of Ms Drinnan’s life, just one of the many doctors she saw wrote

  • six scripts for morphine, oral Ordine, which was found open on the dead woman’s bedside table
  • three scripts for pethidine for pain, which experts told the court was a dangerously addictive drug which had no advantages over other opioids and had been removed from national health schemes years years earlier
  • seven for oxycodone, totalling 140 tablets in eight days; and
  • five for diazepam (Valium).

The court also heard Ms Drinnan often mixed these drugs with alcohol, consuming a bottle of vodka daily.

Many people don't know how to recognise the signs of an overdoseMany people don’t know how to recognise the signs of an overdose. Photo: Penington Institute

http://www.smh.com.au/national/health/opioid-addiction-doctorshopping-accounts-for-increased-prescriptions-and-risk-20170804-gxpboi.html

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One Response to “Opioid addiction: Doctor-shopping accounts for increased prescriptions and risk”

  1. daveyone1 Says:

    Reblogged this on World4Justice : NOW! Lobby Forum..

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