Drug Misuse

Policy

For more information, see HealthPathways: Drug Seekers, and Principles for Quality and Safe Prescribing Practice, developed collectively by the seven authorities who regulate prescribers, including the Medical Council of New Zealand, Nursing Council of New Zealand, and Pharmacy Council of New Zealand.

We prescribe in compliance with Section 24 of the Misuse of Drugs Act 1975. Controlled or restricted drugs are only prescribed if there is sound clinical reason for doing so.

We take steps to make sure that prescribed medications are not used inappropriately:

• Prescribers check the patient's prescription history and follow any treatment plans documented in patient notes.

  Prescriber refers to any authorised prescriber (including designated prescribers or delegated prescribers), as determined by the Medicines Act 1981.

  This could include medical practitioners, authorised nurses, nurse practitioners, and pharmacist prescribers.

  Source: Principles for quality and safe prescribing practice

• Prescribers can refuse to prescribe restricted or controlled drugs if they are not fully satisfied that the medication is appropriate.
• We regularly review repeat prescriptions to make sure they are still beneficial and appropriate for the patient.
• Casual patients are not normally prescribed controlled drugs and are referred back to their usual prescriber.
• We do not prescribe more than 1 to 3 days' supply to a new or unfamiliar patient without comprehensively assessing the rationale and protocol for treatment.

There is zero tolerance for abusive or coercive behaviour. If you feel unsafe around a patient, call for assistance.

See Controlled Drug Prescriptions.

If you suspect drug-seeking behaviour

Refer to bpac: How to identify and manage drug seekers.

If a patient is showing behaviours consistent with drug seeking:

• Take appropriate steps to confirm medication misuse.

  Steps that can be taken to confirm medication misuse include:

  • Checking regional drug-seeker alert networks
  • Drug testing
  • Medicine counts
  • Clinical notes audits – tracking prescription history
  • Creating a formal treatment contract – specifying that a patient may only receive prescriptions from one prescriber and pharmacy.

  Source: bpac^nz

• Contact Ministry of Health: Medicines Control to discuss the problem or request a Restriction Notice.
  • Restriction notices are issued when there is clear evidence of drug misuse. Restriction notices do not require patient consent but are most effective when the patient has agreed to abide by the conditions.

    A restriction notice is issued when there is clear evidence that the person:

    • has been obtaining medication from multiple sources
    • has been obtaining overlapping or multiple medications from one source
    • is likely to seek further supplies
    • is capable of self harm
    • has been selling the medication.

    Source: Ministry of Health

• Document the situation in Medtech and any other electronic patient systems. Add an alert to the patient's PMS record if necessary.

Patients may be dismissed from the practice if they are misusing their medication, not taking the prescribed drug, or taking additional illegal or illicit drugs. We refer or direct dismissed patients to appropriate alternative services.