Cif Shoobridge Gr 20041028

Contributing factors

• Multiple prescriptions of benzodiazepines and opioids from 22 different doctors without inter-provider communication
• Doctor-shopping behaviour not detected by prescribing doctors
• Defunding of doctor-shopping hotline preventing prescription history verification
• Privacy laws requiring patient consent for information release between providers
• Lack of coordination between general practitioners and methadone clinic
• Prescription of Panadeine Forte by Dr D'Hotman without knowledge of methadone commencement
• Multiple benzodiazepine prescriptions by different doctors without awareness of methadone program entry
• Unsupervised weekend take-away methadone doses due to clinic operating 5 days per week only
• Patient's non-disclosure of full medication use to prescribing doctors

Coroner's recommendations

1. Health Insurance Commission to give priority to administrative arrangements for newly-launched prescription shopping project and establish dedicated telephone information line (following recommendation of Victorian Coroner Heather Spooner, 16 June 2004)
2. Health Insurance Commission provide funding for dedicated telephone information line Australia-wide enabling medical practitioners to access complete prescription histories to determine if patients are obtaining medication beyond therapeutic need and to refuse or reduce prescribing of benzodiazepines and opiates to poly drug users
3. Establish alert system for localised general practitioners and health professionals from ATODS and opiate replacement programs to advise of patient admission to or referral to such programs
4. Add Panadeine Forte to list of drugs monitored by Health Insurance Commission given potential dependence upon it
5. Review Health Drugs and Poisons Regulation 1996 Appendix 9 to include codeine phosphate with Panadol as Schedule A drug given addictive nature
6. Queensland Department of Health provide funding for centralised computer system for Drugs of Dependence Unit to monitor benzodiazepines and Panadeine Forte in addition to opiates
7. All medical practitioners be advised of and provided with current voluntary consent form enabling access to prescription history of patients
8. Review privacy laws, rules and regulations governing information provision to medical practitioners, including consideration of legislating requirement for authority enabling PBS to release prescribing history prior to receiving drugs of dependence
9. Queensland Department of Health provide funding for Alcohol Tobacco and Other Drug Services, Methadone Program Clinic and other opiate replacement programs to operate 7 days per week to enable timely assistance and greater supervision
10. Provide funding for takeaway doses of opiate replacements and methadone to be collected from program facilities or pharmacies 7 days per week
11. Royal Australian College of General Practitioners undertake survey of members regarding safeguards in prescribing potential drugs of addiction
12. Royal Australian College of General Practitioners ensure circulation to members of protocol for prescribing benzodiazepines in high doses on regular basis
13. Royal Australian College of General Practitioners ensure regular and continuing medical education on doctor shopping and prescription shopping through training seminars, lectures, and conferences
14. Legislation be enacted to mandate that medical practitioners responsibly report suspected severe cases of drug dependency to Health Insurance Commission and Drug and Dependency Unit